Outcome evaluation of a high school smoking reduction intervention based on extracurricular activities. Adolescent substance use outcomes in the Raising Healthy Children project: a two-part latent growth curve analysis. Self-control skills for preventing smoking. The television, school, and family smoking prevention and cessation project. VIII. Student outcomes and mediating variables. Preventing school failure, drug use, and delinquency among low-income children: long-term intervention in elementary schools. Results of an independent evaluation of Project ALERT delivered in schools by Cooperative Extension. Cigarette smoking and drug use in schoolchildren: III--evaluation of a smoking prevention education programme. Influence of education and advertising on the uptake of smoking by children. Project FLAVOR: 1-Year Outcomes of a Multicultural, School-Based Smoking Prevention Curriculum for Adolescents. Cluster randomised trial of the effectiveness of motivational interviewing for universal prevention. Drug abuse prevention among minority adolescents: posttest and one-year follow-up of a school-based preventive intervention. Long-term effects of implementation intentions on prevention of smoking uptake among adolescents: a cluster randomized controlled trial. A randomized controlled trial of two primary school intervention strategies to prevent early onset tobacco smoking. Evaluation of two school smoking education programmes under normal classroom conditions. A randomized controlled trial of the middle and junior high school D.A.R.E. and D.A.R.E. Plus programs. One-year follow-up evaluation of Project Towards No Drug Abuse (TND-4). [Results of a controlled randomized study on prevention of smoking habit in adolescents]. [Smoking prevention and control among elementary school students in Xuhui district, Shanghai]. Are social-psychological smoking prevention programs effective? The Waterloo study. The effectiveness of Drug Abuse Resistance Education (project DARE): 5-year follow-up results. Do smoking prevention programs really work? Attrition and the internal and external validity of an evaluation of a refusal skills training program. Prevention of smoking in adolescents with lower education: a school based intervention study. Evaluation of a Health Promoting Schools program to reduce smoking in Australian secondary schools. Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high-school students. The effects of the going places program on early adolescent substance use and antisocial behavior. Social-cognitive skill development with sixth graders and its initial impact on substance use. Hutchinson Smoking Prevention Project: long-term randomized trial in school-based tobacco use prevention--results on smoking. A randomised controlled trial of a community intervention to prevent adolescent tobacco use. The Adolescent Substance Abuse Prevention Study: A randomized field trial of a universal substance abuse prevention program. Effectiveness of a school-based substance abuse prevention program. Effects of in-school and tailored out-of-school smoking prevention among Dutch vocational school students. Project Towards No Tobacco Use: implementation, process and post-test knowledge evaluation. Reducing adolescent smoking: a comparison of peer-led, teacher-led, and expert interventions. Does a smoking prevention program in elementary schools prepare children for secondary school? Comparison of two school-based smoking prevention programs among South African high school students: results of a randomized trial. Coronary heart disease prevention in childhood: one-year results of a randomized intervention study. Smoking initiation and escalation in early adolescent girls: one-year follow-up of a school-based prevention intervention for minority youth. Randomized trials on consider this, a tailored, internet-delivered smoking prevention program for adolescents. Results from a statewide approach to adolescent tobacco use prevention. School-based drug prevention among at-risk adolescents: effects of ALERT plus. Evaluation of a respiratory health education program. Effects of a health education program on junior high school students' knowledge, attitudes, and behavior concerning tobacco use. The European Smoking Prevention Framework Approach (EFSA): an example of integral prevention. Effectiveness of a social influence approach and boosters to smoking prevention. Targeting early antecedents to prevent tobacco smoking: findings from an epidemiologically based randomized field trial. Two-year effects of a school-based prevention programme on adolescent cigarette smoking in Guangzhou, China: a cluster randomized trial. Project ALERT: a cluster randomized trial. One-year follow-up evaluation of the Project Towards No Drug Abuse (TND) dissemination trial. A cardiovascular risk reduction program for the classroom. The efficacy of a multicomponent approach to the prevention of cigarette smoking. [An interventional study against cigarette smoking among Dusseldorf high school students 1992-94]. Social influences approach to smoking prevention: the effects of videotape delivery with and without same-age peer leader participation. Preventing alcohol, marijuana, and cigarette use among adolescents: peer pressure resistance training versus establishing conservative norms. Culturally grounded substance use prevention: an evaluation of the keepin' it R.E.A.L. curriculum. Evaluation of a peer-led smoking prevention programme for Romanian adolescents. Immediate and short-term effects of the 5th grade version of the keepin' it REAL substance use prevention intervention. Evaluating the Lions-Quest "Skills for Adolescence" drug education program. Second-year behavior outcomes. The effects of scheduling format and booster sessions on a broad-spectrum psychosocial approach to smoking prevention. Preventive intervention effects on developmental progression in drug use: structural equation modeling analyses using longitudinal data. Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: results of a 3-year study. Preventing Substance Abuse Among American-Indian Adolescents: A Bicultural Competence Skills Approach. An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. The effectiveness of a school-based substance abuse prevention program: EU-Dap cluster randomised controlled trial. The efficacy of social-influence prevention programs versus "standard care": are new initiatives needed? A randomized intervention of smoking for adolescents in urban Wuhan, China. A school-based environmental intervention to reduce smoking among high school students: the Acadiana Coalition of Teens against Tobacco (ACTT). Evaluation of an antismoking educational programme among adolescents in Italy. Tobacco use measurement, prediction, and intervention in elementary schools in four states: the CATCH Study. Long-term evaluation of drug abuse resistance education. Randomized trial of primary school education against smoking. Tobacco-refusal skills and tobacco use among high-risk adolescents. Cluster randomised controlled trial of expert system based on the transtheoretical ("stages of change") model for smoking prevention and cessation in schools. Prevention of smoking in elementary schools. A comprehensive school-based smoking prevention program. Peer acceleration: effects of a social network tailored substance abuse prevention program among high-risk adolescents. [Results of a school addictive substances abuse prevention program: the Barcelona PASE pilot project]. Cardiovascular risk factor prevention in black schoolchildren: two-year results of the "Know Your Body" program. Preventing tobacco use among young people. Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence. Effectiveness of a social influences smoking prevention program as a function of provider type, training method, and school risk. [The effectiveness of a program of smoking prevention among Mexican schoolchildren]. The role of parents and older peers in school-based cardiovascular prevention programs: implications for program development. Activating multi-ethnic youth for smoking prevention: design, baseline findings, and implementation of project SPLASH. Six-month and one-year effects of project EX-4: a classroom-based smoking prevention and cessation intervention program. Project SUCCESS' effects on the substance use of alternative high school students. New inroads in preventing adolescent drug use: results from a large-scale trial of project ALERT in middle schools. Lack of sustainable prevention effect of the "Smoke-Free Class Competition" on German pupils. Preventing tobacco and drug use among Thai high school students through life skills training. Smoking and smokeless tobacco use among adolescents: trends and intervention results. Randomized trial of brief family interventions for general populations: adolescent substance use outcomes 4 years following baseline. Skills intervention to prevent cigarette smoking among adolescents. Skills-building methods to prevent smoking by adolescents. Tobacco and alcohol use outcomes of a school-based intervention in New Delhi. Affective and social influences approaches to the prevention of multiple substance abuse among seventh grade students: results from project SMART. Preventing substance use among Native American youth: three-year results. A comprehensive multi-media program to prevent smoking among black students. A multihealth behavior intervention integrating physical activity and substance use prevention for adolescents. Patterns of change in adolescent smoking behavior and results of a one year follow-up of a smoking prevention program. Using the internet to assist smoking prevention and cessation in schools: a randomized, controlled trial. The effectiveness of a tobacco prevention program with adolescents living in a tobacco-producing region. Effects of a school-based smoking prevention program among subgroups of adolescents. An adaptive approach to family intervention: linking engagement in family-centered intervention to reductions in adolescent problem behavior. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Impact of a preventive intervention targeting childhood disruptive behavior problems on tobacco and alcohol initiation from age 10 to 13 years. Preventing cigarette smoking among children: results of a four-year evaluation of the PAL program. [Promoting non-smoking behavior in 13-year-old students in primary schools and high schools. A prospective, randomized intervention study with 1,956 students]. A school-based harm minimization smoking intervention trial: outcome results. Primary prevention of chronic disease in childhood: changes in risk factors after one year of intervention. Toward dissemination of evidence-based family interventions: maintenance of community-based partnership recruitment results and associated factors. Preventing tobacco use among young people in India: Project MYTRI. The impact on tobacco use of branded youth anti-tobacco activities and family communications about tobacco. The impact of behavioural interventions on young people's attitudes toward tobacco use. A cognitive-behavioral approach to substance abuse prevention: one-year follow-up. Sex specific trajectories in cigarette smoking behaviors among students participating in the unplugged school-based randomized control trial for substance use prevention.
An outcome evaluation of a high school tobacco control intervention using extracurricular activities developed by teachers and students is reported.
                Eligible subjects (n = 3,028) had participated in a randomized trial of an elementary school smoking prevention curriculum. Their high schools were matched in pairs; one school in each pair was randomly assigned to the intervention condition, the second to a "usual-care" control condition. Data were collected at the end of Grades 9 and 10.
                For Grade 8 never smokers, regular smoking rates were significantly lower for males from intervention schools (9.8 vs 16.2%, P = 0.02) at the end of Grade 10. There were no significant differences among Grade 10 smoking rates for females, or for students of either gender with previous smoking experience in Grade 8.
                The extracurricular activities approach to tobacco control is practical to implement and has promise. Raising Healthy Children (RHC) is a preventive intervention designed to promote positive youth development by targeting developmentally appropriate risk and protective factors. In this study, the authors tested the efficacy of the RHC intervention on reducing adolescent alcohol, marijuana, and cigarette use. Ten public schools, which comprised 959 1st- and 2nd-grade students (54% male students, 18% minority, 28% low socioeconomic status), were matched and assigned randomly to either intervention or control conditions. A 2-part latent growth modeling strategy was used to examine change in both use-versus-nonuse and frequency-of-use outcomes while students were in Grades 6-10. Results indicated significant (p < .05) intervention effects in growth trajectories for frequency of alcohol and marijuana use but not for use versus nonuse. These findings provide support for preventive interventions that take a social development perspective in targeting empirically supported risk and protective factors and demonstrate the use of 2-part models in adolescent substance use research.
                Copyright 2005 APA, all rights reserved. This study evaluated the effects of self-control skills intervention to prevent smoking with middle school subjects. Informed and consenting subjects were pretested, then by school were randomly divided into three conditions: experimental, placebo, and test-only control. Experimental condition subjects received self-control skills intervention covering self-instruction, self-reinforcement, problem solving, and interpersonal communication. Placebo condition subjects received a discussion-oriented intervention employing health education methods to prevent smoking. Results at 15-month follow-up indicated that self-control and placebo condition subjects, relative to control condition subjects, improved more on measures of health knowledge and nonsmoking intentions. Self-control skills subjects had better 15-month follow-up scores than subjects in the other two conditions on measures of communication, self-instruction, self-praise, cigarette refusals, and noncompliance to smoke. Self-control condition subjects reported less weekly cigarette smoking compared with placebo and control condition subjects at final follow-up. This paper presents the student outcomes of a large-scale, social-influences-based, school and media-based tobacco use prevention and cessation project in Southern California.
                The study provided an experimental comparison of classroom delivery with television delivery and the combination of the two in a 2 x 2 plus 1 design. Schools were randomly assigned to conditions. Control groups included "treatment as usual" and an "attention control" with the same outcome expectancies as the treatment conditions. Students were surveyed twice in grade 7 and once in each of grades 8 and 9. The interventions occurred during grade 7.
                We observed significant effects on mediating variables such as knowledge and prevalence estimates, and coping effort. The knowledge and prevalence estimates effects decayed partially but remained significant up to a 2-year follow-up. The coping effort effect did not persist at follow-ups. There were significant main effects of both classroom training and TV programming on knowledge and prevalence estimates and significant interactions of classroom and TV programming on knowledge (negative), disapproval of parental smoking, and coping effort. There were no consistent program effects on refusal/self-efficacy, smoking intentions, or behavior.
