Teaching students to resist the social influences that encourage them to smoke is not enough to prevent tobacco use among teenagers, according to the results of a 15-year study of school-based anti-smoking programs.
The study, released last month, found that school programs that took a social- influences approach to smoking prevention—one that helps students identify and resist influences to smoke, such as tobacco marketing, images in popular culture, and peer pressure—had little effect.
“School-based social-influences- intervention programs that started early and were sustained through a period when kids tend to take up smoking were not able to deter smoking,” said Arthur V. Peterson Jr., the lead researcher for the study by the Fred Hutchinson Cancer Research Center in Seattle.
“The result is disappointing to us,” he said, “because the social-influences approach to smoking prevention was such a promising one ... and the main focus of smoking prevention research for over 20 years.”
8,400 Students
The $15 million study, conducted between 1984 and 1999, followed some 8,400 students in grades 3 through 10 in 40 school districts in Washington state.
In half the districts, teachers taught an anti-smoking curriculum designed by the research center’s smoking-prevention project. Teachers in those districts underwent rigorous training in using the curriculum, which included a variety of activities, such as puppet shows and role-playing, that emphasized the dangers of smoking.
The 20 control districts continued to teach various smoking-awareness and -prevention strategies in health classes.
Researchers surveyed the students once they reached 12th grade, and followed up two years after they had finished high school, to determine how many had become daily smokers.
In 12th grade, a little more than one-fourth of the students in both groups said they smoked on a daily basis. About 29 percent of the students in both groups identified themselves as daily smokers two years after they had graduated from high school.
The results, Mr. Peterson said, suggest that the social-influences curriculum failed.
Well-Rounded Plan Needed
Yet the results are not all that surprising, according to some smoking-prevention advocates, who say any single approach to preventing smoking among youths is inadequate. “If we are going to be serious about [curbing smoking among teenagers], we have to look at a comprehensive approach,” said Llelwyn F. Grant, a spokesman for the office on smoking and health at the U.S. Centers for Disease Control and Prevention in Atlanta.
“We have proven that if you have an effective educational strategy in conjunction with community- and media-based activities,” he said, “you can postpone or prevent smoking onset by 20 to 40 percent among teens.”
In a national survey released last February, more than one-third of high school students and almost 13 percent of middle school students reported having recently smoked or chewed some form of tobacco.
Despite such troubling findings, at least six states—Arizona, California, Florida, Massachusetts, Mississippi, and Oregon—have created comprehensive programs that have had considerable success in reducing tobacco use, according to the Washington-based Campaign for Tobacco-Free Kids.
Those campaigns follow the best-practices guidelines of the CDC and the National Cancer Institute, which sponsored the Washington state study. The programs include anti-tobacco advertising; community-based projects that bring in local businesses and organizations to provide counseling, training, or youth education; and services that help smokers quit.
Many also rely on school health classes, rigorous enforcement of laws prohibiting tobacco sales to youths, and research and evaluation.
