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.     

Meanings of smoking and adolescent smoking across ethnicities.

PURPOSE: To develop insight into population-specific meanings of smoking in our highly multicultural middle schools in order to provide effective and appropriate tools for smoking prevention efforts. METHODS: We used focus group interviews to develop the Meanings of Smoking Index (MSI), a nine-item scale that uses a "mark all that apply" strategy to assess what smoking means to children who have tried smoking as well as to those who are susceptible to smoking. In 24 public and parochial middle schools in the greater Los Angeles area, 2336 7th graders (1483 Latino, 565 Asian/ Pacific Islander and 288 white, 55.2% of the sample was female) completed the MSI as part of a school-based trial of culturally-targeted smoking prevention strategies. Items were rank ordered according to salience (rate of endorsement) and relevance (strength of relationship with lifetime smoking) across the entire sample and separately for Hispanic/Latino, Asian/Asian-American and white respondents. Spearman correlation coefficient was used to compare results between ethnicities. RESULTS: The most frequently endorsed meanings were similar across ethnicities. Magnitude of associations between smoking behaviors and meanings were dissimilar across ethnicities. The meaning with the strongest relationship to lifetime smoking for whites and Latinos was "it helps me study" (OR 3.4 and 2.6 respectively), and for Asians was "don't want to make another smoke alone" (OR 5.4). CONCLUSIONS: We have shown previously that interventions on meanings of eating behaviors changed dietary behaviors in adolescents. The present findings suggest that meanings are powerful determinants of adolescent smoking in culturally diverse populations and could offer powerful intervention tools to prevent adolescent smoking.     

A psychosocial approach to smoking prevention for urban black youth

Despite the high rates of smoking-related cancers among black Americans, little is known about the type of smoking prevention program that might be effective with black youth. The current study pilot-tested a promising smoking prevention approach to determine its feasibility, acceptability, and effectiveness. A total of 608 students in nine predominantly black urban junior high schools were stratified by community and randomly assigned to treatment and control conditions. Students in the treatment condition participated in a 12-session smoking prevention program which taught resistance skills and general life skills. Process data indicated that this prevention approach was feasible and acceptable to students, teachers, and administrators. Outcome data indicated that this program reduced the proportion of children who smoked in the past month by 56 percent, and it increased knowledge of the adverse consequences of smoking and normative expectations concerning adult and peer smoking. These results are discussed in terms of their implications for prevention and modifications which might further strengthen the efficacy of this approach for urban black adolescents.     

Longitudinal Effects of Hostility,Depression, and Bullying on Adolescent Smoking Initiation

PurposeThe present study examined the associations between smoking initiation and, hostility, depressive symptoms, and bullying (bullies and bully-victims) among a culturally diverse sample of 1,771 adolescents who reported never having smoked at baseline.MethodsData were obtained from a longitudinal school-based experimental trial of smoking prevention programs in Southern California. Annual survey was performed for students of the sixth, seventh, and eighth grades. All students in the 24 participating schools were invited to participate in the study during the sixth grade.ResultsThe risk of smoking initiation was significantly higher among students who scored higher on hostility and depressive symptoms, and were bully-victims.ConclusionThe findings suggest that tobacco prevention programs should include strategies for managing hostile feelings and negative effect as part of the curriculum. In addition, it might be helpful to identify youth who score high on these psychosocial factors and teach them skills to handle interpersonal conflict and negative feelings to prevent their involvement in substance use.     

用logistic回归方法分析珠海市青少年吸烟行为的影响因素

目的：了解珠海市青少年吸烟行为的影响因素，为制定有效的控烟措施提供科学依据。方法：采取多阶段分层整群抽样法。采用世界卫生组织（WHO）／中国卫生部提供的“全球青少年烟草调查（Global Youth Tobacco Survey，GYTS）中国问卷”，对全市25所中学，初二至高一的47个班，2480名学生进行问卷调查。结果：青少年尝试吸烟率为29．4％（包括只吸一口）。经非条件logistic逐步回归分析，父母亲中有人吸烟的、同伴好友中有人吸烟的、看到教师吸烟的青少年，其吸烟行为发生的危险性分别是其他青少年的1．35倍。2．911倍和1．320倍。其中同伴好友吸烟是影响青少年吸烟行为的最显著因子。结论：珠海市青少年尝试吸烟现象较为普遍，同伴好友、父母吸烟对青少年吸烟行为产生严重影响，应在家庭、学校、社区开展创建无烟家庭、无烟学校活动。加强青少年控烟能力的建设。在全社会形成良好的控烟青少年吸烟的支持性环境。     

Predictors of late-onset smoking and cessation over 10 years.