                Previous reports demonstrated successful development and pilot testing of program components and measures and high acceptance of the program by students and parents. The lack of behavioral effects may have been the result of imperfect program implementation or low base rates of intentions and behavior. A six-year, school-based prevention program, which modified classroom teacher practices, offered parent training, and provided child social skills training, was evaluated for its effects on school failure, drug abuse, and delinquency among low-income urban children. Compared to a low-income control group, children in the intervention group showed enhanced school commitment and class participation. The girls in the group also evidenced lower rates of substance use initiation, while the boys exhibited increased social and school work skills. Reported are results of an independent effectiveness study of the Project ALERT drug prevention program implemented in eight Pennsylvania middle schools by outside program leaders employed by Cooperative Extension. In this randomized, 2-cohort longitudinal evaluation, 1,649 seventh-grade students completed a pretest and four waves of posttests over the 2-year program and 1-year follow-up. Project ALERT's effectiveness was tested through a 3-level hierarchical linear model. Analyses failed to yield any positive effects for substance use or mediators for use in the adult or teen-assisted delivery of the curriculum. An extensive set of additional analyses detected no differential program effects by student risk level, gender, school, or level of implementation quality. Potential explanations for outcomes relative to Project ALERT's original effectiveness trial are discussed, as well as implications for future research, including the need to conduct independent effectiveness studies of previously validated programs in a variety of contexts. A one year randomized controlled trial was used to evaluate the effectiveness of a smoking prevention programme designed by health educationalists for 10-12 year old primary schoolchildren. The study was carried out in the Hunter Region of New South Wales, Australia, using a sample of over 6000 children which would be large enough to detect, with high probability, differences of about 5% in smoking prevalence between the treatment and control groups. We report the results from the children surveyed in 1979 and 1980, before and after the programme was implemented. It was found that there were no significant differences in smoking behaviour between treatment and control groups. The changes that the programme did bring about were very small compared with the overall increases in smoking prevalence which occurred during the study period. The programme's effectiveness varied with both the age and sex of the children. It was most successful among older girls, aged 11-12 years, for whom smoking prevalence rates increased from 10.7% in 1979 to 22.6% in 1980 in the treatment group compared with 6.2% to 26.8% in the control group. It was least successful for younger boys, aged 10-11 years, for whom smoking increased from 9.4% to 14.5% in the treatment group compared with 10.3% to 11.8% in the control group. Attitudes changed in parallel with changes in smoking behaviour. Changes in knowledge differed only slightly between treatment and control groups. Inadequate implementation of the programme by some teachers may have been associated with adverse effects on the children's behaviour, attitudes and knowledge. How effective are peer-led programmes in preventing the uptake of smoking by children? In 1981, we conducted a randomized controlled trial of a school-based educational programme for the prevention of smoking in children who were in their seventh year at school. In this article, the reported results of two years of follow-up confirm an earlier report that both teacher-led and peer-led programmes resulted in a reduction, to about the same degree, in the uptake of smoking by girls, while only the teacher-led programme appeared to be effective in boys. In girls, both the teacher-led and peer-led programmes maintained their effects over the two years of follow-up with adjusted differences in prevalence rates of the uptake of smoking relative to the control group of -6.6% (95% CL, -17.3%, 4.0%) and -8.1% (95% CL, -18.9%, 2.7%), respectively, after two years. In boys, the effect of the teacher-led programme was reduced substantially by the second year with a difference in the prevalence rate of -2.8% (95% CL, -11.2%, 5.6%); for the peer-led programme the difference in the prevalence rate was +6.4% (95% CL, -3.6%, 16.4%). Other variables which had a significant effect on the smoking behaviour were the perceived response to cigarette advertising, parental and sibling smoking status, the perceived parental sanctions on smoking behaviour, selected peer influences and the intention to smoke. The children's perceived responses to cigarette advertising showed the strongest and most consistent evidence of an effect on the uptake of smoking by children who initially were non-smokers. After adjustment for the effects of other variables there was an excess of 15.0% (95% CL, 2.1%, 27.9%) in the prevalence rate of smoking after two years for girls who thought that they were influenced by advertising compared with those who did not. The corresponding difference for boys was 15.3% (95% CL, 4.0%, 26.6%). As smoking-prevention programmes only may delay the onset of smoking in children, it is important that legislative measures be introduced to reduce the effects of cigarette advertising. 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. The prevention of initiation of tobacco, alcohol and drug use is a major societal challenge, for which the existing research literature is generally disappointing. This study aimed to test the effectiveness of adaptation of Motivational Interviewing (MI) for universal prevention purposes, i.e. to prevent initiation of new substance use among non-users, and to reduce risks among existing users.
                Cluster randomised trial with 416 students aged 16-19 years old recruited in 12 London Further Education colleges without regard to substance use status. Individualised MI was compared with standard practice classroom-delivered Drug Awareness intervention, both delivered over the course of one lesson. Prevalence, initiation and cessation rates for the 3 target behaviours of cigarette smoking, alcohol consumption and cannabis use, along with reductions in use and harm indicators after both 3 and 12 months were assessed.
                This adaptation of MI was not demonstrated to be effective in either intention-to-treat or sub-group analyses for any outcome. Unexpected lower levels of cannabis initiation and prevalence were found in the Drug Awareness control condition.
                This particular adaptation of MI is ineffective as a universal drug prevention intervention and does not merit further study.
                Copyright © 2010 Elsevier Ireland Ltd. All rights reserved. Most drug abuse prevention research has been conducted with predominantly White middle-class adolescent populations. The present study tested a school-based drug abuse preventive intervention in a sample of predominantly minority students (N = 3,621) in 29 New York City schools. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills in an effort to provide students with skills and information for resisting drug offers, to decrease motivations to use drugs, and decrease vulnerability to drug use social influences. Results indicated that those who received the program (n = 2,144) reported less smoking, drinking, drunkenness, inhalant use, and polydrug use relative to controls (n = 1,477). The program also had a direct positive effect on several cognitive, attitudinal, and personality variables believed to play a role in adolescent substance use. Mediational analyses showed that prevention effects on some drug use outcomes were mediated in part by risk-taking, behavioral intentions, and peer normative expectations regarding drug use. The findings from this study show that a drug abuse prevention program originally designed for White middle-class adolescent populations is effective in a sample of minority, economically disadvantaged, inner-city adolescents. To test the efficacy of implementation intentions in reducing smoking uptake in a sample of adolescents.
                Classes of adolescents (aged 11-12 years) were randomly allocated to one of four conditions: implementation intention, self-efficacy, two control conditions. An implementation intention or a self-efficacy manipulation (both formed in relation to how to refuse offers of cigarettes) was completed by intervention condition participants at 0, 4, 8, 12, 16, 20, and 24 months.
                Long-term smoking behavior (self-report and objective) was assessed at 48 months post-baseline.
                There were no differences between the two control conditions and the self-efficacy condition. Controlling for baseline smoking, sex, attitudes to smoking, friends and family smoking, and the multilevel nature of the data, intention-to-treat analyses indicated the implementation intention manipulation significantly reduced self-reported smoking compared to the other three conditions combined. Analyses on objectively assessed smoking (carbon monoxide breath measure) in a random subsample of participants also indicated that the implementation intention manipulation compared to the other three conditions significantly reduced smoking.
                Implementation intentions can reduce smoking in adolescent samples. Implications for using implementation intentions to reduce smoking in adolescents are discussed.
                (PsycINFO Database Record (c) 2010 APA, all rights reserved). In this article, we examine the impact of two universal, grade 1 preventive interventions on the onset of tobacco smoking as assessed in early adolescence. The classroom-centered (CC) intervention was designed to reduce the risk for tobacco smoking by enhancing teachers' behavior management skills in first grade and, thereby, reducing child attention problems and aggressive and shy behavior-known risk behaviors for later substance use. The family-school partnership (FSP) intervention targeted these early risk behaviors via improvements in parent-teacher communication and parents' child behavior management strategies. A cohort of 678 urban, predominately African-American, public school students were randomly assigned to one of three Grade 1 classrooms at entrance to primary school (age 6). One classroom featured the CC intervention, a second the FSP intervention, and the third served as a control classroom. Six years later, 81% of the students completed audio computer-assisted self-interviews. Relative to controls, a modest attenuation in the risk of smoking initiation was found for students who had been assigned to either the CC or FSP intervention classrooms (26% versus 33%) (adjusted relative risk for CC/control contrast=0.57, 95% confidence interval (CI), 0.34-0.96; adjusted relative risk for FSP/control contrast=0.69, 95% CI, 0.50-0.97). Results lend support to targeting the early antecedent risk behaviors for tobacco smoking. To assess the effectiveness of two school based smoking education projects in delaying onset of smoking behaviour and in improving health knowledge, beliefs, and values.
                Cluster randomised controlled trial of two projects taught under normal classroom conditions. Schools were allocated to one of four groups to receive the family smoking education project (FSE); the smoking and me project (SAM); both projects in sequence (FSE/SAM); or no intervention at all.
                39 schools in Wales and England matched for size and catchment profile.
                All first year pupils in the schools were included and were assessed on three occasions (4538 before teaching (1988), 3930 immediately after teaching (1989), 3786 at one year follow up (1990)).
                Self reported smoking behaviour (backed by saliva sample) and change in relevant health knowledge, beliefs, and values.
                No consistent significant differences in smoking behaviour, health knowledge, beliefs, or values were found between the four groups. For never smokers at baseline the rate of remaining never smokers in 1990 was 74% (594/804) in the control group, 65% (455/704) in the FSE group, 70% (440/625) in the SAM group, and 69% (549/791) in the FSE/SAM group (chi 2adj = 6.1, df = 3, p = 0.1). Knowledge about effects of smoking rose in all groups from a mean score of 5.4 in 1988 to 6.4 in 1989 and 6.5 in 1990.
                More comprehensive interventions than school health education alone will be needed to reduce teenage smoking. Other measures including further restrictions on access to cigarettes and on the promotion of tobacco products need to be considered. Further research will be needed to develop effective school based health education projects, which should be formally field tested under normal conditions before widespread dissemination. To evaluate the effect of the middle and junior high school Drug Abuse Resistance Education (D.A.R.E.) and D.A.R.E. Plus programs on drug use and violence.
                Randomized controlled trial of 24 schools, with 3 conditions: D.A.R.E. only, D.A.R.E. Plus, and delayed program control.
                Schools and neighborhoods, primarily in Minneapolis-St Paul.
                All seventh-grade students in 24 schools in the academic year 1999-2000 (N = 6237 at baseline, 67.3% were white, and there was 84.0% retention at final follow-up).
                The middle and junior high school D.A.R.E. curriculum in the 16 schools that received D.A.R.E. only and D.A.R.E. Plus. In the 8 schoolts that received D.A.R.E. Plus, additional components included a peer-led parental involvement classroom program called "On the VERGE," youth-led extracurricular activities, community adult action teams, and postcard mailings to parents. The interventions were implemented during 2 school years, when the cohort was in the seventh and eighth grades.
                Self-reported tobacco, alcohol, and marijuana use; multidrug use; violence; and victimization, assessed at the beginning and end of seventh grade and at the end of eighth grade. Growth curve analytic methods were used to assess changes over time by condition.
                There were no significant differences between D.A.R.E. only and the controls; significant differences among boys between D.A.R.E. Plus and controls for tobacco, alcohol, and multidrug use and victimization; significant differences among boys between D.A.R.E. Plus and D.A.R.E. only in tobacco use and violence; and no significant behavioral differences among girls.
                D.A.R.E. Plus significantly enhanced the effectiveness of the D.A.R.E. curriculum among boys and was more effective than the delayed program controls, underscoring the potential for multiyear, multicomponent prevention programs and demonstrating sex differences in response to intervention programs. This paper describes the one-year outcomes of the fourth experimental trial of Project Towards No Drug Abuse. Two theoretical content components of the program were examined to increase our understanding of the relative contribution of each to the effectiveness of the program.
                High schools in Southern California (n=18) were randomly assigned to one of three conditions: cognitive perception information curriculum, cognitive perception information+behavioral skills curriculum, or standard care (control). The curricula were delivered to high school students (n=2734) by project health educators and regular classroom teachers. Program effectiveness was assessed with both dichotomous and continuous measures of 30-day substance use at baseline and one-year follow-up.
                Across all program schools, the two different curricula failed to significantly reduce dichotomous measures of substance use (cigarette, alcohol, marijuana, and hard drugs) at one-year follow-up. Both curricula exerted an effect only on the continuous measure of hard drug use, indicating a 42% (p=0.02) reduction in the number of times hard drugs were used in the last 30 days in the program groups relative to the control.
                The lack of main effects of the program on dichotomous outcomes was contrary to previous studies. An effect on an ordinal count measure of hard drug use among both intervention conditions replicates previous work and suggests that this program effect may have been due to changes in cognitive misperception of drug use rather than behavioral skill. We describe the results of a randomized controlled study on the efficacy of a smoking prevention program based on behavioral methods (Waterloo Smoking Prevention Program 1, adapted). 792 children of 12-13 years of age from the Health District of Rozzano (MI) were the study base. The program was delivered directly by voluntary teachers during school classes. Two follow-up, at 18 and 36 month from the end of the program were conducted using self-administered questionnaire and telephonic interviews. At 36 months the proportion of non-smokers was higher in the intervention group (55% vs 44%; OR (adjusted for clustering) = 1.7; p = .03) and that of regular (at least one cigarette a week) smokers lower (22% vs 39%) than in the control group. We found no difference of effect between males and females students. Social pressure associated with starting to smoke (friends, sibsters, parents smokers) measured before intervention had no demonstrable influence on efficacy. We propose this kind of intervention for Italian students as an effective and low-cost program, even though more research is needed to maintain effectiveness of these kind of programs beyond adolescence. To evaluate the effectiveness of a school-based smoking prevention and control intervention program among elementary school students.
                Through two phase cluster sampling, 566 pupils in grade 4 and grade 5 of two schools were assigned to intervention group and control group. One year comprehensive smoking intervention was conducted in the intervention group. The assessment was carried out through three questionnaires: pre- and post-intervention, 6-month after intervention.
                After one year intervention, pupils in the intervention group significantly improved their knowledge and attitudes related to tobacco use. The rate of attempting smoking decreased form 7.8% to 2.6% and the rate of passive smoking from 53.6% to 41.8%. The difference between the intervention and control groups was statistically significant. However, several index started to decline at 6-month follow up survey.
