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PubMed1985

A cognitive developmental approach to smoking prevention.

Most smoking prevention programs for middle-schoolers target non-smokers. These programs seek to educate young people about the hazards of smoking, influence young peoples' attitudes toward smoking, and reduce initial experimentation with cigarettes by providing social- and life-skills training. The program described in this chapter incorporates these features and adds a component which explores, in some depth, the nature of the user's response to cigarettes. This component focuses on the young person's physical and psychological reaction to cigarette smoking, and provides a knowledge base which promotes a negative evaluation of that reaction. This component targets all young people, but it is anticipated that it will be especially effective with pre-addictive experimenters who are wondering what smoking can "do for them". One challenge for the future is the development of intervention strategies that have something to offer the young addicted smoker who wishes to quit smoking. These young people are largely unserved by school-based smoking education programs, drug abuse programs, and organized smoking therapies.

Adolescent↗
PubMed2006

Effect of televised, tobacco company-funded smoking prevention advertising on youth smoking-related beliefs, intentions, and behavior.

OBJECTIVE: To relate exposure to televised youth smoking prevention advertising to youths' smoking beliefs, intentions, and behaviors. METHODS: We obtained commercial television ratings data from 75 US media markets to determine the average youth exposure to tobacco company youth-targeted and parent-targeted smoking prevention advertising. We merged these data with nationally representative school-based survey data (n = 103,172) gathered from 1999 to 2002. Multivariate regression models controlled for individual, geographic, and tobacco policy factors, and other televised antitobacco advertising. RESULTS: There was little relation between exposure to tobacco company-sponsored, youth-targeted advertising and youth smoking outcomes. Among youths in grades 10 and 12, during the 4 months leading up to survey administration, each additional viewing of a tobacco company parent-targeted advertisement was, on average, associated with lower perceived harm of smoking (odds ratio [OR]=0.93; confidence interval [CI]=0.88, 0.98), stronger approval of smoking (OR=1.11; CI=1.03,1.20), stronger intentions to smoke in the future (OR=1.12; CI=1.04,1.21), and greater likelihood of having smoked in the past 30 days (OR=1.12; CI=1.04,1.19). CONCLUSIONS: Exposure to tobacco company youth-targeted smoking prevention advertising generally had no beneficial outcomes for youths. Exposure to tobacco company parent-targeted advertising may have harmful effects on youth, especially among youths in grades 10 and 12.

Adolescent↗
PubMed1992

[A review of studies on school-based smoking prevention programs].

Research papers on school-based programs designed to prevent adolescent smoking were reviewed to determine trends in the development of smoking prevention programs as well as measures and methods of evaluation. In the USA and Europe, evaluation studies have demonstrated that the most promising smoking prevention approaches are those that focus primary attention on the psychosocial factors promoting smoking initiation. In Japan, however, most programs have shown little success. The following recommendations are made for improving the methods for evaluating program effectiveness and the future of research orientation of educational program on adolescent smoking. 1) Refinement and standardization of evaluation methods to be valid and feasible for use in studies of Japanese adolescents. 2) Improved study designs for evaluation of program effectiveness which include control groups and long term follow-up. 3) Applying smoking prevention programs which were demonstrated to be effective in the USA and Europe. 4) Development of effective cessation programs for adolescent smokers.

Adolescent↗
PubMedDate not supplied

Teaching children self-care for chronic disease prevention: obesity reduction and smoking prevention.

A general health education program was developed for 1,252 students in six New York city area school districts. The purpose of the three-year project was to reduce the prevalence of risk factors associated with increased cardiovascular and cancer risk in adults. The curriculum included nutrition, antitobacco, and hypertension-control materials. A smaller, experimental intensive health behavior program was also developed for obese children (weight greater than or equal to 120% ideal for height, age, and sex). A smoking prevention program was offered to children with the aim of discouraging new smokers. Findings show that: 1) such a school-based primary disease prevention program is feasible and highly acceptable; and 2) reduction of obesity and new cigarette smoking occurred with intensive intervention involving small groups of students. On the other hand, a general health education itself had little effect in the total population in reducing the incidence of extreme clinical values (such as physical inactivity, high blood pressure, as well as smoking and obesity) for their age and sex. It is recommended that future programs for higher risk children concentrate on behavioral change rather than on general education.

Activities of Daily Living↗
PubMed2002

Smoking prevention counseling practices of Montreal general practitioners.