PURPOSE: To identify predictors of smoking onset and cessation between early (age 13 years) and late adolescence (age 18 years) and between late adolescence (age 18 years) and young adulthood (age 23 years). METHODS: We employed logistic regression to predict smoking initiation and cessation for an ethnically diverse sample of 3056 adolescents recruited from 30 West Coast schools in 1985 and observed from age 13 to age 23 years. Fifty-six percent of the sample was female. Predictors tapping sociodemographic characteristics, environmental influences, attitudes and beliefs about smoking, bonds with school, and problem behavior were measured at age 13 years (older teenager models) and at age 18 years (young adult models). RESULTS: Robust predictors of both initiation and cessation across the two developmental periods included doing poorly in middle/high school and prior smoking behavior. Predictors common to three of the four models included being young for one's grade cohort and intending to smoke in the next 6 months. Early deviant behavior and drinking fostered initiation among older teenagers, but problem behavior as an older teenager did not predict young adult initiation. Smokers who had few or no high school friends who smoked and felt able to resist prosmoking pressures at age 18 years were more likely to quit by age 23 years. Being female predicted initiation by age 18 years; being African-American, Hispanic, or Asian inhibited it. CONCLUSIONS: The strong association of prior smoking behavior and intentions with later smoking status among both adolescents and young adults underscores the importance of starting smoking prevention early and continuing it through high school. Such programs might also consider the greater vulnerability of females, youth who are young for their grade cohort, and those who are doing poorly in school.     

Draw the line/respect the line: a randomized trial of a middle school intervention to reduce sexual risk behaviors

OBJECTIVES: This study evaluated the long-term effectiveness of Draw the Line/Respect the Line, a theoretically based curriculum designed to reduce sexual risk behaviors among middle school adolescents. METHODS: The randomized controlled trial involved 19 schools in northern California. A cohort of 2829 sixth graders was tracked for 36 months. RESULTS: The intervention delayed sexual initiation among boys, but not girls. Boys in the intervention condition also exhibited significantly greater knowledge than control students, perceived fewer peer norms supporting sexual intercourse, had more positive attitudes toward not having sex, had stronger sexual limits, and were less likely to be in situations that could lead to sexual behaviors. Psychosocial effects for girls were limited. CONCLUSIONS: The program was effective for boys, but not for girls.     

北京市房山区2019年中小学生尝试吸烟状况及影响因素分析

目的 为了解房山区中小学生尝试吸烟状况及其影响因素,以及烟草相关知信行情况,为进一步做好青少年控烟工作提供科学依据。 方法 采用多阶段分层整群抽样方法抽取房山区3所小学、2所初中、1所高中和1所职高共1 507名学生进行了问卷调查。分析不同学段学生尝试吸烟情况以及对烟草的知信行情况。使用多因素logistic回归分析儿童青少年吸烟行为的相关影响因素。 结果 房山区2019年中小学生尝试吸烟率为6.30%,小学、初中、高中、职高学生尝试吸烟率分别为3.46%、4.12%、3.53%、25.56%,差异有统计学意义(χ²=145.304,P＜0.01)。多因素logistic回归分析显示职高学段、身边有朋友吸烟、见到电视电影中有吸烟镜头、模仿偶像吸烟等变量是中小学生尝试吸烟的危险因素。烟草相关知识各题目的正确率学段差异均有统计学意义(P＜0.01)。男生对于烟草的肯定比例明显高于女生,性别、学段差异均有统计学意义(P＜0.01)。78.90%的学生表示今后肯定不会吸烟。52.02%的学生会劝阻身边吸烟的人,1.26%的学生会跟随身边人一起吸烟。22.16%的学生表示会模仿明星偶像抽烟,性别和学段差异有统计学意义(P＜0.01)。 结论 作者简介:孟毅(1982-),女,北京市房山人,学士,主管医师,主要从事学校卫生工作和健康教育工作。儿童青少年的控烟是今后降低全社会人群吸烟率的关键。控制儿童青少年吸烟需要学校、家庭和社会的综合防控,创建轻松和谐、无烟健康的支持性环境,强化知识宣教与干预,使儿童青少年牢固掌握相关知识的同时,产生心理认同,将控烟行动坚持一生。     