                The result demonstrated the effectiveness and feasibility of tobacco control in elementary school and the positive effect must be developed. Recent evaluations of smoking prevention programs have suggested considerable promise for curricula emphasizing resistance of social influences. The present study extends these evaluations by addressing key methodological limitations in previous work. Twenty-two matched schools were randomized to experimental and control conditions. Grade 6 students received a 6-week core curriculum, plus additional sessions through Grades 7 and 8. Questionnaires, and saliva samples to validate self-reported smoking behavior, were collected at five times over the 2-year study period. Cross-sectional and longitudinal analyses examined program impact for five levels of initial smoking experience, ranging from "never smoker" through regular, weekly smoker. Significant program effects were documented, most clearly for those having some experience with smoking before the program began and for those with smoking peer and family models. This study provides the methodologically most rigorous test to date of social influence programs for smoking prevention and documents for the first time significant effects for those at high risk for smoking. This article reports the results of a 5-year, longitudinal evaluation of the effectiveness of Drug Abuse Resistance Education (DARE), a school-based primary drug prevention curriculum designed for introduction during the last year of elementary education. DARE is the most widely disseminated school-based prevention curriculum in the United States.
                Twenty-three elementary schools were randomly assigned to receive DARE and 8 were designated comparison schools. Students in the DARE schools received 16 weeks of protocol-driven instruction and students in the comparison schools received a drug education unit as part of the health curriculum. All students were pretested during the 6th grade prior to delivery of the programs, posttested shortly after completion, and resurveyed each subsequent year through the 10th grade. Three-stage mixed effects regression models were used to analyze these data.
                No significant differences were observed between intervention and comparison schools with respect to cigarette, alcohol, or marijuana use during the 7th grade, approximately 1 year after completion of the program, or over the full 5-year measurement interval. Significant intervention effects in the hypothesized direction were observed during the 7th grade for measures of students' general and specific attitudes toward drugs, the capability to resist peer pressure, and estimated level of drug use by peers. Over the full measurement interval, however, average trajectories of change for these outcomes were similar in the intervention and comparison conditions.
                The findings of this 5-year prospective study are largely consonant with the results obtained from prior short-term evaluations of the DARE curriculum, which have reported limited effects of the program upon drug use, greater efficacy with respect to attitudes, social skills, and knowledge, but a general tendency for curriculum effects to decay over time. The results of this study underscore the need for more robust prevention programming targeted specifically at risk factors, the inclusion of booster sessions to sustain positive effects, and greater attention to interrelationships between developmental processes in adolescent substance use, individual level characteristics, and social context. This study investigated the effects of a smoking prevention program that emphasized refusal skills training on 1730 adolescents in three high schools and six middle schools. Classes within these schools were randomly assigned to treatment or no-treatment conditions to avoid confounding schools with treatment condition. The effects of attrition on the internal and external validity of the study were examined. Although the results indicated an apparent effect of the program at the 1-year follow-up in deterring continued smoking among those who were smoking at pretest, this result may have been due to a higher rate of attrition among high-rate smokers in the treatment condition than in the control condition. Attrition also affected external validity. Across both conditions, subjects who were smoking at pretest and who were at risk to smoke were more likely to be missing at follow-up. The program did have an effect on the refusal skills of participants and the validity of this effect was not jeopardized by differential attrition. To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students.
                Group randomised controlled trial.
                26 Dutch schools that provided junior secondary education.
                1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years.
                Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition.
                Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis.
                In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant.
                In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect. 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. Few studies have examined the long-term efficacy of computer-based smoking prevention and cessation programs. We analyzed the long-term impact of A Smoking Prevention Interactive Experience (ASPIRE), a theoretically sound computer-based smoking prevention and cessation curriculum for high school students. Sixteen predominantly minority, inner-city high schools were randomly assigned to receive the ASPIRE curriculum or standard care (receipt of the National Cancer Institute's Clearing the Air self-help booklet). A total of 1160 students, 1098 of whom were nonsmokers and 62 smokers at baseline, were included. At 18-month follow-up, among baseline nonsmokers, smoking initiation rates were significantly lower in the ASPIRE condition (1.9% vs. 5.8%, p < .05). Students receiving ASPIRE also demonstrated significantly higher decisional balance against smoking and decreased temptations to smoke. Differences between groups in self-efficacy and resistance skills were not significant. There was a nonsignificant trend toward improved smoking cessation with ASPIRE, but low recruitment of smokers precluded conclusions with respect to cessation. ASPIRE demonstrated the potential for an interactive multimedia program to promote smoking prevention. Further studies are required to determine ASPIRE's effects on cessation. This study evaluated the effects of a school-based intervention on growth trajectories of smoking, drinking, and antisocial behavior among early adolescents. Seven middle schools were randomized to intervention or comparison conditions and students in two successive cohorts (n = 1484) provided five waves of data from sixth to ninth grade. The Going Places Program, included classroom curricula, parent education, and school environment components. Latent growth curve analyses demonstrated significant treatment group effects, including reducing increases in friends who smoke, outcome expectations for smoking, and smoking progression, but had non-significant effects on drinking or antisocial behavior. The Going Places Program was effective in preventing increases in smoking progression, but its efficacy as a more cross-cutting problem behavior preventive intervention was not confirmed. nan No long-term impact has yet been observed with the use of the social-influences approach to school-based smoking prevention for youth. However, whether this lack of impact is due to methodologic problems with the studies or to the failure of the interventions is unclear. The Hutchinson Smoking Prevention Project (HSPP), conducted from September 1984 through August 1999, aimed to attain the most rigorous randomized trial possible to determine the long-term impact of a theory-based, social-influences, grade 3-12 intervention on smoking prevalence among youth.
                Forty Washington school districts were randomly assigned to the intervention or to the control condition. Study participants were children enrolled in two consecutive 3rd grades in the 40 districts (n = 8388); they were followed to 2 years after high school. The trial achieved high implementation fidelity and 94% follow-up. Data were analyzed with the use of group-permutation methods, and all statistical tests were two-sided.
                No significant difference in prevalence of daily smoking was found between students in the control and experimental districts, either at grade 12 (difference [Delta] = 0.2%, 95% confidence interval [CI] = -4.6% to 4.4%, and P =.91 for girls; Delta = 0.3%, 95% CI = -5.0% to 5.5%, and P =.89 for boys) or at 2 years after high school (Delta = -1.4%, 95% CI = -5.0% to 1.6%, and P =.38 for girls; Delta = 2.6%, 95% CI = -2.5% to 7.7%, and P =.30 for boys). Moreover, no intervention impact was observed for other smoking outcomes, such as extent of current smoking or cumulative amount smoked, or in subgroups that differ in a priori specified variables, such as family risk for smoking.
                The rigor of the HSPP trial suggests high credence for the intervention impact results. Consistent with previous trials, there is no evidence from this trial that a school-based social-influences approach is effective in the long-term deterrence of smoking among youth. Experimental evaluation of comprehensive community wide programme to prevent adolescent tobacco use.
                Eight pairs of small Oregon communities (population 1700 to 13 500) were randomly assigned to receive a school based prevention programme or the school based programme plus a community programme. Effects were assessed through five annual surveys (time 1-5) of seventh and ninth grade (ages 12-15 years) students.
                The community programme included: (a) media advocacy, (b) youth anti-tobacco activities, (c) family communications about tobacco use, and (d) reduction of youth access to tobacco.
                The prevalence of self reported smoking and smokeless tobacco use in the week before assessment.
                The community programme had significant effects on the prevalence of weekly cigarette use at times 2 and 5 and the effect approached significance at time 4. An effect on the slope of prevalence across time points was evident only when time 2 data points were eliminated from the analysis. The intervention affected the prevalence of smokeless tobacco among grade 9 boys at time 2. There were also significant effects on the slope of alcohol use among ninth graders and the quadratic slope of marijuana for all students.
                The results suggest that comprehensive community wide interventions can improve on the preventive effect of school based tobacco prevention programmes and that effective tobacco prevention may prevent other substance use. The purpose of the study was to determine whether a universal school-based substance abuse prevention program, Take Charge of Your Life (TCYL), prevents or reduces the use of tobacco, alcohol, or marijuana.
                Eighty-three school clusters (representing school districts) from six metropolitan areas were randomized to treatment (41) or control (42) conditions. Using active consenting procedures, 19,529 seventh graders were enrolled in the 5-year study. Self-administered surveys were completed by the students annually. Trained Drug Abuse Resistance Education (D.A.R.E.) police officers presented TCYL in seventh and ninth grades in treatment schools. Analyses were conducted with data from 17,320 students who completed a baseline survey. Intervention outcomes were measured using self-reported past-month and past-year use of tobacco, alcohol, and marijuana when students were in the 11th grade.
                Main effect analyses show a negative program effect for use of alcohol and cigarettes and no effect for marijuana use. Subgroup analyses indicated that the negative effect occurred among nonusers at baseline, and mostly among white students of both genders. A positive program effect was found for students who used marijuana at baseline. Two complementary papers explore the relationship of the targeted program mediators to the use of alcohol, tobacco, and marijuana and specifically for students who were substance-free or who used substances at baseline.
                The negative impact of the program on baseline nonusers of alcohol and tobacco indicate that TCYL should not be delivered as a universal prevention intervention. The finding of a beneficial effect for baseline marijuana users further supports this conclusion. The programmatic and methodological challenges faced by the Adolescent Substance Abuse Prevention Study (ASAPS) and lessons learned offer insights for prevention researchers who will be designing similar randomized field trials in the future. A grade five through eight substance abuse prevention program, later incorporated into the Michigan Model for Comprehensive School Health Education, was developed, implemented, and evaluated. Results focus on students who received seven lessons on alcohol in grade six, and eight lessons on tobacco, alcohol, marijuana, and cocaine in grade seven taught by their regular classroom teachers (after a 6-hour training in the social pressures resistance skills curriculum). Students (N = 442) received either two years of the program or none, and completed individually-coded questionnaires. Repeated measures analysis of variance resulted in significant treatment by occasion interactions on the use of alcohol, cigarettes, marijuana, cocaine, and other drugs, as well as on knowledge. At the end of grade seven, program students' rates of substance use had increased significantly less and knowledge of alcohol pressures, effects, and skills to resist had increased significantly more than those of comparison 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. 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. To test the effectiveness of a psychosocial strategy of smoking deterence on seventh grade students, the School Health Education Development project implemented peer-led, teacher-led, and expert-led interventions in six Vermont schools. Four additional schools served as control groups. The teacher-led approach reduced the rate of smoking onset and the intention to smoke in the future among highly vulnerable females but not among males. The peer-led approach reduced the behavioral intention to smoke for both sexes but did not affect current smoking behavior. The expert-led approach did not produce favorable effects. Both the peer-led and teacher-led interventions had positive, though not significant, effects on student perception of locus of control. In the control schools, females experienced higher levels of smoking onset than males. Generally, the study points toward further development of a teacher-led approach to smoking deterence based on the theory of adolescent psychosocial development and the principle of continuous reinforcement. A smoking prevention program was developed to prepare children in elementary school for secondary school. This study assessed the effects on smoking in secondary school.
                In 2002, 121 schools in The Netherlands were randomly assigned to the intervention or control group. The intervention group received 3 lessons in 5th grade of elementary school and a second 3 lessons in 6th grade. The control group received "usual care". Students completed 5 questionnaires: before and after the lessons in 5th and 6th grade and in the first class of secondary school. At baseline, 3173 students completed the questionnaire; 57% completed all questionnaires.
                The program had limited effect at the end of elementary school. One year later in secondary school significant effects on behavioral determinants and smoking were found. The intervention group had a higher intention not to smoke (β=0.13, 95% confidence interval=0.01-0.24) and started to smoke less often than the control group (odds ratio=0.59, 95% confidence interval=0.35-0.99): smoking increased from 2.5% to 3.6% in the intervention group and from 3.2% to 6.5% in the control group. Girls showed the largest differences in smoking between intervention and control condition.
                A prevention program in elementary school seems to be effective in preventing smoking.
                Copyright © 2010 Elsevier Inc. All rights reserved. Smoking rates are projected to increase substantially in developing countries such as South Africa.
                The aim of this study was to test the efficacy of two contrasting approaches to school-based smoking prevention in South African youth compared to the standard health education program. One experimental program was based on a skills training/peer resistance model and the other on a harm minimization model.
                Thirty-six public schools from two South African provinces, KwaZulu-Natal and the Western Cape, were stratified by socioeconomic status and randomized to one of three groups. Group 1 (comparison) schools (n = 12) received usual tobacco use education. Group 2 schools (n = 12) received a harm minimization curriculum in grades 8 and 9. Group 3 schools (n = 12) received a life skills training curriculum in grades 8 and 9. The primary outcome was past month use of cigarettes based on a self-reported questionnaire.
                Five thousand two hundred sixty-six students completed the baseline survey. Of these, 4,684 (89%) completed at least one follow-up assessment. The net change in 30-day smoking from baseline to 2-year follow-up in the control group was 6% compared to 3% in both harm minimization (HM) and life skills training (LST) schools. These differences were not statistically significant. Intervention response was significantly moderated by both gender and race. The HM intervention was more effective for males, whereas the life skills intervention was more effective for females. For black African students, the strongest effect was evident for the HM intervention, whereas the strongest intervention effect for "colored" students was evident for the LST group.
