School prevention program fails to curb teen smoking

  Scientists say they will have to go back to the drawing board to find new ways to deter young people

Scientists say they will have to go back to the drawing board to find new ways to deter young people from smoking after a 15-year study revealed that a school-based prevention program did not work.

And even as the findings of the multi-year Hutchinson Smoking Prevention Project (HSPP) study have left researchers baffled and surprised, they are quick to add there is little time to spend pondering the results: It is estimated that at least five million American children alive today will die of smoking-related illnesses, says Arthur V. Peterson Jr., PhD, a member of the Fred Hutchinson Cancer Research Center in Seattle and lead author of the study.

"This shows us that school programs alone are not able to do the job," Peterson says. "We have to go back to the drawing board to understand the social influences of smoking on our kids. We need to examine it better and get behavioral sciences involved more and then come up with a better approach and targets for intervention."

Peer pressure, heavy marketing to light up

The HSPP study tracked 8,388 students in grades three through 12 from September 1984 through August 1999 in 40 school districts in Seattle.

Using an age-appropriate, gradual program, researchers trained teachers to present lessons aimed at helping students in 20 of the districts identify numerous societal pressures that often lead to smoking, like peer pressure, tobacco marketing, and tobacco advertising. The intervention also highlighted the misleading perceptions surrounding those pressures and tried to motivate students to shun smoking. In the meantime, students from 20 other districts made up a control group that was taught a regular health curriculum.

Results published in the Dec. 20 issue of the Journal of the National Cancer Institute show there was no significant difference in prevalence of daily smoking between students in the experimental districts and those in the control districts -- with 26% of male high school seniors reporting they smoked daily in both groups and 24% of female seniors reporting daily tobacco use in both the experimental and control groups. The results shattered the theory that a school-based push to outline social influences on smoking would lead to deterrence. The researchers employed guidelines recommended by experts at the National Cancer Institute and the Centers for Disease Control and Prevention (CDC) for planning and implementing effective school-based programs for the prevention of tobacco use.

In an editorial accompanying the study, experts from the Kentucky School of Public Health maintain that the study itself was thorough, elegantly designed, and superbly carried out -- clearly pointing to a need for further research into the complex causes and risk factors for youth smoking.

A broader approach needed

The study authors recommend that further research could help in the development of novel strategies for prevention, which could include both school- and community-based intervention programs. Peterson says one such approach to deter smoking is to establish telephone hotlines for people who want to quit smoking and to lobby parents to intervene. "Parents can help by talking to their children, and for those who do smoke, they can help their kids by quitting."

Similarly, the editorial recommends a "comprehensive tobacco control program that includes strictly enforced school tobacco-free policies, active parent and community involvement, cessation services for students and staff, and coordination with community and media efforts to reduce tobacco use."

Ron Todd, MSEd, director of tobacco programs for the American Cancer Society, endorses that course of action. Todd says CDC statistics for 1998-99 reflect a slight decline in regular tobacco use among U.S. teens, after rising steadily since 1991. He attributes the dip to increases in cigarette prices and greater anti-smoking awareness.

"What this study demonstrates is the fact that an isolated school programs alone are not as effective as having a comprehensive approach," Todd says.

Todd cites states like California and Massachusetts that have recently started a comprehensive anti-smoking campaign, which includes increasing the number of no-smoking areas in public places and wide access to cessation programs. "When you have other programs in addition to school-based programs, they change the social environments that support not smoking. The idea here is you do many things and don’t rely on one program."

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