Abstract
INTRODUCTION: Youth e-cigarette use remains a substantial public health concern in West Virginia. West Virginia's Clear Future launched in 2023 to deliver the CATCH My Breath (CMB) vaping-prevention curriculum statewide in middle school grades 5 to 8. This evaluation assessed the first 2 years of implementation, including reach, student outcomes, and implementation lessons. METHODS: A single-group, repeated cross-sectional pre-post evaluation was conducted among students in grades 5 to 8 during the 2023 to 2024 and 2024 to 2025 school years. Anonymous, unlinked surveys were administered before and after the 4-lesson CMB course to measure vaping-related knowledge, refusal intentions, susceptibility among never-users, ever use, and 30-day use. Evaluation was approved by the West Virginia University Institutional Review Board (Protocol 2406984259). RESULTS: Across 2 years, 13 734 students participated in 94 schools across 39 counties. By Year 2, at least 1 trained educator was present in all 55 counties. Student acceptability was high (learned a lot, 87.9%; less likely to vape, 85.5%; confident in refusal skills, 82.1%). Knowledge improved: recognition that e-liquid is not mostly water increased in both years (Year 1: 41.3%-62.4%; Year 2: 36.1%-65.5%; P < .001). Among never-users, susceptibility declined in grade 8 (Year 1) and increased in grade 5 (Year 2); other grades showed no significant change. Ever-use and 30-day use showed no significant pre-post change. CONCLUSIONS: Statewide CMB implementation produced substantial knowledge gains, high student acceptability, and full county coverage by Year 2. Teacher feedback noted barriers related to time, technology access, and pacing, highlighting the need for offline-ready delivery and age-tailored content.