                The two experimental curricula both produced similar overall reductions in smoking prevalence that were not significantly different from each other or the control group. However, the impact differed by gender and race, suggesting a need to tailor tobacco and drug use prevention programs. More intensive intervention, in the classroom and beyond, may be needed to further impact smoking behavior. A six-year intervention study of the feasibility and effectiveness of a program aimed at the primary prevention of coronary heart disease (CHD) has been initiated among children in six school districts in Westchester County, New York. Schools randomly were assigned either to the intervention program or to a control group. The intervention program consists of a curriculum focusing on nutrition, physical fitness, and cigarette smoking prevention. The study population at baseline comprised 1,822 fourth-graders. This paper presents the findings at baseline and at one-year follow-up for the following target risk factors: systolic and diastolic blood pressure, plasma total and high-density lipoprotein (HDL) cholesterol, serum thiocyanate, ponderosity index, triceps skinfold thickness, and postexercise pulse recovery rate. After one year of intervention, the program was found to be acceptable to school administrators, teachers, parents, and children. Small net changes in the favorable direction were observed for diastolic blood pressure and thiocyanate. Intervention programs in schools may, after sufficient duration, prove to be effective in lowering CHD risk. To examine the effectiveness of a drug abuse prevention program in reducing the initiation and escalation of smoking in a sample of predominantly minority junior high school girls.
                The 15-session prevention program teaches social resistance skills within the context of a broader intervention designed to promote general personal and social competence skills, and is implemented in the seventh grade. Smoking rates in girls from 29 New York City public schools who received the program (n = 1,278) were compared to smoking rates in a control group of girls (n = 931) who did not.
                Those who participated in the program were less likely to initiate smoking relative to controls, due in part to significant program effects on smoking intentions, smoking knowledge, perceived peer and adult smoking norms, drug refusal skills, and risk taking. Experimental smokers in the intervention group were less likely to escalate to monthly smoking relative to controls, due in part to significant program effects on smoking intentions.
                A school-based drug abuse prevention approach previously found to be effective among white youth significantly reduced smoking initiation and escalation among urban minority girls. 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. The 1985 Minnesota Legislature established guidelines for school-based tobacco-use prevention programming and provided financial incentives to school districts to encourage them to adopt a broad range of preventive measures. The Minnesota-Wisconsin Adolescent Tobacco-Use Research Project was funded by the National Cancer Institute in 1986 to evaluate the Minnesota initiative through two parallel studies.
                The Four Group Comparison Study was a prospective study of 48 school "units" which were randomly assigned to one of four conditions in 1987. Baseline observations were taken in the sixth grade in 1987, interventions were delivered in the seventh grade, and follow-up observations were taken in the seventh, eighth, and ninth grades. The Four Group Comparison Study was designed to evaluate the three middle-school interventions that were most widely adopted by Minnesota school districts as a result of the 1985 legislation. The Two State Comparison Study was a serial cross-sectional study of representative districts in Minnesota and Wisconsin. Annual surveys of ninth graders were conducted from 1986-1990. The Two State Comparison Study was designed to determine whether tobacco-use patterns changed in Minnesota relative to Wisconsin following the Minnesota legislation.
                The prospective study indicated that none of the interventions was more effective in reducing adolescent tobacco use compared with a randomized control group. The serial cross-sectional study revealed that there was a modest net decline in Minnesota relative to Wisconsin from 1986 to 1990, but that it was within the range of chance variation.
                Taken together, these results indicate that this legislative initiative was insufficient to reduce adolescent tobacco use statewide during the 5-year study period. Together with results from other recent studies, they suggest that even more intensive efforts may be required to effect widespread reductions in adolescent tobacco use. In a recent randomized field trial, Ellickson et al. found the Project ALERT drug prevention curriculum curbed alcohol misuse and tobacco and marijuana use among eighth-grade adolescents. This article reports effects among ninth-grade at-risk adolescents. Comparisons between at-risk girls in ALERT Plus schools (basic curriculum extended to ninth grade with five booster lessons) and at-risk girls in control schools showed the program curbed weekly alcohol and marijuana use, at-risk drinking, alcohol use resulting in negative consequences, and attitudinal and perceptual factors conducive to drug use. Program-induced changes in perceived social influences, one's ability to resist those influences, and beliefs about the consequences of drug use mediated the ALERT Plus effects on drug use. No significant effects emerged for at-risk boys or at-risk adolescents in schools where the basic ALERT curriculum (covering seventh and eighth grades only) was delivered. Possible reasons for gender differences and implications for prevention programming are discussed. nan nan A smoking prevention project in six European countries (European Smoking prevention Framework Approach) was developed, featuring activities for adolescents, schools and parents, including out-of-school activities. Consensus meetings resulted in agreement between the countries on goals, objectives and theoretical methods. Countries' specific objectives were also included. National diversities required country-specific methods to realize the goals and objectives. The community intervention trial was used as the research design. Since interventions took place at the community level, communities or regions were allocated at random to the experimental or control conditions. Complete randomization was achieved in four countries. At baseline, smoking prevalence among 23 125 adolescents at the start of the project was 5.6% for regular smoking and 4.0% for daily smoking. Smoking prevalence rates were higher among girls than boys in all countries as far as weekly smoking was concerned. Process evaluations revealed that the project's ambitions were high, but were limited by various constraints including time and delays in receiving funds. Future smoking prevention projects should aim to identify the effective components within the social influence approach as well as within broader approaches and on reaching sustained effects. This paper presents the short-term and long-term results of a randomized smoking prevention trial. The purpose was to evaluate two smoking prevention programs, a social influence (SI) program and a SI program with an additional decision-making component (SI(DM)). Moreover, the contribution of boosters was assessed as well. Fifty-two schools were randomly assigned to the SI program, the SI(DM) program or a control group. Half of the treatment schools were randomly assigned to the booster condition; the other half did not receive boosters. Both programs consisted of five lessons, each lasting 45 min, and were given in weekly sessions in grades 8 and 9 of high schools in the Netherlands. The most successful program was the SI program with boosters which resulted in a significantly lower increase in smoking rates (5.6 and 9.7%, respectively) compared to the control group (12.6 and 14.9%, respectively) at both 12 and 18 months follow-up. The results suggest that boosters can be an effective tool for maintaining or increasing the effectiveness of smoking prevention programs. It is recommended that the SI program with the booster be implemented at the national level, since this intervention showed the greatest behavioral effects. This study examined whether interventions aimed at aggressive/disruptive classroom behavior and poor academic achievement would reduce the incidence of initiation of smoking.
                An epidemiologically based, universal randomized preventive trial involved 2311 children in 2 classroom-based preventive interventions or controls. Each intervention was directed at 1 of the aforementioned 2 antecedents over first and second grades in 19 urban schools.
                Smoking initiation was reduced in both cohorts for boys assigned to the behavioral intervention.
                Targeting early risk antecedents such as aggressive behavior appears to be an important smoking prevention strategy. The prevalence of adolescent smoking has been increasing rapidly in China. Theory-based smoking prevention programmes in schools may be an effective approach in preventing smoking among Chinese adolescents.
                A school-level cluster randomized controlled trial was conducted among 7th and 8th grade students (N = 2343) in four junior high schools in southern China during 2004-06. The theory-based, multi-level intervention was compared with the standard health curriculum. Outcome measures comprised changes in students' smoking-related knowledge, attitudes and behaviour.
                The mean knowledge scores from baseline to the 1- and 2-year follow-ups increased more in the intervention group than in the control group, whereas there was little change in attitude scores. At the 1-year follow-up (the total sample), the interventions reduced the probability of baseline experimental smokers' escalating to regular smoker [7.9 vs 18.3%; adjusted odds ratio (OR) 0.34, 95% confidence interval (CI) 0.12-0.97, P = 0.043], but did not reduce the probability of baseline non-smokers' initiating smoking (7.9 vs 10.6%; adjusted OR 0.86, 95% CI 0.54-1.38, P = 0.538). At the 2-year follow-up (only 7th grade students), similar proportions of baseline non-smokers initiated smoking in the intervention group and the control group (13.5 vs 13.1%), while a possibly lower proportion of baseline experimental smokers escalated to regular smoking in the intervention group than the control group (22.6 vs 40.0%; adjusted OR 0.43, 95% CI 0.12-1.57, P = 0.199).
                This multi-level intervention programme had a moderate effect on inhibiting the escalation from experimental to regular smoking among Chinese adolescents, but had little effect on the initiation of smoking. The programme improved adolescents' smoking-related knowledge, but did not change their attitudes towards smoking. To evaluate the effects of Project ALERT on adolescents' lifetime and 30-day use of cigarettes, alcohol, marijuana, and inhalants.
                Cluster randomized trial.
                Schools from 11 states were enrolled in 2 successive cohorts from 2004 to 2008.
                All public schools in the United States that included grades 6 through 8 and enrolled at least 100 students in sixth grade were recruited. Of the 40 schools that began the study, 34 (17 per condition) completed it. Data were analyzed from 5883 unique participants. Intervention Project ALERT, a manualized classroom-based substance use prevention curriculum for the middle grades, was taught to sixth and seventh graders.
                Students were surveyed before the onset of the intervention, as sixth graders, and after the completion of the 2-year intervention, as seventh graders. Outcome measures included lifetime and 30-day use of cigarettes, alcohol, marijuana, and inhalants.
                At baseline, students in the intervention condition were slightly to moderately more likely to report use for each of the 8 measures examined than were students in the control condition. For all measures except lifetime use of cigarettes, these differences were less pronounced at follow-up and therefore were in the direction of favorable program effects. These changes were statistically significant, however, for only 1 outcome measure, past 30-day use of alcohol (reduction in the adjusted odds ratio from 2.07 at baseline to 1.32 at follow-up; P = .006).
                Project ALERT was not effective when delivered to the sixth grade population we targeted. The aims of this trial, conducted 2004-2008, were to examine (1) the effectiveness of Project Towards No Drug Abuse (TND) at the one-year follow-up when implemented on a large scale; and (2) the relative effectiveness of two training approaches for program implementers.
                A total of 65 high schools from 14 school districts across the United States were randomized to one of three conditions: regular workshop training, comprehensive implementation support, or standard care control. Physical education and health teachers delivered the program to students (n=2538). Program effectiveness was assessed with dichotomous measures of 30-day substance use at baseline and one-year follow-up.
                When the program conditions were considered in aggregate and compared to controls, the program showed a marginally significant effect in lowering marijuana use from baseline to the one-year follow-up. Significant program effects on hard drug use were achieved for baseline non-users only. There were no differences in the effects of the two program conditions.
                Positive outcomes may be achieved by trained teachers when they implement Project TND in real-world high school environments; however, program effects are likely to be weaker than those achieved in efficacy trials. Training workshops may be adequate to build capacity for successful program implementation.
                Copyright © 2010 Elsevier Inc. All rights reserved. A quasi-experimental, longitudinal study was conducted to test the effectiveness over a 1-year period of a cardiovascular risk reduction program for school-age children. The effectiveness of the program was measured with the children's knowledge of physiology of the heart and cardiovascular risk factors, their health habits, and their physical measurements. Ninety-eight children between the ages of 9 and 12 years participated in the study. The experimental group received a series of five 40-minute sessions on physiology of the heart, smoking, hypertension, diet, and physical activity. Short-term effectiveness of the program was found for the children's knowledge of physiology of the heart and smoking. Long-term effectiveness was found for running activity. nan Between 1992 and 1994, an interventional program was held in the secondary schools ("Hauptschulen") in Düsseldorf contra cigarette smoking. The program was conducted in the following way. Half of the schools (intervention schools) were involved in this program which consisted of 15 sessions. The other schools served as control groups. During the first year of this program school-teachers and a physician taught students about the function and the abilities of the healthy heart and lung. The students developed adversions to smoking. In addition, the students learned by role-plays how to say no to a cigarette without embarrassment. These role-plays were videotaped. During the second year of this program the role-plays were repeated and teaching about the heart and the lungs was augmented. Also, every student got the opportunity to meet and talk with a famous athlete. Furthermore, smoking-cessation programs were hold in four intervention schools. The program started in the sixth grade with a questionnaire administered to 878 schoolchildren. During this time the average age of the children was 13 years. Because of a large fluctuation, the questioning could be repeated with only 630 of these children (71.8%) after 2 years. At the end of the study the number of smokers had increased two times greater in the control schools than in the intervention schools (boys: 20.5% points vs 9.4% points; girls: 44.3% points vs 21.0% points). Obviously, the continuation of the program during the second year was important in making the program successful. Among the participants of the intervention program there was a trend to stop smoking. But the program was not able to prevent non-smokers from starting the habit. On the other hand, of the children who started smoking during the program, more girls in the intervention schools quit smoking than in the control schools. At the end of the program more girls than boys (mean age 15 years) smoked. Almost one-fourth of the boys, and from the control schools one-third of the girls were already daily smokers. The smokers obtained cigarettes from kiosks, from friends, vending machines, vendors or shops, but seldom from their homes. This study tested the hypothesis that cigarette smoking adoption among adolescents could be suppressed by providing school-based videotape instruction for resisting social influences to smoke. The utilization of same-age peer leaders was also varied to test whether their participation in the classroom would enhance program effects. Seventh grade students (N = 540) from one junior high school in Southern California were randomly assigned by classrooms (N = 15) to: (a) videotape instruction, (b) videotape instruction plus peer leader involvement, or (c) survey-only. Seventh grade students (N = 234) in a second junior high school served as a measurement-only control. Assessments were conducted at the beginning and end of the academic year. Results revealed a marked suppression in the onset of both experimental and regular smoking among those students exposed to the pressure resistance training with peer leader involvement. Pressure resistance training without peer leader involvement produced a more variable and less powerful effect on students' smoking behavior. Data collected on students' use of alcohol and marijuana revealed a generalized suppression effect, albeit weaker than for tobacco, among those students exposed to the social resistance training with peer leader involvement. Results provide further encouraging support for the use of peer-led pressure resistance training in preventing adolescent drug use. Two strategies for preventing the onset of alcohol abuse, and marijuana and cigarette use were tested in junior high schools in Los Angeles and Orange Counties, California. The first strategy taught skills to refuse substance use offers. The second strategy corrected erroneous normative perceptions about prevalence and acceptability of use among peers and established conservative groups norms regarding use.
