Fifteen-year follow-up of smoking prevention effects in the North Karelia youth project.

OBJECTIVES: This study evaluated the long-term effects of a school- and community-based smoking prevention program in Finland. METHODS: Four intervention schools from North Karelia and two control schools from another province were chosen for the evaluation. Students who received the intervention were taught to resist social pressures to smoke. The program began in 1978 with seventh-grade students and ran through 1980, with a 15-year follow-up. In North Karelia, a community-based smoking cessation program for adults was also carried out. RESULTS: Mean lifetime cigarette consumption was 22% lower among program subjects than among control subjects. Smoking and prevalence were lower up to the age of 21. CONCLUSIONS: Long-term smoking prevention effects can be achieved if a school-based program using a social influence model is combined with community and mass media interventions.     

Effects of in-school and tailored out-of-school smoking prevention among Dutch vocational school students

This paper evaluates a smoking prevention intervention aimed at vocational school students, consisting of an existing Dutch in-school program (three lessons each lasting 50 min) and a computer-based tailored out-of-school program (three tailored letters with smoking prevention messages mailed to students' homes). Nineteen schools that already participated in the in-school program were randomly assigned to the in-school or to the combined in-school and out-of-school condition. The remaining 17 schools were randomly assigned to the out-of-school condition or to the control group. Effect outcomes were assessed at 6, 12 and 18 months after a pre-test, and were based on initiation among never-smokers and continuation among ever-smokers. Twelve months after the pre-test (post-test 2), the in-school intervention was successful in preventing vocational school students from continuing to smoke, compared with students in the control condition [odds ratio (OR) = 0.49; 95% confidence interval (CI) = 0.29-0.84]. Eighteen months after the pre-test (post-test 3), the tailored out-of-school intervention was successful in preventing smoking initiation, compared with students in the control condition (OR = 0.42; 95% CI = 0.18-0.96). The effect of the combined approach was not larger than the sum of the effects of the in-school and the out-of-school effects.     

Six-year follow-up of the first Waterloo school smoking prevention trial.

This paper reports six-year follow-up data from the first large-scale randomized trial of the social influences approach to smoking prevention. In 1979, 22 schools were randomly assigned to program or control conditions. Students in program schools received a social influences curriculum in six core and two maintenance sessions in grade 6, two booster sessions in grade 7, and one booster session in grade 8. All students were assessed at pretest (T1), immediate posttest (T2), end of grade 6 (T3), beginning and end of grade 7 (T4 and T5), end of grade 8 (T6), and grades 11 and 12 (T7 and T8). Ninety percent of study students were relocated and data obtained from over 80 percent of them at T8. Program effects on experimental smoking observed in grades 7 and 8 had completely decayed by T8, six years after the beginning of the program. Grade 6 smoking experience and social risk were each strong predictors of T8 smoking behavior. Subjects who had left school were smoking at more than twice the rate of subjects still in high school (grade 12) at T8. We discuss implications of the results.     

Evaluation of a Health Promoting Schools program to reduce smoking in Australian secondary schools

This randomized controlled trial evaluated the effectiveness of a multicomponent Health Promoting Schools (HPS) intervention program in improving self-reported smoking outcomes among a cohort of adolescents in 22 public secondary schools in the Hunter Region of New South Wales, Australia. Pre-test surveys were completed by students in the first 2 years of secondary school, with a 2-year post-test survey. Multivariate analyses examined intervention effect for the main outcome, post-test smoking behavior, controlling for pre-test smoking status, school and other confounders. The sample comprised the cohort of 1852 students who completed both surveys. The results demonstrated that the HPS program failed to improve smoking behavior over the 2 years (equal increase of 10% in both groups). The program was successful in improving smoking knowledge, but not attitudes, in intervention versus control group (P < 0.001). Independent predictors of post-test smoking included: pre-test smoking [odds ratio (OR) = 5.44; 95% confidence interval (CI) = 3.20-9.28], being female (OR = 0.55; CI = 0.35-0.87), having more close friends who smoked (OR = 1.42; CI = 1.33-1.52), peer group having no clear opinion about smoking (OR = 3.23; CI = 1.27-8.27), having more positive and less negative attitudes towards smoking, and being less involved in school activities. We discuss methodological issues in multicomponent community-based interventions, and highlight the strengths and limitations of this study.     