BACKGROUND: Primary care physicians are potentially important sources of interventions aimed at preventing youth smoking. Yet recent surveys suggest that physician smoking prevention practices are less than optimal. OBJECTIVES: To document prevention counseling practices and to identify correlates of these activities in a random sample of general practitioners in Montreal, Quebec. METHODS: A cross-sectional mail survey. RESULTS: Of 440 eligible general practitioners (GPs), 337 (77%) completed the questionnaire. General practitioners were more likely to ascertain the smoking status of adolescents (70.9%) than preadolescents (35.7%). Although about half of the GPs offered advice to prevent smoking onset in young adults (48.6%) and adolescents (48.3%), fewer did so for preadolescents (34.4%); only 12.1% advised parents to discuss smoking onset with their children. Correlates of ascertaining smoking status included female sex (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.07-3.41), lower proportion of walk-in patients (OR, 2.73; 95% CI, 1.31-5.80), awareness of the "stage of behavior change" model (OR, 2.17; 95% CI, 1.18-4.04), and higher self-efficacy (OR, 4.12, 95% CI, 2.00-8.69). Correlates of provision of prevention advice included more hours spent in direct patient care (OR, 1.93; 95% CI, 1.13-3.34), favorable beliefs and attitudes (OR, 1.73; 95% CI, 1.06-2.83), and higher self-efficacy (OR, 4.32; 95% CI, 2.25-8.44). CONCLUSIONS: Our results point to the need for renewed efforts to enhance preventive efforts in primary care settings. Intervention programs for GPs should emphasize overcoming unfavorable beliefs and attitudes and low self-efficacy. Future research should evaluate the effect of brief prevention counseling adapted to increasingly busy practices.

Adolescent↗
PubMed1982

Patterns of change in adolescent smoking behavior and results of a one year follow-up of a smoking prevention program.

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.

Adolescent↗
PubMed2006

School-based smoking prevention programs for adolescents in South Korea: a systematic review.

The number of research papers evaluating programs designed to prevent adolescent smoking have increased in the last 13 years in Korea. The purpose of this study was to evaluate these programs, to review the features of the studies and to systemically assess the results on the knowledge about, and attitude to, smoking and smoking behavior. Database searched were national digital library (NDL) and the Research Information Service System, which are major literature search systems for all academic fields in South Korea, and the Research Information Center for Health, which is a database for health field. A total of 11 papers were included. Program contents are described under five categories and the mode of delivery is described. Methodological features were investigated and effect of the size of the study on variables investigated was computed. Knowledge was the main content of the program in most of the studies. Most studies delivered classroom-based instructions that were mainly didactic presentations. School-based smoking programs have not influenced adolescent smoking behavior as much as anticipated. Methodological problems were discussed. Several recommendations are made to improve effectiveness of smoking prevention programs and reduce methodological flaws in future studies.

Adolescent↗
PubMed1990

Sociodemographic characteristics of cigarette smoking initiation in the United States. Implications for smoking prevention policy.

Cigarette smoking initiation greatly influences smoking prevalence in the United States. To understand better the initiation of cigarette smoking, we estimated the age-specific incidence of cigarette smoking initiation in relation to race/ethnicity, sex, and educational attainment, using the reported age at smoking onset for 18- to 35-year-old respondents in the 1987 National Health Interview Survey (N = 14764) and the Hispanic Health and Nutrition Examination Survey (N = 3123) conducted during 1982 to 1984. Among white, black, and Hispanic respondents the incidence of smoking initiation increased rapidly after 11 years of age, reaching a peak in groups 17 to 19 years of age, rapidly declining in groups through age 25 years, and gradually declining thereafter. Age-specific smoking initiation rates were generally lower among black than white respondents, similar between white and Hispanic respondents, and appreciably higher among black and Hispanic men than women. Compared with persons who graduated from high school, persons with less than high school education were consistently more likely to start smoking cigarettes during childhood and adolescence. These data indicate that age and educational attainment are the factors most consistently associated with cigarette smoking initiation among all race/ethnic groups in the United States. These data also emphasize the need for smoking-prevention education beginning at an early age, particularly among persons of low socioeconomic status.

Adolescent↗
PubMed1994

Intraclass correlation among common measures of adolescent smoking: estimates, correlates, and applications in smoking prevention studies.

Most adolescent smoking prevention studies employ designs in which classrooms, schools, school districts, or sometimes whole communities are assigned to treatment conditions while observations are made on individual students. The critical design feature in such community trials is the nesting of intact social groups within treatment conditions. This combination requires that the treatment effect be assessed against the between-group variance; unfortunately, that variance is usually larger than for randomly constituted groups and its precision is usually less than that for the within-group variance. These factors often combine to reduce power so that it is almost impossible to detect important treatment effects in an otherwise well designed and properly executed study. To address these problems, investigators need good estimates of the intraclass correlation for the variables of interest, which together with the number of observations per unit determine the magnitude of the extra variation in the nested design. The purpose of this paper is to describe the methods and results from a study designed to generate estimates of intraclass correlation for common outcomes in adolescent smoking prevention studies and to discuss the use of these estimates in the planning of new studies.

Adolescent↗
PubMedDate not supplied

Factors affecting attrition in a longitudinal smoking prevention study.