                Four experimental conditions were created by randomly assigning schools to receive (a) neither of the experimental curricula (placebo comparison), (b) resistance skill training alone, (c) normative education alone, or (d) both resistance skill training and normative education. Students were pretested prior to the program and post-tested 1 year following delivery of the program.
                There were main effects of normative education for summary measures of alcohol (P = 0.0011), marijuana (P = 0.0096), and cigarette smoking (P = 0.0311). All individual dichotomous measures of alcohol, marijuana, and tobacco use indicated significant reductions in onset attributable to normative education. There were no significant main effects of resistance skill training.
                These results suggest that establishing conservative norms is an effective strategy for preventing substance use. This paper reports on the evaluation of a culturally grounded prevention intervention targeting substance use among urban middle-school students. The curriculum consists of 10 lessons promoting antidrug norms and teaching resistance and other social skills, reinforced by booster activities and a media campaign. Three versions were delivered: Mexican American, combined African American and European American, and Multicultural. Thirty-five middle schools were randomly assigned to 1 of the 3 versions or the control. Students completed baseline and follow-up questionnaires over a 2-year period (total 6,035 respondents). Analyses utilizing a generalized estimating equations approach assessed the overall effectiveness of cultural grounding and the cultural matching hypothesis. Support was found for the intervention's overall effectiveness, with statistically significant effects on gateway drug use as well as norms, attitudes, and resistance strategies but with little support for the cultural matching hypothesis. Specific contrasts found the Mexican American and Multicultural versions impacted the most outcomes. The goal of this study was to assess the effects of a school-based smoking prevention programme that used both a video and peer-led discussion groups among Romanian junior high school students aged 13-14 years. The programme embraced the social influence approach and concentrated on enhancing self-efficacy and the acquisition of cigarette refusal skills. Twenty schools were randomly assigned to the control and experimental conditions, resulting in 55 participating classes from the seventh grade (28 in the control group and 27 in the experimental group). Pretest and 9 months follow-up data on weekly smoking initiation and psychosocial variables were collected from 1071 students. Multilevel logistic regression analyses demonstrated a significant effect of the programme on adolescents' smoking behaviour after 9 months. At post-test, weekly smoking onset was 4.5% in the experimental group versus 9.5% in the control group. Furthermore, the programme had significant effects on smoking-related beliefs. In the experimental group, this resulted in a more negative attitude towards smoking, increased social self-efficacy levels and a more negative intention towards smoking. These findings show that short-term effects of the smoking prevention programme can be realized in Romania. More studies are needed to analyse how to maintain these effects over time. This study assessed the immediate and short-term outcomes of adapting a culturally-grounded middle school program, keepin' it REAL, for elementary school students. After curriculum adaptation, 10 schools were randomly assigned to the intervention in 5th grade with follow-up boosters in 6th grade; 13 schools were randomly assigned to the control condition, implementing the school's pre-existing substance use prevention programming. Students (n=1566) completed a questionnaire prior to curriculum implementation and follow-up questionnaires toward the end of 5th and 6th grade. The 5th grade kiR curriculum generally appeared no more effective than the control schools' programming in changing students' resistance or decision-making skills; substance use intentions, expectancies, or normative beliefs; or lifetime and recent substance use. Such findings have implications for the age appropriateness of school-based programs. Thirty-four schools (n=7426 consented sixth graders, 71% of the eligible population) were randomized to conditions to test the hypothesis that Skills for Adolescence (SFA), a widely used comprehensive life skills training curriculum with a dedicated drug education unit, is more effective than standard care in deterring and delaying substance use through middle school. Two-year posttest (1-year post-intervention) data were collected from 5691 eighth graders (77% of those who completed the sixth-grade survey and 87% of those who completed the seventh-grade survey). Lifetime and recent (last 30 days) use of five substances or combinations of substances was compared using mixed-model regression to control for school clustering. There were two significant treatment main effects at the end of the eighth grade: lifetime (P=.05) and recent (P<.03) marijuana use were lower in SFA than control schools with pretest usage and salient demographic and psychosocial variables controlled. There was also one significant Treatment x Pretest Usage interaction around binge drinking. Baseline binge drinkers in SFA schools were less likely to report recent binge drinking than students in control schools (P<.01); there were no treatment differences among baseline nonbinge drinkers. Analyses of potential mediators of SFA treatment effects on eighth-grade binge drinking and marijuana use suggested that SFA increased self-efficacy around drug refusal skills, but did not affect behavioral intentions, perceptions of harm, or perceived peer norms. These 2-year (1-year post-intervention) outcomes offer some additional support for SFA effectiveness and the general thrust of school-based, life skills-based prevention programs. The promising sixth- through eighth-grade findings for SFA, a commercially available program, provide a further step in bridging a major gap in the "research to practice" literature: theory-based interventions that have documented behavioral effects have not enjoyed large-scale implementation, while intuition-based programs that have no documented effects still enjoy wide exposure. The effectiveness of a fifteen session psychosocial smoking prevention strategy was tested on 902 seventh graders from seven junior high schools in suburban New York over 2 years. The prevention program was implemented by regular classroom teachers and consisted of a cognitive component dealing with the immediate consequences of cigarette smoking, a decision-making component, a relaxation-training component, a social skills training component, and a self-improvement component. In addition to testing the overall effectiveness of this approach, the relative efficacy of two different scheduling formats was compared and the extent to which "booster" sessions conducted during the year after completion of the program helped to maintain reductions in new smoking was also examined. Results indicated that the prevention program was able to reduce new cigarette smoking by 50% at the end of the first year and by 55% at the end of the second year for the intensive format condition. New regular cigarette smoking was reduced by 87% in the second year for the students in the booster condition. Significant changes consistent with nonsmoking were also evident on several cognitive, attitudinal, and personality variables. This study examined the plausibility of the gateway hypothesis to account for drug involvement in a sample of middle school students participating in a drug abuse, prevention trial. Analyses focused on a single prevention approach to exemplify intervention effects on drug progression. Improvements to social competence reduced multiple drug use at 1- and 2-year follow-ups. Specific program effects disrupted drug progression by decreasing alcohol and cigarette use over 1 year and reducing cigarette use over a 2-year period. Controlling for previous drug use, alcohol was integrally involved in the progression to multiple drug use. Subgroup analyses based on distinctions of pretest use/nonuse of alcohol and cigarettes provided partial support for the gateway hypothesis. However, evidence also supported alternate pathways including cigarette use as a starting point for later alcohol and multiple drug use. Findings underscore the utility of targeting more than one gateway substance to prevent escalation of drug involvement and reinforce the importance of social competence enhancement as an effective deterrent to early-stage drug use. Students (N = 4,466) attending 56 schools in New York State were involved in a 3-year study testing the effectiveness of a cognitive-behavioral approach to substance abuse prevention. In a randomized block design, schools were assigned to receive (a) the prevention program with formal provider training and implementation feedback, (b) the prevention program with videotaped provider training and no feedback, or (c) no treatment. After pretest equivalence and comparability of conditions with respect to attrition were established, students who received at least 60% of the prevention program (N = 3,684) were included in analyses of program effectiveness. Significant prevention effects were found for cigarette smoking, marijuana use, and immoderate alcohol use. Prevention effects were also found for normative expectations and knowledge concerning substance use, interpersonal skills, and communication skills. Tobacco, alcohol, and drug use are problems for American-Indian people. We reviewed these problems and the explanations for them and described a bicultural competence skills approach for preventing substance abuse with American-Indian adolescents. Data from a study of that approach suggest its efficacy with American-Indian youth. At posttest and a 6-month follow-up, American-Indian subjects who received preventive intervention based on bicultural competence skills concepts improved more than did American-Indian subjects in a no-intervention control condition on measures of substance-use knowledge, attitudes, and interactive skills, and on self-reported rates of tobacco, alcohol, and drug use. Our findings have implications for future substance-abuse prevention research with American-Indian people. Schools in many countries undertake programmes for smoking prevention, but systematic reviews have shown mixed evidence of their effectiveness. Most peer-led approaches have been classroom-based, and rigorous assessments are scarce. We assessed the effectiveness of a peer-led intervention that aimed to prevent smoking uptake in secondary schools.
                We undertook a cluster randomised controlled trial of 10 730 students aged 12-13 years in 59 schools in England and Wales. 29 schools (5372 students) were randomly assigned by stratified block randomisation to the control group to continue their usual smoking education and 30 (5358 students) to the intervention group. The intervention (ASSIST [A Stop Smoking In Schools Trial] programme) consisted of training influential students to act as peer supporters during informal interactions outside the classroom to encourage their peers not to smoke. Follow-up was immediately after the intervention and at 1 and 2 years. Primary outcomes were smoking in the past week in both the school year group and in a group at high risk of regular smoking uptake, which was identified at baseline as occasional, experimental, or ex-smokers. Analysis was by intention to treat. This study is registered, number ISRCTN55572965.
                The odds ratio of being a smoker in intervention compared with control schools was 0.75 (95% CI 0.55-1.01) immediately after the intervention (n=9349 students), 0.77 (0.59-0.99) at 1-year follow-up (n=9147), and 0.85 (0.72-1.01) at 2-year follow-up (n=8756). The corresponding odds ratios for the high-risk group were 0.79 (0.55-1.13 [n=3561]), 0.75 (0.56-0.99 [n=3483]), and 0.85 (0.70-1.02 [n=3294]), respectively. In a three-tier multilevel model with data from all three follow-ups, the odds of being a smoker in intervention compared with control schools was 0.78 (0.64-0.96).
                The results suggest that, if implemented on a population basis, the ASSIST intervention could lead to a reduction in adolescent smoking prevalence of public-health importance. To evaluate the effectiveness of the school-based drug abuse prevention program developed in the EU-Dap study (EUropean Drug Abuse Prevention trial) in preventing the use of tobacco, alcohol and drugs at the post-test.
                Cluster Randomised Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. A pre-test survey assessing past and current substance use was conducted before the implementation of the program. The program consisted in 12-hour class-based curriculum based on a comprehensive social-influence approach. A post-test survey was carried out in all participating schools, 3 months after the end of the program. The association between program condition and change in substance use at post-test was expressed as adjusted Prevalence Odds Ratio (POR), estimated by multilevel regression model.
                Program effects were found for daily cigarette smoking (POR=0.70; 0.52-0.94) and episodes of drunkenness in the past 30 days (POR=0.72; 0.58-0.90 for at least one episode, POR=0.69; 0.48-0.99 for three or more episodes), while effects on Cannabis use in the past 30 days were of marginal statistical significance (POR=0.77; 0.60-1.00). The curriculum was successful in preventing baseline non-smokers or sporadic smokers from moving onto daily smoking, but it was not effective in helping baseline daily smokers to reduce or stop smoking.
                School curricula based on a comprehensive social-influence model may delay progression to daily smoking and episodes of drunkenness. This study evaluates the effects of a school-based smoking prevention program after 1 year, using school (22 middle/elementary schools, 15 high schools) as both the unit of randomization and the unit of analysis. The multigrade level (grades 6 through 9) intervention was designed to address comprehensively the social influence factors that encourage smoking. Teacher survey data indicated that treatment schools had a median of 10 classroom sessions devoted to tobacco/drug use education, 5 of which were the sessions designed for this evaluation, and control schools had also dedicated a median of 10 classroom sessions to tobacco/drug education. Thus, the study evaluated the incremental effects of the social influence intervention compared to "standard-care" curricula. Among those who reported smoking one or more cigarettes in the month prior to the intervention, there was a significant treatment effect on rate of smoking at one year, but no grade level, gender, or interaction effects. The 1-year covariate-adjusted smoking rate among pretest smokers in the treatment schools was 76.6 cigarettes per month, compared to 111.6 cigarettes per month in control schools, a 31.4% difference. These effects were not accounted for by differential subject attrition. The analyses for nonsmokers, however, showed no significant effects, and the program did not affect self-reported alcohol or marijuana use. Taken together with the results of other prevention studies, these results point to the need for the development and evaluation of new initiatives to prevent substance use. 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.
                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.
                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).