Project FLAVOR: 1-Year Outcomes of a Multicultural, School-Based Smoking Prevention Curriculum for Adolescents

To evaluate a multicultural smoking prevention curriculum, 16 schools were randomized to receive the multicultural curriculum or a standard curriculum and program effects on 1-year smoking initiation among 1430 never smokers were assessed. Hispanic boys who received the multicultural curriculum were less likely to initiate smoking than were those who received the standard curriculum; effects were insignificant among other groups. The prevention effect among Hispanic boys is encouraging, but additional research is needed to improve prevention effects among other groups.     

Primary prevention of chronic diseases in adolescence: effects of the Midwestern Prevention Project on tobacco use

This article reports six-month, one-year, and two-year effects of a longitudinal multicomponent community program directed toward delaying the onset of cigarette smoking in adolescence. Results are based on a longitudinal panel of sixth and seventh grade students from eight schools in the Kansas City Standard Metropolitan Statistical Area (n = 1,122). In the fall of 1984, schools were assigned to either a program group, which received school, booster, parent, and mass media program components, or a control group that received regular health education programming in school and mass media exposure. By six months, there was a significant effect of the program on recent smoking, with the prevalence of smokers in the program group increasing more slowly than in the control group. At two years, 19% of students in the program group reported smoking in the last month versus 29% of students in the control group; and 12% versus 19%, respectively, reported smoking in the last week. The lifetime prevalence rate showed a marginal program effect at two years, with 57% of students in the program group having smoked once or more compared with 65% in the control group. The program was also effective across different levels of cigarette use ranging from no current use to use of one pack or more per day at two years.     

Preventing Adolescent Substance Use Through an Evidence-Based Program: Effects of the Italian Adaptation of Life Skills Training

Evidence-based preventive interventions for adolescent substance use, violence, and mental health issues are increasingly being adapted and disseminated internationally. In the present paper, we report the results of an effectiveness study that was part of a comprehensive initiative by a coalition of health promotion organizations in the Lombardy region of Italy to select, culturally adapt, implement, evaluate, and sustain an evidence-based drug abuse prevention program developed in the USA. Findings are presented from a large-scale effectiveness study of the Life Skills Training prevention program among over 3000 students attending 55 middle schools in Italy. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills. Relative to comparison group students, students who received the prevention program were less likely to initiate smoking at the post-test and 2-year follow-up, and less likely to initiate weekly drunkenness at the 1-year follow-up. The program had direct positive effects on several cognitive, attitudinal, and skill variables believed to play a protective role in adolescent substance use. The findings from this study show that a drug abuse prevention program originally designed for adolescents in the USA is effective in a sample of Italian youth when a rigorous and systematic approach to cultural adaptation is followed that incorporates the input of multiple stakeholders.     

Three-year follow-up on the effects of a smoking prevention program for elementary school children with a quasi-experimental design in Japan

OBJECTIVE: We performed the follow-up tests for three years for junior high school students by the quasi-experimental design to investigate the medium-term effect of smoking prevention education in the elementary school. METHODS: The intervention group consisted of 106 school students of three elementary schools and received a smoking prevention program in the elementary school. Moreover, the follow-up tests were conducted at each grade of junior high school, and the booster program was mailed. The comparison group consisted of 193 school students of another three elementary schools without the program. RESULTS: The intervention effects were recognized on knowledge up to the second grade of junior high school for boys and up to the third grade for girls, on awareness of the importance of not smoking at the second grade, and on the intention of smoking at the age of 20 for girls up to the first grade. On the other hand, the intervention effects were not recognized on smoking experience for boys and girls. However, increase of the rate of smoking experience was not significant in the intervention group, while it was significant in the comparison group. CONCLUSION: The effect of the program for three years was judged to be moderate.     

