Smoking-prevention programs in schools do little to keep teenagers from lighting up in the long run, concludes a research review out last week.
The report, published in the Journal of Adolescent Health, is based on an examination of eight evaluations conducted during the 1980s and 1990s on popular, nationally recognized school-based anti-smoking or anti-drug programs. The studies showed that the programs, typically offered in elementary or middle schools, kept children from smoking cigarettes in the short term. But one to seven years down the road, when those students reached 12th grade, they smoked as frequently as peers who had never been exposed to prevention lessons.
“There may be an intervention out there that schools are using that is effective,” said Dr. Sarah E. Wiehe, the lead author. “But, if they’re using any of the programs that have been studied at length, they’re probably not effective.”
The full report, “A Systematic Review of School-Based Smoking Prevention Trials With Long-Term Follow-Up,” is available online from the Journal of Adolescent Health. See also the abstract. ()
Experts said the new study, coupled with others yielding similarly dismal results for particular programs such as Drug Abuse Resistance Education, or DARE, suggest that policymakers may want to think twice about mounting school-based smoking-prevention programs when other measures, such as media campaigns, cigarette price boosts, or smoke-free environments, might be cheaper and more effective ways of curbing youth smoking.
“I’m not saying there’s absolutely no role for schools,” said Stanton A. Glantz, the director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. “But I think it’s time to recognize that something that seemed like a good idea once just isn’t.”
Mr. Glantz, who wrote an editorial accompanying the report, is not connected with the new study.
As an alternative to the packaged programs, he said, schools might consider using information on tobacco to teach real-world issues, such as the science of addiction or the effects of secondhand smoke, and incorporating those topics into the regular curriculum.
“Integrating tobacco issues into the curriculum in this way will help schools focus on what they should be doing and do best: teaching kids critical-thinking skills,” Mr. Glantz wrote in his editorial. In the report, he also called on the federal Centers for Disease Control to use the growing body of research evidence on the ineffectiveness of prevention programs to revise its guidelines for schools.
Lessons Learned
But representatives of some of the programs that were examined also noted that the studies included in the review were based on earlier, and possibly less effective, versions of their programs.
“We’ve learned a lot about how kids learn over the last 20 years,” said James J. McGivney, the Mid-Atlantic regional director for the Los Angeles-based DARE program. He said the recently revamped program no longer features a local police officer standing at the front of the room and lecturing students on the dangers of drugs. Instead, officers work with small groups of students, coaching them in role-playing and decisionmaking.
Dr. Wiehe said the eight programs her research team studied used a variety of approaches to teach students about the dangers of smoking, making it difficult to tell whether some approaches worked better than others.
The only model that was able to sustain results over the long run was the LifeSkills Program, an interactive curriculum that begins with intensive sessions in 7th grade and then offers “booster” lessons in 9th and 10th grades. By 12th grade, 27 percent of LifeSkills program participants reported smoking at least one cigarette a month, compared with 33 percent of students in the control group.
But experts said those results should be viewed with caution, because the evaluation was conducted by the program’s developer, Cornell University researcher Gilbert J. Botvin.
What may be happening, Dr. Wiehe said, is that the school-based programs simply postpone the start of smoking for many students. Still, since studies show that more than 80 percent of adult smokers picked up the habit before age 18, she added, it makes sense to continue targeting anti-smoking efforts at teenagers.
“The question is whether we should continue those intervention efforts later, past the age of 18,” Dr. Wiehe said.
Her study was underwritten by the Robert Wood Johnson Foundation of Princeton, N.J. Dr. Wiehe’s co-authors, who are from the University of Washington in Seattle, are: Michelle M. Garrison, a research consultant in the department of pediatrics; Dr. Dimitri A. Christakis, an associate professor of pediatrics; Dr. Beth E. Ebel an assistant professor of pediatrics; and Dr. Frederick P. Rivara, a professor of pediatrics and epidemiology.