                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. A school-based environmental program to reduce adolescent smoking was conducted in 20 schools (10 intervention; 10 control) in south central Louisiana. The 9th grade cohort (n = 4,763; mean age = 15.4 yrs; 51% female; 61% Caucasian; 30-day smoking prevalence at baseline = 25%) was followed over four years for 30-day smoking prevalence with the school as the unit of analysis. Although prevalence decreased in intervention schools and increased in control schools in Year 2 the significant difference between the two groups at baseline was not overcome by the intervention and increases in prevalence were observed in both groups in Years 3 and 4. The higher the percentage of white students in a school the higher the prevalence rates regardless of intervention/control status. Boys' and girls' smoking rates were similar. These outcome data, student feedback and process evaluation provide a basis for continuing to create more innovative adolescent tobacco control programs. In most countries the school has been the common setting for antismoking education. Programmes have usually been directed towards the younger age groups and they have met with various degrees of success. In general, such programmes have been shown to be less effective than one might expect, and much remains to be learned about the types of educational experiences that are effective in preventing adolescents from becoming habitual smokers. In Italy, the problem of educating young people about smoking is particularly pressing today. The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multistate field trial examining the effects of school environment, classroom curricula, and family intervention components in promoting the cardiovascular health of elementary school students. The purpose of this paper is to describe the CATCH tobacco use intervention and measurement, including the adoption of tobacco-free school policies.
                In this study, changes in school tobacco use policies and smoking experimentation among students were assessed. Smoking experimentation was measured in all CATCH schools when the students were in their fifth-grade year. A total of 6,527 subjects in 96 schools in California, Louisiana, Minnesota, and Texas answered questions about behaviors and potential correlates of smoking as part of the CATCH health behavior questionnaire in Spring 1994. School tobacco use policy, an important complement to classroom- and home-based prevention efforts, was promoted as part of the CATCH intervention. The degree to which such policy was implemented was measured using surveys of school officials.
                At the end of fifth grade, only 4.8% of the subjects indicated that they had experimented with tobacco. School intervention condition was not a factor in the prediction of experimentation. Those whose best friend or sibling smoked, or who had ready access to cigarettes in the home, were more likely to have experimented with smoking. In the 3 years of the study, the percentages of tobacco-free schools went up from 49.7 to 76.8%. Though differences in the rate of policy adoption could not be directly attributed to the CATCH intervention, the implementation of the tobacco-free schools' policies did vary substantially from state to state. Minnesota and Texas, with stronger state laws supporting local policy, had nearly completely smoke-free schools. In spite of a statewide tobacco control initiative, California was slower to implement school policies. Louisiana, which allows local decision making regarding smoking policy, had the most difficulty establishing a policy for all districts.
                Future studies should examine the impact of parallel policy interventions that are ongoing at both school and state levels. Tobacco-free policies appear to be a crucial part of school-based interventions and must be tailored to political and regional factors affecting a given school district. Project DARE (Drug Abuse Resistance Education) is the most prevalent school-based drug-use prevention program in the United States, but there is little evidence of its effectiveness. Results from a longitudinal evaluation of the program in 36 schools in Illinois provide only limited support for DARE's impact on student's drug use immediately following the intervention, and no support for either continued or emerging impact on drug use 1 or 2 years after receiving DARE instruction. In addition, DARE had only limited positive effects on psychological variables (i.e., self-esteem) and no effect on social variables (e.g., peer resistance skills). Possible substantive and methodological explanations for the relative lack of DARE's effectiveness observed in this study are discussed. Since 1974 an anti-smoking campaign consisting of a one-day educational intervention has been carried out in primary schools in Milan by the Italian League against Cancer (Milan Division). All but two of the 165 schools were randomized to evaluate the intervention effect. A total of 8549 children aged 9-10 were allocated to the intervention group and 8897 to the control group. Four years later a self-administered questionnaire was distributed in order to investigate the children's smoking habits. The proportion of smokers was 8.05% and 8.72% (p = 0.23) respectively for the intervention and control groups. It was concluded that sporadic educational intervention carried out during primary school years has little or no impact in preventing cigarette smoking in teenagers. Psychosocial tobacco use prevention programs are based on the assumption that refusal skills training will have a suppressive effect on the onset of use by enabling non-using adolescents to refuse offers of cigarettes and smokeless tobacco. The present study investigated this assumption with 389 high-risk junior high-school students involved in a prevention program during their seventh, eighth, and ninth-grade years. Direct behavioral measures of refusal skills were taken by having subjects respond to audiotaped offers of tobacco and then rating the quality of their responses. These ratings were then linked to tobacco use measures obtained at the end of each of the 3 study years. Results showed that the comprehensive prevention program produced a favorable trend in delaying or preventing the onset of tobacco use. However, the refusal skills training, which was carried out throughout the 3-year intervention period, produced significant differences in overall refusal skill quality only at the seventh grade. Moreover, refusal skill quality was not related to overall tobacco use or cigarette use at any grade. To examine whether a year long programme based on the transtheoretical model of behaviour change, incorporating three sessions using an expert system computer program and three class lessons, could reduce the prevalence of teenage smoking.
                Cluster randomised trial comparing the intervention to a control group exposed only to health education as part of the English national curriculum.
                52 schools in the West Midlands region. Participants: 8352 students in year 9 (age 13-14 years) at those schools.
                Prevalence of teenage smoking 12 months after the start of the intervention.
                Of the 8352 students recruited, 7444 (89.1%) were followed up at 12 months. The intention to treat odds ratio for smoking in the intervention group relative to control was 1.08 (95% confidence interval 0.89 to 1.33). Sensitivity analysis for loss to follow up and adjustment for potential confounders did not alter these findings.
                The smoking prevention and cessation intervention based on the transtheoretical model, as delivered in this trial, is ineffective in schoolchildren aged 13-14. nan Eighth, ninth and tenth graders (N = 281) from two schools in suburban New York participated in a study to test the efficacy of a 10-session comprehensive psychosocial smoking prevention program. Schools were randomly assigned to experimental and control conditions. All students were given a pretest, posttest and three-month follow-up which assessed smoking behavior as well as knowledge and personality variables. There were significantly fewer new "smokers" in the experimental school than in the control school at both the initial posttest (p less than .01) and the three-month followup (p less than .05) along with significantly greater changes on some of the knowledge and personality variables. Overall, these results support the use of a smoking prevention strategy that focuses on the main psychosocial factors promoting the onset of cigarette smoking by teaching students basic coping skills. To test whether a social network tailored substance abuse prevention program can reduce substance use among high-risk adolescents without creating deviancy training (iatrogenic effects).
                A classroom randomized controlled trial comparing control classes with those receiving an evidence-based substance use prevention program [Towards No Drug Abuse (TND)] and TND Network, a peer-led interactive version of TND. Students (n = 541, mean age 16.3 years) in 75 classes from 14 alternative high schools completed surveys before and approximately 1 year after curriculum delivery. Past-month use of tobacco, alcohol, marijuana and cocaine were assessed.
                Overall, TND Network was effective in reducing substance use. However, the program effect interacted with peer influence and was effective mainly for students who had peer networks that did not use substances. Students with classroom friends who use substances were more likely to increase their use.
                A peer-led interactive substance abuse prevention program can accelerate peer influences. For students with a peer environment that supports non-use, the program was effective and reduced substance use. For students with a peer environment that supports substance use, an interactive program may have deleterious effects. A pilot project for the prevention of substance abuse in schools (PASE) has been developed in 1988-90 in sixth and seventh grades (12-14 years-old) in 11 primary schools in the city of Barcelona (Spain). Data on consumption smoking, alcohol and drugs were obtained before the implementation of the project, shortly afterwards, and in the next school year. These results are presented, comparing the evolution of attitudes, beliefs and behavior of these school children with a control group composed of students from reference schools. The results suggest a modest but significant effect of the program, which seems to decrease over time for smoking, suggesting the need for booster interventions to maintain its effects. A five-year intervention study of the effectiveness of the "Know Your Body" program in reducing coronary heart disease risk factors among black students in the District of Columbia, who were in grades 4-6 at baseline, was begun in 1983. Nine schools were stratified on socioeconomic status and randomly assigned to control and intervention groups. The "Know Your Body" curriculum focuses on nutrition, fitness, and the prevention of cigarette smoking. At baseline, 1,234 students were eligible for the screening in which the following target risk factors were measured: systolic and diastolic blood pressures, ponderosity index, triceps skinfold thickness, postexercise pulse recovery rate, serum total and high density lipoprotein (HDL) cholesterol, and serum thiocyanate. After two years of intervention, results indicated that the program may have had a favorable impact on the following risk factors: systolic and diastolic pressures, HDL cholesterol, ratio of total to HDL cholesterol, fitness (postexercise pulse recovery rate), and smoking. Significant net changes in the favorable direction also were found for health knowledge and attitude toward smoking. Blood pressure reduction was associated with decreased ponderosity and improved fitness, and increased HDL cholesterol was associated with decreased ponderosity. These results are consistent with other evaluations of the "Know Your Body" program, suggesting that the program may be effective in reducing chronic disease risk in diverse school populations. Preventing tobacco use in youths may be an easier task than helping adults break the habit of smoking and overcome its ill effects. Using experimental procedures based on social work techniques, this study suggests that social work efforts are an effective tool in programs and services that focus on primary prevention. Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach.
                Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors.
                At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline.
                The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use. This study determined the effect of provider (nurse or teacher) and training method (workshop or self-preparation) on outcomes of a social influences smoking prevention program.
                One hundred elementary schools were stratified by school risk score (high risk = high smoking rate among senior students) and assigned randomly to conditions: (1) teacher/self-preparation, (2) teacher/workshop, (3) nurse/self-preparation, (4) nurse/workshop, and (5) control. Intervention occurred in grades 6 to 8. Smoking status at the end of grade 8 was the primary endpoint variable.
                Intervention reduced grade 8 smoking rates in high-risk schools (smoking rates of 26.9% in control vs 16.0% in intervention schools) but not in low-risk schools. There were no significant differences in outcome as a function of training method and no significant differences in outcome between teacher-provided and nurse-provided interventions in high- and medium-risk schools. Although nurses achieved better outcomes than did teachers in low-risk schools, neither provider type achieved outcomes superior to the control condition in those schools.
                Workshop training did not affect outcomes. Teachers and nurses were equally effective providers. Results suggest that programming should target high-risk schools. The main objective of this study was to determine if a program emphasizing training for coping with the social pressures to smoke cigarettes is effective in preventing initial experimentation in the same population. Six elementary schools in Tijuana, Mexico, were included in this prospective study with the participation of 168 sixth-graders. After a baseline survey students were randomly assigned to an intervention and a control group. A program that emphasizes peer-pressure resistance skills to avoid smoking was applied to the intervention group. The control group received no intervention. After 10 months a second survey was carried out in both groups. A significantly smaller proportion of subjects in the intervention group experimented with tobacco during the follow-up period when compared with controls (8.1% vs 20%; p < 0.05). Although designed as a prevention tool, the program also had a therapeutic effect. The proportion of subjects in the intervention group that quit smoking was significantly higher than that of the control group (72% vs 34.78%; p < 0.01). We conclude that this peer pressure resistance skill program was effective in preventing experimentation with tobacco among sixth graders in Tijuana, Mexico. This article describes a set of studies which compare the effectiveness of innovative interventions led by older peers and which included a parent component with teacher-led interventions for nutrition, blood pressure, and smoking prevention. Information about the agreement between parents' and children's (grades six through eight) perception of the children's health behavior and family interaction was also found, by surveying parents and children in 1051 households. Both teacher-led and older peer-led interventions were successful in increasing behavioral capabilities for nutrition and blood pressure, measured one year after the interventions. Results of the parent-child survey showed reasonable agreement between parents and children for reports of the child's exercise, dieting, and fast food consumption, but poorer agreement for smoking and perceptions of family interaction. Results are discussed in relation to the planning of future programs designed to address the importance of peer and parental role models. Achieving significant reductions in tobacco use by youth is an important challenge. There is a pressing need to develop and evaluate innovative strategies that stimulate youth involvement and are effective in multi-ethnic populations. This article describes an innovative tobacco prevention trial, and reports baseline characteristics of participants and findings about implementation of the curriculum.
                The aim of Project SPLASH is to evaluate the impact of a school-based smoking prevention intervention that emphasizes active involvement of middle school students, on rates of smoking initiation and regular smoking in a multi-ethnic cohort of youth in Hawaii. Project SPLASH is a group randomized trial that compares a 2-year innovative intervention with a social influence prevention program, in 20 public schools in Hawaii. The main outcome is mean 30-day smoking prevalence rates.
                The response rate was 78.4%. Approximately 1 in 4 students had tried smoking and 30-day smoking prevalence at baseline was 8%. Intervention and control groups were comparable in terms of tobacco use, gender, ethnicity, behavioral, environmental, and psychosocial characteristics. Differences in ethnic identification, socio-economic status, acculturation, and involvement in prevention activities may be due to chance. The intervention was well implemented by teachers across both the intervention and control school classes.
                For this study, 20 schools in Hawaii with close to 4000 participating students were recruited. Student smoking behavior and curriculum implementation were comparable by group status. The intervention study has the potential to elucidate how youth respond to an intervention with student involvement that incorporates cognitive and social action components. This study evaluated the efficacy of a version of Project EX that was adapted for implementation in the classroom context (Project EX-4). This paper reports the program outcomes based on pretest, six-month, and one-year follow-up surveys.
                An 8 session classroom-based curriculum was tested with a clustered randomized controlled trial that involved a total of 1097 students in 6 program and 6 control alternative high schools. Weekly and monthly smoking was assessed at the three time points. Outcome effects were analyzed with multi-level random coefficients models.
                Students in the program condition experienced a greater reduction in weekly smoking and monthly smoking, at 6-and-12-month follow-ups. The net change varied between -5.1% and -7.6%, comparing the program condition to the control condition.