桂西地区中学生药物滥用综合干预中期效果评价

目的 评价中学生药物滥用“认知-技能-应对方式-自我效能”模式的中期干预效果,为预防青少年吸毒提供一定的依据.方法 以百色市城乡4所普通中学学生为对象,随机分为试验组和对照组.试验组接受该模式的干预方案,对照组开展简单的药物滥用防治知识讲座.干预前与干预后试验组和对照组均采用自填问卷进行测评.结果 试验组与对照组学生人口学特征及干预前各项得分差异均无统计学意义(P值均＞0.05);干预后即时,试验组有关非法药物认知和一般自我效能的得分较对照组均有不同程度提高(P值均＜0.05),自责得分低于对照组(P值均＜0.05);随访时间内,干预组认知(海洛因/可卡因和大麻)、求助和一般自我效能感得分均高于对照组(P值均＜0.05),自责得分低于对照组(P值均＜0.05).认知(冰毒和K粉)、自责、合理化和一般自我效能感得分有随访时间和分组的交互作用(P值均＜0.05).认知各项、解决问题、幻想、一般自我效能感和抵御技能在干预即时处最高(p值均＜0.05),合理化得分总体呈下降趋势(P值均＜0.05).结论 “认知-技能-应对方式-自我效能”能提升学生拒绝毒品的认知,改善自我效能感和青少年的应对技能.     

广西百色市中学生药物滥用预防干预效果评价

目的 评价认知-技能-应对方式-自我效能模式对中学生药物滥用预防的干预效果.方法 在广西壮族自治区百色市4所普通中学中进行整群抽样,随机分为干预组和对照组.干预组采用认知-技能-应对方式-自我效能模式进行干预,对照组不采取任何干预措施.干预前后,采用自我填表的方式,对2组进行调查问卷测评.结果 干预组与对照组除年龄略有差异外.性别、生活居住地和独生子女构成均有良好均衡性.干预前,2组对有关药物滥用的认知得分除海洛因.可卡因(t=3.135,P=0.002)外,对其他常见毒品的认知得分差异均无统计学意义(均P＞0.05);应对方式、一般自我效能和抵御技能得分的差异均无统计学意义.干预后,干预组对药物滥用的认知得分均明显高于对照组,除海洛因.可卡因外(F=9.495,P=0.002).其他常见毒品的认知得分差异均有统计学意义(P＜0.001);应对方式中除解决问题方式的得分差异无统计学意义(F=2.635,P=0.105)外,自责(F=52.166),求助(F=13.634),幻想(F=5.124).退避(F=8.791),合理化(F=15.251)等应对方式的得分差异均有统计学意义(P＜0.001或P＜0.05).一般自我效能的得分(F=7.395,P=0.007)和抵御技能的得分均比对照组提高(F=87.748,P＜0.001).干预前后.2组曾尝试非法药物、过去30d内尝试非法药物、曾使用多种非法药物等药物滥用率的差异均无统计学意义.结论 认知-技能-应对方式-自我效能干预措施可以帮助学生增强远离毒品的意识,改善自我效能感,树立正确的态度.提高青少年抵御同伴压力的技能和应对技能.     

Smoking prevention for ethnically diverse adolescents: 2-year outcomes of a multicultural, school-based smoking prevention curriculum in Southern California

BACKGROUND: Effective school-based curricula are needed to prevent smoking among ethnically diverse adolescents. This study evaluated a multicultural smoking prevention curriculum in ethnically diverse Southern California middle schools. METHODS: Students in 24 middle schools (N = 3157 sixth graders) received the multicultural curriculum, a similar curriculum without references to cultural issues, or a control condition. Odds ratios for experimentation with smoking over a 2-year period were calculated. RESULTS: The multicultural program was associated with a lower risk of smoking between sixth and eighth grade, relative to the control group. Program effects varied according to the ethnic composition of the schools. In schools with predominantly Hispanic populations, the multicultural curriculum was more effective than the control, but the standard curriculum was not. In schools with predominantly Asian or multicultural populations, the standard curriculum was more effective than the control, but the multicultural curriculum was not. Analyses stratified by ethnicity within the schools revealed that the multicultural curriculum was effective among Hispanic students within predominantly Hispanic schools, but not among Hispanic students within predominantly Asian/multicultural schools. CONCLUSIONS: Smoking prevention for adolescents in culturally diverse school contexts is a challenge. In this study, a multicultural curriculum was most effective among Hispanic students in predominantly Hispanic schools. Further research is needed to determine the best ways to prevent smoking in predominantly Asian and multicultural schools.     