BACKGROUND: In longitudinal smoking prevention studies, a difficulty in evaluating treatment effects is understanding whether bias is associated with those who do not complete the study. This study presents the significant predictors of attrition and suggests how to reduce attrition bias in evaluating program effects. METHODS: Survival analysis methods were used to assess factors associated with attrition at different time points of the study. RESULTS: Results of the analysis indicate that those who drop out tend to be of lower academic achievement, have lower tobacco and health knowledge, and have lower social influence/resistance skills knowledge, and are more likely to be smokers and to be marijuana users. Blacks are more likely to drop out than the other ethnic groups. Gender is not a significant predictor for dropout. The dropout rates among the treatment conditions are significantly different. CONCLUSIONS: The findings of this study demonstrate that attritions in longitudinal smoking prevention studies are not at random. By considering the characteristics of dropouts, one can reduce attrition bias using available procedures and can take appropriate strategies for reducing dropout rates in future smoking prevention studies.

Adolescent↗
PubMed1994

Seven-year follow-up of a smoking-prevention program for children.

Smoking-prevention programs, run by both teachers, and teachers and peers, have been introduced into school curricula in many parts of the world. This paper describes a long-term follow-up of a randomised controlled trial of a smoking education program for children conducted in Western Australia. Seven years after the first survey of 2,366 Year 7 students in 1981, 68 per cent of initial participants were traced through public records; 53 per cent of these responded to a new survey concerning smoking. Previous follow-up after one and two years had shown that both teacher-led and peer-led programs continued to reduce the taking up of smoking by girls to about the same degree, whereas in boys, the teacher-led program appeared to be effective after one year but neither program was effective after two years. In nonsmoking girls, both the intervention programs maintained their effects at the seven-year follow-up, with an almost 50 per cent reduction in smoking prevalence in the intervention group. Nonsmoking girls appeared to respond to cigarette advertisements. Mothers seemed to influence nonsmokers of both sexes and brothers seemed to influence smokers of both sexes. The seven-year follow-up confirmed the results seen at two years for boys, that the effects of the education program had dissipated. However, this study suggests that the smoking-prevention program had a lasting effect on preventing girls from taking up smoking.

Adolescent↗
PubMed1999

Why do effective smoking prevention programs work? Student changes in social cognitive theory constructs.

Psychosocial smoking prevention programs can decrease adolescent smoking initiation. This study determined if the theoretical variables targeted in a psychosocial smoking prevention program can be improved significantly by participation in a smoking prevention program. The Social Cognitive Theory constructs examined included behavioral capability to resist positive images of smoking, refusal skill-efficacy, total positive refusal expectations and importance, and total negative refusal expectations and importance. The smoking prevention program had a significant impact on student refusal skill-efficacy and total positive refusal expectations and importance. However, the program did not affect behavioral capability to resist positive images of smoking and total negative refusal expectations and importance. Results from the study can be used to improve the impact of psychosocial prevention programs on targeted Social Cognitive Theory constructs and support the continued practice of cigarette refusal strategy role-plays, addressing various types of pressure and emphasizing positive outcomes from cigarette refusals.

Analysis of Variance↗
PubMed1996

[Teachers' attitudes toward smoking prevention at schools].

Teenage smoking continues to present a significant public health problem. Children begin to smoke in elementary and middle school, although consumption is highest during university studies. In spite of their limitations, school-based campaigns are the most effective weapons against smoking. Spanish educational authorities have developed an interdisciplinary anti-smoking curriculum for health education. In practice, however, the curriculum is not usually implemented. An understating of teachers' attitudes toward such campaigns can lead to their better design, contributing to greater cooperation and better outcome. We therefore surveyed teachers participating in the School-based Smoking Prevention Plan during 1993-1995. Teachers had a generally favorable opinion of the campaign and wanted to continue it; they were well disposed to cooperate more actively with the physicians who carried it out.

Adult↗
PubMed2003

The European Smoking Prevention Framework Approach (ESFA): short-term effects.

The European Smoking Prevention Framework Approach (ESFA) resulted in a smoking prevention project for six European countries. It included activities on four levels: adolescents, schools, parents and out-of-school activities. Common goals and objectives were developed, but countries were also able to include additional objectives. National diversities required country-specific methods. The most important common element was a school-based programme consisting of at least five lessons paying attention to social influence processes and training in refusal skills. During the first year, significantly more smoking prevention activities were realized in experimental schools compared with control schools. Not all countries had the same number of lessons on resisting peer pressures. Significant cognitive changes were observed in Spain, resulting in more negative attitudes, increased self-efficacy levels and a more negative intention towards smoking in the experimental group. Counter-productive cognitive effects were observed in the UK. Significantly less onset of weekly smoking in experimental groups was found in Finland (4.7%) and Spain (3.1%). Counter-productive effects were observed in Denmark and the UK. In conclusion, while having common objectives, the ESFA approach allowed for a great deal of diversity. Fundamental research using dismantling designs is needed to be able to detect the most effective elements of smoking prevention programmes for different age groups. Attention to parenting styles and practices is also needed.

Adolescent↗