                The implementation of Project EX in a classroom setting produced decreases in smoking among students in the program, relative to those in the standard care control condition. It is likely that a classroom-based smoking prevention/cessation program can lead to lower overall smoking prevalence than a cessation program that is implemented in a school-based smoking cessation clinic format. Project SUCCESS is a selective and indicated substance use prevention program that targets high risk students in secondary school settings. We evaluated the effects of Project SUCCESS on adolescents' substance use immediately following program implementation, and again one year later. Two successive cohorts of alternative high schools were randomly assigned to an intervention or control group, yielding seven schools per condition. Main outcomes included 30-day use of alcohol, marijuana, and illegal drugs excluding marijuana, and drinking to intoxication. We conducted exploratory analyses on 30-day cigarette use. Using Hierarchical Linear Modeling, we found that students in the control schools reported significantly less use of illegal drugs excluding marijuana than those in the intervention group at the first posttest; however, this effect did not persist one year later. There were no other outcome effects of even a marginal nature. While results of this study do not provide evidence of Project SUCCESS' effectiveness, students' program exposure was low. It is possible that Project SUCCESS would perform better in schools with higher and more regular rates of attendance.
                Copyright 2009 Elsevier Ltd. All rights reserved. We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities.
                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.
                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.
                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. This study examines the effectiveness of the school-based campaign "Smoke-Free Class Competition" as a means of preventing young non-smokers from taking up smoking.
                Based on two measurements of the Heidelberg Children's Panel Study (1998 and 2000), a longitudinal sample of 1704 pupils was examined: 948 in the intervention group and 756 in the control group. In order to evaluate the effects of the intervention, we compared the smoking behavior in the intervention and the control group at two points in time, shortly before, and 18 months after the intervention, on an individual case basis.
                (1) Stabilization of never-smoking rates: the proportion of pupils remaining a never-smoker at the follow-up is 62.1% in the intervention group and 61.5% in the control group (OR 1.02, 95% CI: 0.83-1.24); (2) Lowering of relapse rates among ex-smokers: the proportion of former smokers who had not started smoking again in the follow-up is 45.1% in the intervention group and 41.4% in the control group (OR 1.07, 95% CI: 0.77-1.49).
                The "Smoke-Free Class Competition" did not prevent smoking among adolescents and does not appear to be an effective substitute to the complete ban of tobacco advertising, the abolition of vending machines and the creation of smoke-free environments in German schools. Tobacco and drug use remain major public health concerns. The aim of this study was to evaluate the effectiveness of a school health intervention program using life skills training (LST) to reduce tobacco and drug use among Thai high school students. A randomized pretest and post-test comparative design was used to evaluate the effectiveness of the LST program. A total of 170 Thai students in grades 7-12 were randomly selected. The students in the control group received the tobacco and drug education curriculum normally provided; the intervention group received a LST program that provided information and skills specifically related to drug and tobacco use. Students in the school health intervention program had statistically significant positive effects regarding knowledge level, attitudes, and the development of refusal, decision-making, and problem-solving skills. The results showed that a LST program was effective for preventing tobacco and drug use in Thai high school students. Data from a 2-year study describe tobacco use trends, perceptions, and prevention effects for 1,281 5th and 6th graders enrolled in 12 randomly selected Washington State elementary schools. Youths were pretested, then randomly divided by school into skills, discussion, and control groups. Preventive intervention curriculums for the skills and discussion groups included age-relevant information on smoked and smokeless tobacco use, peer testimonials, debates, games, and homework. Youths in the skills group also learned communication and problem-solving methods for handling difficult situations around tobacco use. Following intervention, youths were posttested, then retested semiannually for 2 years. During the 2-year study, three-quarters of all smokers and nonusers and half of all smokeless tobacco users maintained their statuses. Only 10 percent of all smokers and 3 percent of all smokeless users quit their habits. One in six reported new tobacco use, one-third of smokers began using smokeless tobacco, and two-thirds of all smokeless users began smoking during the study. Most youths at final measurement perceived smokeless tobacco as less of a health risk than smoking. Nearly one in two of all smokeless users intended to smoke, and two-thirds were actually smoking at 24-month followup. Both smoked and smokeless tobacco use rates increased in all groups, and youths in the skills intervention group consistently showed the lowest rates relative to the other groups. These findings demonstrate the potential of skills intervention methods for lowering tobacco use rates among adolescents. This study examined the long-term substance use outcomes of 2 brief interventions designed for general population families of young adolescents. Thirty-three public schools were randomly assigned to 3 conditions: the 5-session Preparing for the Drug Free Years Program, the 7-session Iowa Strengthening Families Program, and a minimal contact control condition. The pretest involved 667 6th graders and their families. Assessments included multiple measures of initiation and current use of alcohol, tobacco, and marijuana. Pretest data were collected in the 6th grade and the reported follow-up data were collected in the 10th grade. Significant intervention-control differences in initiation and current use were found for both interventions. It is concluded that brief family skills-training interventions designed for general populations have the potential to reduce adolescent substance use and thus have important public health implications. Skills intervention to prevent cigarette smoking was evaluated with 689 adolescents. At 24-month follow-up, youths who received health information and skills intervention had lower intentions to smoke and less cigarette use than youths who received health information alone and youths who received no intervention. Conclusions about the effects of skills intervention are strengthened by the common preparation and random assignment of intervention leaders and by process measurement data. This study evaluated cigarette smoking prevention methods with a sample of adolescent females and males. Arranged by school, 331 informed and consenting sixth graders were randomly divided into four groups: 1) pretest, skills-building methods, posttest; 2) pretest, discussion methods, posttest; 3) pretest and posttest; and 4) posttest only. All subjects were followed for 6 and 15 months after the posttest. Outcome results on measures of non-smoking intentions, attitudes, predictions, problem-solving abilities, and peer interactions favored subjects in the skills-building group when compared with subjects in the discussion and pretest-posttest control groups. Smoking rates at posttest and at both follow-ups were lower in the skills-building group than in the other three groups. Results from posttest-only subjects did not support pretest reactivity. The study's strengths and limits are discussed along with directions for future smoking prevention research. To reduce tobacco use among adolescents.
                Thirty schools in New Delhi, India, were randomly assigned to 3 conditions: school-based and family-based intervention, school-based intervention only, or control group. Students were in the seventh grade at pretest (N = 4,776). The smoking intervention included posters, booklets, classroom activities, debates, and a signature campaign. The family intervention involved home activities. The survey measured tobacco knowledge, attitudes, offers, use, and intentions.
                Intervention students were significantly less likely than controls to have been offered, received, experimented with, or have intentions to use tobacco.
                The project had a significant impact on tobacco use. Two drug abuse prevention curricula were tested to determine their efficacy in preventing the onset of tobacco, alcohol, and marijuana use among adolescents. The first program focused on prevention through social pressure resistance training. The second featured affective education approaches to prevention. Curricula were tested on seventh grade students. Subjects were pretested just prior to the program and were post-tested at 12 and 24 months. Post-test analyses indicated that the social program delivered to seventh grade subjects was effective in delaying the onset of tobacco, alcohol, and marijuana use. No preventive effect of the affective education program was observed. By the final post-test, classrooms that had received the affective program had significantly more drug use than controls. This study developed and tested skills- and community-based approaches to prevent substance abuse among Native American youth. After completing pretest measurements, 1,396 third- through fifth-grade Native American students from 27 elementary schools in five states were divided randomly by school into two intervention arms and one control arm. Following intervention delivery, youths in all arms completed posttest measurements and three annual follow-up measurements. Youths in schools assigned to the intervention arms learned cognitive and behavioral skills for substance abuse prevention. One intervention arm additionally engaged local community residents in efforts to prevent substance use among Native American youth. Outcome assessment batteries measured youths' reported use of smoked and smokeless tobacco, alcohol, and marijuana. Over the course of the 3.5-year study, increased rates of tobacco, alcohol, and marijuana use were reported by youths across the three arms of the study. Though cigarette use was unaffected by intervention, follow up rates of smokeless tobacco, alcohol, and marijuana use were lower for youths who received skills intervention than for youths in the control arm. Community intervention components appeared to exert no added beneficial influence on youths' substance use, beyond the impact of skills intervention components alone. Finally, gender differences were apparent across substances, measurements, and study arms, with girls smoking more cigarettes and boys using more smokeless tobacco, alcohol, and marijuana. Much research has been done in developing and implementing smoking prevention programs; however, few studies have focused on urban Black populations. In November of 1989, a comprehensive prevention program was implemented to decrease the incidence of new smokers within the adolescent population in a Black community. The program combined a school-based curriculum with a comprehensive media intervention. All components of the program were financed by business leaders from the targeted community. There were two experimental conditions: one group participated in a school-based intervention and were prompted to participate in a multi-media intervention and the other group had access to the multi-media intervention; however, they were not prompted to participate. A key finding was that the rate of smoking decreased for all children involved in the intervention. The authors present a model that can be employed to prevent other high-risk behaviors within the Black population. The primary purpose of this study was to test the efficacy of a brief, multi-health behavior intervention integrating physical activity and alcohol use prevention messages for high school-aged adolescents. A total of 604 participants, 335 9th and 269 11th grade students from a suburban high school in northeast Florida participated in this study. A randomized control trial was conducted with participants randomly assigned within grade levels to receive either a brief consultation and prescription with a mailed reinforcing follow-up flyer (Project SPORT) or a minimal intervention control consisting of a wellness brochure provided in school and a pamphlet about teen health and fitness mailed to the home. Differences between intervention groups were evaluated with a series of MANCOVA tests. Project SPORT participants demonstrated significant positive effects at 3-months postintervention for alcohol consumption, alcohol initiation behaviors, alcohol use risk and protective factors, drug use behaviors, and exercise habits, and at 12-months for alcohol use risk and protective factors, cigarette use, and cigarette initiation (p's < 0.05). A post hoc analysis examining interactions between past 30-day use of marijuana and/or cigarettes by treatment group indicates significant positive effects for drug using adolescents who received Project SPORT on alcohol consumption, drug use behaviors, and drug use initiation at 3-months, and for drug use behaviors and exercise habits at 12-months (p's < 0.05). A brief, 12-min one-on-one consultation integrating alcohol avoidance messages within those promoting fitness and other positive health behaviors holds promise for influencing adolescent alcohol and cigarette use and other health behaviors at posttreatment and 1 year later. Long-term sustained effects for cigarette and marijuana use, and both vigorous and moderate physical activity, were found among adolescents using marijuana and/or cigarettes prior to intervention. A smoking prevention program for adolescents conducted in two public middle schools focused on resisting peer pressure to smoke and understanding the intent of commercial cigarette advertising. One class in each school participated in the program group and one served as a control group. The program consisted of eight sessions and was conducted by first-year medical students. Data on smoking behavior and related information were obtained from self-administered questionnaires at baseline, at the conclusion of the program, and one year later. One year after the program was concluded, the proportion of non-smokers was higher among those who had participated in the program than among the controls. This suggests that routine implementation of smoking prevention programs in conventional school settings may be productive in reducing the prevalence of cigarette smoking. To evaluate the impact of a classroom-based, Web-assisted tobacco intervention addressing smoking prevention and cessation with adolescents.
                A two-group randomized control trial with 1,402 male and female students in grades 9 through 11 from 14 secondary schools in Toronto, Canada. Participants were randomly assigned to a tailored Web-assisted tobacco intervention or an interactive control condition task conducted during a single classroom session with e-mail follow-up. The cornerstone of the intervention was a five-stage interactive Web site called the Smoking Zine (http://www.smokingzine.org) integrated into a program that included a paper-based journal, a small group form of motivational interviewing, and tailored e-mails.
                Resistance to smoking, behavioral intentions to smoke, and cigarette use were assessed at baseline, postintervention, and three- and six-month follow-up. Multilevel logistic growth modeling was used to assess the effect of the intervention on change over time.
                The integrated Smoking Zine program helped smokers significantly reduce the likelihood of having high intentions to smoke and increased their likelihood of high resistance to continued cigarette use at 6 months. The intervention also significantly reduced the likelihood of heavy cigarette use adoption by nonsmokers during the study period.
                The Smoking Zine intervention provided cessation motivation for smokers most resistant to quitting at baseline and prevented nonsmoking adolescents from becoming heavy smokers at 6 months. By providing an accessible and attractive method of engaging young people in smoking prevention and cessation, this interactive and integrated program provides a novel vehicle for school- and population-level health promotion. This study investigated the efficacy of a social-influences tobacco prevention program conducted with adolescents living in a high tobacco production area.
                Students in 10 experimental schools completed the tobacco prevention program and a booster intervention. Control students received health education as usual.
                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.