Active Parent Consent for Health Surveys With Urban Middle School Students: Processes and Outcomes*

BACKGROUND: To achieve high participation rates and a representative sample, active parent consent procedures require a significant investment of study resources. The purpose of this article is to describe processes and outcomes of utilizing active parent consent procedures with sixth-grade students from urban, ethnically diverse, economically disadvantaged K-8 public schools involved in an evaluation of a middle school service-learning program. METHODS: As part of the evaluation of the Lead Peace-Plus service-learning program, active parent consent was obtained for participation in school-based health surveys conducted with sixth graders in 3 schools. To achieve acceptable rates of parent permission, we employed multiple procedures including regular communication with school staff, incentives for involved schools and teachers, a multipronged approach for reaching parents, and direct encouragement of students to return forms through repeated classroom visits, individual and classroom incentives. We used Fisher's exact tests to compare selected characteristics among students whose parents weren't reached, those whose parents refused, and those whose parents consented to survey participation. RESULTS: We achieved a parent response rate of 94.6% among sixth-grade students. No significant differences in student gender, race/ethnicity, school, or free/reduced lunch status were identified across parent consent status groups. Rates of absenteeism were significantly higher (p = .03) among students whose parents weren't reached compared to other groups. CONCLUSIONS: Employing a multifaceted active parent consent campaign can result in high rates of parental response with limited sampling bias among an urban, ethnically diverse and economically disadvantaged group of middle school students.     

The interaction of curriculum type and implementation method on 1-year smoking outcomes in a school-based prevention program

Studies have shown that the effectiveness of programs or curricula may depend in part on who delivers the material. In adolescent health education programs, peer leaders are often recruited to implement programs because they are more persuasive to other adolescents than adults. Teachers also systematically vary how groups are constructed in school-based health education programs. This study compared the effects of three leader and group selection methods within the context of two tobacco prevention programs. Eight schools received a social influences program (Chips) and eight received a program with a multicultural emphasis (Flavor). Within these 16 schools 84 classrooms consisting of 1486 students were randomly assigned to one of three leader and group creation conditions: (i) leaders defined as those who received the most nominations by students and groups created randomly (random group), (ii) same as (i) but groups created by assigning students to the leaders they nominated (network), and (iii) leaders and groups created by teachers (teacher). One year follow-up data showed that main effects of the curriculum and network assignments were non-significant on smoking initiation when entered alone. Interaction terms of curriculum and assignment methods, however, were significant such that the network and teacher conditions were less effective than the random group condition with Chips, and more effective than random group condition with Flavor. These data show that school-based prevention programs should be evaluated in light of who implements the program. Even a peer-led program will be differentially effective based on how leaders are selected and how groups are formed, and this effect may be curriculum dependent.     

Cross-Cultural Adaptation and Evaluation of a Home-Based Program for Alcohol Use Prevention among Urban Youth: The “Slick Tracy Home Team Program”

The current study describes the extensive cross-cultural adaptation of a brief home-based alcohol prevention program for racially and ethnically diverse sixth grade students and their families, using a randomized controlled trial design involving 60 public schools in the city of Chicago (N = 3,623 students). The adapted program achieved high participation levels (73%) overall, as well as in single parent families, non-English homes, and low-income students, among other at risk groups. Lower levels of factors associated with the onset of alcohol use (i.e., normative expectations and outcome expectations) were achieved in the intervention group compared to the control group. However, no differences were observed for several other protective factors or alcohol use. Editors' Strategic Implications: The experimental design, large sample, and specific adaptation of the program for an ethnically diverse urban population of children and their families provide a model for culturally appropriate prevention efforts. Further, the attitudinal results (and dose-response findings) of the Slick Tracy alcohol prevention program are promising.     

