TV, Parents Students Linked in Novel Anti-Smoking Effort
Calling it "the most serious indictment of cigarette smoking the Public Health Service has yet made," C. Everett Koop last week released the latest Surgeon General's Report on the health consequences of smoking.
But amid the gloomy news that 30 percent of all cancer deaths in this country can be linked to smoking, the Surgeon General reported one "encouraging trend": An annual survey conducted by the Institute for Social Research at the University of Michigan for the National Institute on Drug Abuse has found that the number of high-school seniors with a daily cigarette habit has dropped from 29 percent in 1977 to 20 percent in 1981.
And as Dr. Koop was discussing the report in Washington, more than 50,000 young teenagers from five Southern California counties started on a two-week program aimed at lowering the teenage smoking rate still further by discouraging younger students from taking up the smoking habit.
Though fifth- through 10th-grade classes from 160 public and private schools are participating in the California program, the majority of students were seventh graders.
According to officials of the new program, children most often begin smoking cigarettes regularly when they are in the seventh grade. Since the steepest rate of increase takes place over the next three years, between the seventh and 10th grades, "it is easier," they say, "to stop students from smoking at this age before it becomes a habit."
A joint effort developed by the University of Southern California (usc), the American Lung Association of Los Angeles County, and kabc-tv Channel 7 (the local abc affiliate), the Smoking Prevention/Cessation Program combines classroom instruction with two elements novel to such instruction--parental involvement and television.
"We believe this will be a unique approach, quite different from other such smoking-prevention programs because it involves a wide-scale effort enlisting the combined cooperation of the schools, commercial television, and parents," says Dr. Brian Flay, assistant director of the University's Health Behavior Research Institute and the chief coordinator of the school program.
The decision to involve the local network and the students' parents was deliberate, Dr. Flay notes, based on the institute's past research.
"Before, we limited the program to classroom instruction conducted by our own health educators. After administering these programs, we saw a 50-percent to 75-percent reduction in the number of students who became smokers over the following several years."
But the usc researchers expected the success rate to drop somewhat, he said, if teachers without special training conducted the classes--as would be likely in a large-scale effort.
"To regain this potential loss," explained Dr. Flay, "we coordinated the classroom program with the television station and the families so that the three parts are very well-integrated."
The 600 participating teachers, 25 of whom received special instruction prior to the program, were given detailed curriculum manuals prepared by the usc team outlining classroom discussion and activities. And five peer leaders from each class, who were selected by their classmates, also received their own guidebooks, which explained how to play out certain parts during class discussions and role-playing.
Research evidence indicates that using peer leaders makes those particular students more committed to the program and makes the program more effective with their classmates, explained Dr. Flay.
The students were given their own take-home manuals with homework exercises. They were also assigned to watch Dr. Art Ulene's "Feeling Fine" segment on the 5 P.M. edition of Eyewitness News. Dr. Ulene is a public-health expert and a frequent guest on nbc's Today show.
Parents were asked to watch Dr. Ulene's program with their children, then join in answering the homework questions.
"Traditional smoking-prevention education focuses almost entirely on physiological and health consequences," Dr. Flay explained. "Frankly, that approach has not been very effective."
Instead, he continued, the usc/kabc-tv program differs in three ways. "We concentrate on the many social pressures that may contribute to smoking," he said. "We stress development of social skills to resist such pressures, meaning we give instruction in the art of saying 'no.' And, when we do focus on the consequences, we underline the immediate rather than the long-term effects, such as decreased athletic performance."
The most effective aspects of the program, said Dr. Flay, were making the students aware of social influences of smoking--media, family, and peer pressure--and giving them an opportunity to practice the social skills to resist such pressures.
Laurel Kenthak, principal of Suzanne Intermediate School in the Walnut Valley Unified School District, reported that reaction from students, parents, and teachers was "extremely enthusiastic." All but 100 students from Suzanne (who served as a control group) of the 900 6th, 7th, and 8th graders in the school participated in the program.
This week, the second part of the usc/kabc-tv program devoted to cessation will begin, though no classroom instruction will be given.
Students, parents, and members of the community who are smokers have been invited to participate, and the television station has made program booklets available to the public. (As of early last week, the station had received over 20,000 requests for the booklets.)
Dr. Ulene will continue his nightly five-minute segments but will address cessation skills and discuss materials that will help people quit smoking.
The usc institute plans to follow the students over a two-year period. "The students will be retested in March or April, then one year later, and again the following year," said Dr. Flay, "so we will follow them over two years."
The tests will measure students' perception of their behavioral skills, how well they are able to say 'no,' and how many have become smokers or have become reformed smokers.
For more information on the usc/kabc-tv program, write: Dr. Brian Flay, Health Behavior Research Institute, University of Southern California, 1985 Zonal Avenue, Los Angeles, Calif. 90033.