                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. In autumn 1995 The Norwegian Cancer Society in cooperation with The Research Center for Health Promotion, University of Bergen started a study of school-based interventions aiming at preventing smoking among pupils in Norwegian secondary schools. The study comprised a nationwide sample of 4441 students at 99 schools (195 classes). This panel of students is followed through annual data collections till they graduate in spring 1997. Written consensus from students and parents was obtained from 95%. Schools were systematically allocated to one of four groups: Group A, control; Group B, intervention, containing classroom program, involvement of parents and teacher courses; Group C, like B, but without teacher courses; Group D, like B, but without parental involvement. Baseline data were collected by questionnaires administered in class in November 1994 and the first follow-up survey was carried out in May 1995. At follow-up the proportion of smokers had increased by 8.3 percentage points in Group A (control) and by 1.9 percentage points in Group B (most extensive intervention). As expected, the recruitment of smokers was higher in Groups C and D than in the ideal intervention, but lower than in the control group. Effects of the most extensive program among subgroups of students were examined by comparing Groups A and B. Students are categorized as high risk or low risk based on scores on scales measuring sensation seeking, physical maturity, antisocial behavior and parental smoking. The effect of the program on recruitment of smokers seems to have been at least as strong or even stronger among 'high-risk' students than among other students. This study used Complier Average Causal Effect analysis (CACE; see G. Imbens & D. Rubin, 1997) to examine the impact of an adaptive approach to family intervention in the public schools on rates of substance use and antisocial behavior among students ages 11-17. Students were randomly assigned to a family-centered intervention (N = 998) in 6th grade and offered a multilevel intervention that included (a) a universal classroom-based intervention, (b) the Family Check-Up (selected; T. J. Dishion & K. Kavanagh, 2003), and (c) family management treatment (indicated). All services were voluntary, and approximately 25% of the families engaged in the selected and indicated levels. Participation in the Family Check-Up was predicted by 6th-grade teacher ratings of risk, youth reports of family conflict, and the absence of biological fathers from the youths' primary home. Relative to randomized matched controls, adolescents whose parents engaged in the Family Check-Up exhibited less growth in alcohol, tobacco, and marijuana use and problem behavior during ages 11 through 17, along with decreased risk for substance use diagnoses and police records of arrests by age 18. This study evaluated the substance initiation effects of an intervention combining family and school-based competency-training intervention components. Thirty-six rural schools were randomly assigned to 1 of 3 conditions: (a) the classroom-based Life Skills Training (LST) and the Strengthening Families Program: For Parents and Children 10-14, (b) LST only, or (c) a control condition. Outcomes were examined 1 year after the intervention posttest, using a substance initiation index (SII) measuring lifetime use of alcohol, cigarettes, and marijuana and by rates of each individual substance. Planned intervention-control contrasts showed significant effects for both the combined and LST-only interventions on the SII and on marijuana initiation. Relative reduction rates for alcohol initiation were 30.0% for the combined intervention and 4.1% for LST only. The distal impact of a school based universal preventive intervention targeting disruptive behavior problems on tobacco and alcohol use from age 10 to 13 years was explored. Second grade classrooms (children aged 7 years) were randomly assigned to the intervention or a control condition. Tobacco and alcohol use from age 10 to 13 years was available for 477 children (72% of original sample). The impact of intervention on the initial level and growth in probability of substance use was explored. Results showed that intervention children had lower probabilities of tobacco use over the ages 10-13 years. This effect remains significant when controlling for (male) sex, pre-intervention levels of conduct problems, exposure to prenatal smoking or current parental smoking. For alcohol use, no effect of intervention during childhood was found. However, intervention children reported having a lower probability in alcohol use with age among those children reporting having used in the last week. The results underscore the importance of the early prevention of disruptive behavior problems substance use initiation. Implications for prevention and research are discussed. The issue of prevention of tobacco use has received a great deal of attention in recent years. As an outgrowth of this interest, several smoking prevention programs based on a social influence approach have been developed. One example of these types of programs is the Peer Assisted Learning (PAL) prevention program which was produced by Health and Welfare Canada. We discuss the preliminary results of a prospective cohort evaluation of the PAL program. This evaluation suggests that the program has some utility in preventing the uptake of tobacco use among young males; however, its efficacy with females has been negligible. It is clear that prevention programming will have to consider targeting males and females in different ways. 1956 7th grade students of high schools and secondary modern schools in three cities with 110,000 to 180,000 inhabitants were asked about cigarette, alcohol and drug consumption using questionnaires. Subsequently 1080 of the students took part in a newly invented non-smoking curriculum which was held during 8 lessons within 4 weeks (intervention group (I)). The lessons were performed by non-smoking physicians who had passed a training programme before. 876 students served as control (C) group. 2 years later the questioning was repeated. The number of students who started smoking within the two years was significantly lower in the intervention group. In the high schools a significant effect was seen in boys (I: 13.0%, K: 22.4%; p < 0.01) and girls (I: 21.4%, K: 28.4%; p < 0.05) whereas in secondary modern schools a significant effect was seen only in boys (I: 17.4%, K: 25.2%; p < 0.05) not in girls (I: 18.0%, K: 22.0%; n.s.). First-time consumers of drugs like cannabis, marihuana and organic solvents were found less often in the intervention group among boys in high schools than in the control group (I: 14.9%; K: 23.6%; p < 0.05). No effects of the intervention were seen in girls of high schools and in students of secondary modern schools. No effects of the intervention were seen on alcohol consumption. Students who drank beer, wine or liquor several times a week were found at the same rate in the intervention and control groups. We conclude that a non-smoking intervention of 8 lessons in the 7th grade of high schools and secondary modern schools may lower the rate of first-time consumers of cigarettes but not of alcohol and drugs. To determine the impact of a school-based harm minimization smoking intervention compared to traditional abstinence-based approaches.
                A school-based cluster randomized trial was conducted in Perth, Western Australia in 30 government high schools from 1999 to 2000. Over 4000 students were recruited to participate and schools were assigned randomly to either the harm minimization intervention or a standard abstinence-based programme.
                The harm minimization intervention comprised eight 1-hour lessons over 2 years, quitting support from school nurses and enactment of policies to support programme components. Comparison schools implemented standard abstinence-based programmes and policies.
                Cigarette smoking was categorized at two levels: regular smoking, defined as smoking on 4 or more days in the previous week; and 30-day smoking as any smoking within the previous month.
                At immediate post-test (20 months post-baseline), after accounting for baseline differences, school-level clustering effects, socio-economic status, gender and family smoking, intervention students were less likely to smoke regularly [OR = 0.51, 95% confidence interval (CI) = 0.36, 0.71] or to have smoked within the previous 30 days (OR = 0.69, 95% CI = 0.53, 0.91).
                The school-based adolescent harm minimization intervention appears to have been more effective than the abstinence-based social influences programme at reducing regular smoking. A five-year intervention study of the feasibility and effectiveness of a program aimed at the primary prevention of chronic disease was initiated in 1980 among children in 22 elementary schools in the Bronx, New York. Schools randomly were assigned either to the intervention program or to a control group. The intervention program consists of a curriculum focusing on nutrition, physical fitness, and cigarette smoking prevention. The study population at baseline comprised 2,283 fourth-graders. Subjects were eligible at baseline and at one-year follow-up for participation in a medical examination in which the following target risk factors were measured: systolic and diastolic blood pressures, plasma total and high-density lipoprotein (HDL) cholesterol, serum thiocyanate, ponderosity index, triceps skinfold thickness, and postexercise pulse recovery rate. After one year of intervention, systolic pressure increased less in the intervention group than among controls. Diastolic pressure decreased in both groups, but more in the intervention subjects than in controls. Total cholesterol decreased in the intervention group while increasing among controls. Significant net changes in the favorable direction also were observed for total cholesterol/HDL cholesterol ratio and for thiocyanate. These observations indicate that it is feasible to implement a school-based program aimed at the primary prevention of chronic disease. The intervention program appears to have had a favorable effect on several target risk factors. Although the effects were relatively small, intervention programs in schools may prove to be effective in lowering chronic disease risk. A major challenge in the dissemination of evidence-based family interventions (EBFIs) designed to reduce youth substance use and other problem behaviors is effective and sustainable community-based recruitment. This understudied topic is addressed by a preliminary study of 14 community-university partnership teams randomly assigned to an intervention condition in which teams attempted sustained implementation of EBFIs with two cohorts of middle school families. This report describes attendance rates of recruited families maintained over time and across both cohorts, along with exploratory analyses of factors associated with those rates. When compared with community-based recruitment rates in the literature, particularly for multisession interventions, relatively high rates were observed; they averaged 17% across cohorts. Community team functioning (e.g., production of quality team promotional materials) and technical assistance (TA) variables (e.g., effective collaboration with TA, frequency of TA requests) were associated with higher recruitment rates, even after controlling for community and school district contextual influences. Results support the community-university partnership model for recruitment that was implemented in the study. We assessed the effectiveness of a 2-year multicomponent, school-based intervention designed to reduce tobacco use rates among adolescents in an urban area of India.
                Students from 32 schools in Delhi and Chennai, India, were recruited and randomly assigned to an intervention or control group. Baseline, intermediate, and outcome data were collected from 2 cohorts of 6th- and 8th-grade students in 2004; 14,063 students took part in the study and completed a survey in 2004, 2005, or 2006. The intervention consisted of behavioral classroom curricula, school posters, a parental involvement component, and peer-led activism. The main outcome measures were self-reported use of cigarettes, bidis (small hand-rolled, often flavored, cigarettes), and chewing tobacco and future intentions to smoke or use chewing tobacco.
                Findings showed that students in the intervention group were significantly less likely than were students in the control group to exhibit increases in cigarette smoking or bidi smoking over the 2-year study period. They were also less likely to intend to smoke or chew tobacco in the future.
                School-based programs similar to the intervention examined here should be considered as part of a multistrategy approach to reducing tobacco use among young people in India. In a randomized controlled trial, we evaluated the effect on tobacco use onset among middle school students of Family Communications (FC) activities designed to mobilize parental influences against tobacco use and Youth Anti-tobacco Activities (YAT) designed to market anti-tobacco norms to adolescents. We conducted a simple, two-condition experimental design in which 40 middle schools, with a prevalence of tobacco use at or above the Oregon median, received, by random assignment, either the intervention or no intervention. State, county, and local prevention coordinators around Oregon served as liaisons to schools. To generate interest, staff made presentations to these groups and distributed marketing packets at several conferences. Dependent variables were indices of smoking prevalence and use of smokeless tobacco (ST) in the prior month. Additionally, we created an intervention manual so that other communities could replicate this study. The findings suggest that efforts to influence parents to discourage their children's tobacco use and efforts to market an anti-tobacco perspective to teens are effective in preventing smoking. The impact of YAT is consistent with experimental and nonexperimental evaluations of media campaigns to influence young people not to smoke. The objective of the present study was to study the ability to influence young at-risk patients' attitudes toward tobacco use through two intervention methods that were performed by dental health professionals.
                Two interventions, a brief individual motivational interview and an adapted school lecture, were studied, and both were compared with a control group. Before and after interventions, a questionnaire was used. Patients born in 1989 and 1992 who were judged by the dental personnel as potentially at risk for dental diseases, a total of 301 individuals, were included.
                Both before and after interventions, the results showed a generally negative attitude towards tobacco use. A majority of the participants were positive towards measures that were taken to control the spread of tobacco use, younger participants (born 1992) to a greater extent (73%) than the older participants (born 1989) (54%). Important factors that kept the participants away from tobacco use were the harmful effects and the approaches of parents and friends. The older participants believed to a greater extent that they would try smoking as adults. No change in tobacco use was registered after intervention, although the participants reported an increased use among friends.
                The two pedagogical methods that were used in the present study influenced the young people's attitudes towards tobacco use only to a small extent. However, the period between 12 and 15 years old seems to provide a good opportunity to influence attitudes towards tobacco. The adolescents' demand for interactive learning and their development of attitudes and tobacco use habits in relation to family and friends provide opportunities to use new pedagogical models. This study presents one-year follow-up data from an evaluation study testing the effectiveness of a cognitive-behavioral substance abuse prevention approach which emphasizes the teaching of social resistance skills within the larger context of an intervention designed to enhance general social and personal competence. The follow-up study involved 998 eighth graders from 10 suburban New York junior high schools. Two schools were assigned to each of the following conditions (a) peer-led intervention, (b) peer-led intervention with booster sessions, (c) teacher-led intervention, (d) teacher-led intervention with booster sessions, and (e) control. The original intervention was implemented in the seventh grade; the booster intervention was implemented during the eighth grade. Results indicate that this type of prevention strategy, when implemented by peer leaders in the seventh grade and when additional booster sessions are provided during the eighth grade, can reduce tobacco, alcohol, and marijuana use. Similar effects are evident for females when the prevention program is implemented with fidelity by classroom teachers. Moreover, the prevention program is also capable of producing a significant impact on several hypothesized mediating variables. Understanding the developmental pathways and sex differences in cigarette smoking behaviors in adolescents has the potential to positively impact substance abuse prevention and to reduce smoking-related health problems. Using data from the Unplugged school-based prevention trial, we investigated different patterns of smoking behavior development among secondary school students in the Czech Republic.
                Growth mixture modeling was used to examine different trajectories in cigarette smoking behaviors among male and female students (N=1874 6th graders; 50.4% male, mean age 11.8 years at baseline) participating in the Unplugged school-based randomized control trial for substance use prevention.
                A two-class model characterized cigarette use as a function of sex and Unplugged intervention status. More rapid cigarette use increases were observed in females (OR=1.17, p=0.01 in both rapid/moderate and slow smoking escalator classes) as compared to males. Further, in both classes, more rapid increases in smoking were observed for the control group as compared to the intervention group (OR=1.22, p<0.01 slow escalators; OR=1.54, p=0.08 rapid/moderate escalators). There was no difference in sex distribution when comparing the two classes (OR=1.02, p=0.98).
                This study adds to a growing literature on developmental and sex differences in cigarette use among adolescents. This research supports additional multi-year prevention strategies aimed at adolescent females and early treatment programs for adolescent smokers to prevent increasing cigarette use with age.
                Copyright © 2012 Elsevier Ltd. All rights reserved.