上海市中学生控烟干预研究

目的探索中学控烟的干预模式并评价干预效果。方法采用两阶段整群抽样法,以2所中学的预备班和初一年级学生为研究对象。对干预组进行为期一年的综合控烟干预,并通过干预前、干预后、干预后半年分别进行问卷调查评价干预效果。结果干预后干预组一年内的尝试吸烟率由9·7%下降到4·2%,重度被动吸烟率由15·5%下降到12·2%,有关烟草预防的认知、态度、技能有所提高,并且大部分效果在干预半年后得以持续。结论学校综合性控烟干预可行、有效,但还需要进一步和社区控烟相结合。     

The effects of a three-year smoking prevention programme in secondary schools in Helsinki

BACKGROUND: This study evaluates the effects of a 3-year smoking prevention programme in secondary schools in Helsinki. The study is part of the European Smoking prevention Framework Approach (ESFA), in which Denmark, Finland, the Netherlands, Portugal, Spain and the UK participated. METHODS: A total of 27 secondary schools in Finland participated in the programme (n = 1821). Schools were randomised into experimental (13) and control groups (14). The programme included 14 information lessons about smoking and refusal skills training. The 3-year smoking prevention programme was also integrated into the standard curriculum. The community-element of the programme included parents, parish confirmation camps and dentists. The schools in the experimental group received the prevention programme and the schools in the control group received the standard health education curriculum. RESULTS: Among baseline never smokers (60.8%), the programme had a significant effect on the onset of weekly smoking in the experimental group [OR = 0.63 (0.45-0.90) P = 0.009] when compared with the control group. Being female, doing poorly at school, having parents and best friends who smoke and more pocket money to spend compared with others were associated with an increased likelihood of daily and weekly smoking onset. These predictors did not have an interaction effect with the experimental condition. CONCLUSION: This study shows that a school- and community-based smoking prevention programme can prevent smoking onset among adolescents.     

New inroads in preventing adolescent drug use: results from a large-scale trial of project ALERT in middle schools

OBJECTIVES: We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities. METHODS: Fifty-five South Dakota middle schools were randomly assigned to program or control conditions. Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade. Program effects for 4276 8th-graders were assessed 18 months after baseline. RESULTS: The revised Project ALERT curriculum curbed cigarette and marijuana use initiation, current and regular cigarette use, and alcohol misuse. Reductions ranged from 19% to 39%. Program effects were not significant for initial and current drinking or for current and regular marijuana use. CONCLUSIONS: School-based drug prevention programs can prevent occasional and more serious drug use, help low- to high-risk adolescents, and be effective in diverse school environments.     

A randomized intervention of smoking for adolescents in urban Wuhan, China

BACKGROUND: Tobacco use is a significant public health problem in China. Culturally specific smoking prevention programs are needed for Chinese adolescents. This study evaluated a school-based smoking prevention curriculum with a social normative approach developed in the United States for adolescents in urban Wuhan, China. METHODS: As a randomized trial, the intervention was implemented in 1998 with 7th grade students in seven schools with seven matched control schools. Multilevel logistic regression models were used to compare ever and recent (past-month) smoking behaviors for the control and program conditions. RESULTS: At the 1-year follow-up, smoking had increased more rapidly in the control schools than in the program schools. The odds of baseline nonsmokers initiating smoking did not differ between the program and control groups (OR=1.08 with 95% CI=0.71, 1.64). The program prevented progression to recent smoking among boys who were baseline ever smokers. Among boys who were recent smokers at baseline, the prevention program significantly reduced risk of remaining recent smokers at follow-up (OR=0.45 with 95% CI=0.23, 0.88). CONCLUSIONS: This social normative smoking prevention curriculum did not demonstrate a significant primary prevention effect but showed potential for secondary prevention. Culturally specific smoking prevention programs are needed for Chinese adolescents.     

Tobacco use among youth and adults in Mainland China: the China Seven Cities Study

OBJECTIVE: The China Seven Cities Study (CSCS) monitors geographic and temporal trends in tobacco use among adolescents and adults in seven cities throughout Mainland China: Harbin, Shenyang, Wuhan, Chengdu, Kunming, Hangzhou, and Qingdao. This article presents the methodology and prevalence data from the baseline survey of the CSCS, conducted in 2002. METHODS: Stratified random samples of middle schools, high schools, and colleges were selected within each city. Students and their parents completed self-report surveys of their tobacco use. Data were obtained from 6138 middle school students, 5848 academic high school students, 2448 vocational high school students, 2556 college students, and 25 697 parents. RESULTS: Smoking prevalence varied across age groups, school types, genders, and cities. Past-month smoking prevalence was 9% among middle school students, 8% among academic high school students, 26% among vocational high school students, 21% among college students, and 40% among parents. Smoking prevalence was higher among males than among females, with larger gender disparities among adults than among youth. Smoking also varied across cities, with higher smoking prevalence in southwestern cities and lower prevalence in coastal cities. Intraclass correlations of students within schools are presented to inform statistical power estimates for further research in China. CONCLUSIONS: These results provide a baseline for future longitudinal studies of smoking in these cities and identify demographic groups at risk for tobacco-related disease. Effective smoking prevention programmes for youth and smoking cessation programmes for adults are needed in China, especially in the lower-income southwestern cities and in vocational high schools throughout the country.     