吸烟与饮酒对铜山县高中男生心理健康的影响

目的 探讨吸烟，饮酒及吸烟饮酒并存行为对心理健康的影响。方法 抽取江苏省铜山县3个中学的高中男生，采用现场随机干预实验的方法，其中1所学校为对照组，另2所学校分别接受健康危险认知和社会危险认知的干预措施。记录干预前被试的吸烟，饮酒状态，干预后进行无记名问卷调查和心理健康测定。后使用SCL-90，资料分析使用有序分类状态Logistic回归和方差分析方法。结果 吸烟，饮酒及吸烟饮酒并存行为与心理健康存在着密切关系。它们与GSI（临床症状量表总均分）类别关系的RR值分别为4.063,2.308和9.025。且前两具有显的交互作用（u=2.9383,P=0.0016)，观察期行为矫正较未矫正GIS低，行为启动较未启动GSI高，结论 吸烟，饮酒对青少年心理健康有着不良的影响。而吸烟饮酒行为并存危害更大。     

The effect of endorsement by local opinion leaders and testimonials from teachers on the dissemination of a web-based smoking prevention program

The effect of endorsement by local opinion leaders and teacher testimonials on dissemination of a web-based program to prevent smoking was tested in a group-randomized 2 x 2 factorial post-test-only design with 394 junior and senior high schools. Schools were assigned to condition by region served by local tobacco control coalitions. Visits to the 'Consider This' (CT) website were recorded. Teachers at 226 schools completed a post-test. More schools receiving the opinion leader letter had visits to the website by teachers (12%) than schools not receiving it (4%, P = 0.015). More teachers at schools receiving the testimonials reported reading the materials (29%) than those not receiving them (22%, P = 0.059). Testimonials created more intentions to use CT (49% testimonials, 35% no testimonials, P = 0.047). Testimonials may be effective at increasing teachers' exposure to the promotional materials but recommendations from opinion leaders appear to convince some teachers to visit and assign students to use it.     

The effectiveness of a tobacco prevention program with adolescents living in a tobacco-producing region.

OBJECTIVES: This study investigated the efficacy of a social-influences tobacco prevention program conducted with adolescents living in a high tobacco production area. METHODS: Students in 10 experimental schools completed the tobacco prevention program and a booster intervention. Control students received health education as usual. RESULTS: After 2 years of treatment, smoking rates in the treatment group (vs the control group) were lower for 30-day, 7-day, and 24-hour smoking. The intervention had more of an impact on those who were involved in raising tobacco than it did on those not involved in raising tobacco. CONCLUSIONS: Although modest, effects were achieved with minimal intervention time in a high-risk group, indicating that social-influences prevention programs may be effective in such groups.     

Randomized trials on consider this, a tailored, internet-delivered smoking prevention program for adolescents.

The Internet may be an effective medium for delivering smoking prevention to children. Consider This, an Internet-based program, was hypothesized to reduce expectations concerning smoking and smoking prevalence. Group-randomized pretest-posttest controlled trials were conducted in Australia (n = 2,077) and the United States (n = 1,234) in schools containing Grades 6 through 9. Australian children using Consider This reported reduced 30-day smoking prevalence. This reduction was mediated by decreased subjective norms. The amount of program exposure was low in many classes, but program use displayed a dose-response relationship with reduced smoking prevalence. American children only reported lower expectations for smoking in the future. Intervening to prevent smoking is a challenge, and this data suggest small benefits from an Internet-based program that are unlikely to be of practical significance unless increased by improved implementation. Implementation remains the major challenge to delivering interventions via the Internet, both for health educators and researchers.     

Longitudinal effects of the midwestern prevention project on regular and experimental smoking in adolescents

The purpose of this study was to compare longitudinal smoking prevention program effects estimated on a population-based cohort sample of sixth- and seventh-grade students (average n per year = 4,664) using different schools as units of analysis (middle/junior high school as the school of origin or high school as the endpoint school of intervention). Fifty schools in 15 school districts were demographically matched and assigned to either a school and community-based program for prevention of cigarette, alcohol, and marijuana use, or a health education as usual control group. Smoking was measured by questionnaires administered to the students. An expired air (CO) measure of smoking was also administered to increase accuracy of self-reports. Program effects were estimated with regression analyses, controlling for school-level socioeconomic status, racial/ethnic make-up, urbanicity, and grade. Using school of origin as the unit of analysis, program effects showed 1 year net reductions of -8, -6, and -5% in prevalence rates of smoking in the last month, last week, and last 24 hr; 2-year program effects showed similar net reductions of -6, -5, and -3% (P's less than 0.10-0.001). Analyses with endpoint school as the unit showed slightly weaker effects at the 2-year follow-up, the year during which 64% of students had moved to a junior high or high school. The findings are discussed in terms of the potential contamination of experimental groups in longitudinal studies from school consolidations, family mobility, and feeder patterns to high schools, and the different smoking environments represented by middle, junior high, and high schools.     

Project Towards No Tobacco Use: implementation, process and post-test knowledge evaluation

This paper describes the curricula contents, and presents data to evaluate the implementation, process and immediate post-test knowledge of Project Towards No Tobacco Use (Project TNT). Four different school-based tobacco use prevention curricula were developed to counteract the effects of three types of tobacco use acquisition variables typically addressed within a comprehensive social influences program: (1) peer approval for using tobacco (normative social influence), (2) incorrect social informational provided about tobacco use (information social influence) and (3) lack of knowledge or misperceptions about physical consequences resulting from tobacco use. Three curricula were designed to counteract the effects of single acquisition variables, whereas a fourth curriculum was designed to counteract the effects of combined social and physical consequences-related influences. These curricula were delivered to seventh grade students by trained project health educators to maximize implementation. 'Program' schools, those schools that received one of these curricula, were compared to 'control' schools that provided asystematic health education delivered by school personnel. A total of five conditions were contrasted through use of a randomized experiment involving 48 southern California junior high schools. This paper documents high levels of implementation in all program conditions. Also, favorable process ratings were obtained across the four program conditions, using multiple measures and sources of ratings (students, health educators and classroom teachers who observed curricula delivery). Finally, knowledge item sets completed by the students demonstrated discriminant validity across all five conditions. Because the program conditions were discriminable, yet were quite similar in implementation and process ratings, planned future study of behavioral outcomes can be interpreted as relatively uncontaminated by delivery or credibility confounds.     

The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students.

OBJECTIVES: This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS: A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS: At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS: Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs.     

Application of a generalized random effects regression model for cluster-correlated longitudinal data to a school-based smoking prevention trial

In cluster-randomized trials, groups of subjects (clusters) are assigned to treatments, whereas observations are taken on the individual subjects. Since observations on subjects in the same cluster are typically more similar than observations from different clusters, analyses of such data must take intracluster correlation into account rather than assuming independence among all observations. Random effects models are useful for this purpose. The problem becomes more complicated if, in addition, repeated observations are taken on subjects over time. This introduces intraindividual correlation, which is typical for longitudinal studies. The Waterloo Smoking Prevention Project, study 3 (WSPP3), 1989-1996, is a study giving rise to cluster-correlated longitudinal data, where schools were randomized to either a smoking intervention program or to a control condition. Smoking status was assessed on grade 6 students in these schools, with annual follow-up observations throughout elementary and high school years. The authors illustrate the use of a generalized random effects model for analyzing this type of data. This model obtains appropriate estimates and standard errors for both individual-level covariates and those at the level of the cluster.     

Impact of the life skills training curriculum on middle school students tobacco use in Marion County, Indiana, 1997-2000

Evaluation of school-based tobacco prevention and control programs have yielded mixed results. This study assessed the impact of the Life Skills Training curriculum on Marion County, Ind., middle school students' knowledge, attitudes, and ability to make good lifestyle decisions. From 1997 to 2000, students in grades six to eight in the study schools received the Life Skills Training curriculum. Survey data (n = 1,598) were used to compare tobacco use behavior, attitudes, and knowledge of those exposed with those not exposed to the program. Of the students surveyed, 12.5% were currently smoking. There were significantly fewer current smokers, and more students exposed to the program indicated they intended to stay smoke-free. Fewer of those participating in the program "hung out" with smokers and more said they could easily refuse a cigarette if offered one. Students completing the Life Skills Training curriculum were more knowledgeable about the health effects of smoking. Program effects were different for male and female students as well as for White and Black students.