Keeping middle school students abstinent: outcomes of a primary prevention intervention.

PURPOSE: (a) To test the longer-term (6-12 month) effect of a school-based intervention designed to delay the onset of sexual intercourse on continuation of abstinence, (b) to compare the effect of the intervention when delivered by different providers, and (c) to describe the factors that influence students' transition from abstinence to sexual activity. METHODS: This study was a nonrandomized control trial with one control and three intervention groups. The setting was health education classes in urban, predominantly ethnic minority schools. The participants were middle school students (N = 1352; mean age, 13.1 years) in five schools. Of participants, 50% were African American, 20% white, 16% Hispanic, and 14% other. Youth were assigned to one of four groups. The control group consisted of the regular school health curriculum and teacher. All three intervention groups received the Rochester AIDS Prevention Project curriculum, but implemented by different types of instructors, including ethnically diverse male-female pairs of adult professional educators; male-female pairs of extensively trained high school peer educators; and school district health teachers. A confidential questionnaire administered preintervention and at long-term follow-up (mean, 44 weeks) measured demographics, risk behaviors, and sexual intercourse history. RESULTS: At preintervention, 27% of girls and 62% of boys reported sexual intercourse experience. At follow-up, 19% and 32%, respectively, of the previously abstinent girls and boys had "transitioned" to sexual activity. Increasing age (p <.01, females; p <.001, males), lower socioeconomic status (p <.0001), and higher general risk behaviors (p <.0001) best predicted the transition. Logistic regression indicated that the intervention was effective for peer-taught males (p =.02) and regular teacher-taught males (p =.001) and females (p =.05). CONCLUSIONS: Successful abstinence maintenance was only possible among those subjects who were not already sexually experienced at study enrollment. Baseline scores regarding intercourse and general life risks already evident by seventh grade suggest that urban, school-based primary prevention interventions must occur before adolescence. Early adolescence interventions need to include both abstinence and safer sex messages.     

Ethnic and Gender Differences in Alcohol Use Among a Longitudinal Sample of Inner-City Adolescents

The purpose of this study was to determine if ethnic and gender differences in alcohol use exist among a cohort of inner-city adolescents during each of the 3 years of middle school. Students in 22 urban schools completed self-report questionnaires with measures of alcohol use (frequency of drinking, amount of drinks per occasion, and frequency of drunkenness) at three annual assessments. Of the participating students, 2312 identified themselves as Asian, Black, Hispanic or White. Analyses of variance were conducted to test for ethnic group (Asian, Black, Hispanic, White) and gender differences in alcohol use. Ethnic differences were found for all three alcohol measures at each assessment point. Boys drank more frequently than girls during the first 2 years. Asian and Black adolescents appeared to be at lower risk for alcohol use.     

广东省城市学生吸烟与被动吸烟现状及吸烟危害认知调查

目的了解城市青少年吸烟与被动吸烟状况及吸烟相关认知状况，了解学校控烟措施开展情况，为进一步开展针对性的控烟工作提供依据。方法采用分层整群抽样的方法，在广州市、江门市抽取大学、中学、小学各1所，各调查100名学生，在增城市抽取中学、小学各1所，各调查100名学生，采用中国疾病预防控制中心控烟办公室统一设计的《学生被动吸烟调查问卷》对学生吸烟、被动吸烟情况、吸烟相关知识等进行调查。结果共调查学生800人，其中男生474人，女生326人。学生现在吸烟率为6．3％，男生为8．4％，女生为3．1％，大、中、小学生分别为8．0％、7．3％、4．0％。学生在家里和家外遭受被动吸烟的比例分别为32．4％和36．1％。学生中父母、朋友、老师吸烟，学生自身尝试吸烟率较高。学生对吸烟与被动吸烟损害健康的知晓率分别为95．9％和91．1％。小学生控烟相关教育开展较好，大学校园内控烟宣传栏和组织控烟为主题的活动较少。结论青少年吸烟和被动吸烟情况较为严重，要通过大力开展学校控烟健康教育工作，提供控烟与戒烟相关服务与资讯，来预防青少年吸烟和减少二手烟的危害。