Elsevier

Preventive Medicine

Volume 46, Issue 4, April 2008, Pages 289-297
Preventive Medicine

Review
Effective practices for school-based tobacco use prevention

https://doi.org/10.1016/j.ypmed.2007.10.003Get rights and content

Abstract

Background

Research evidence addressing effectiveness of tobacco use prevention interventions has accumulated since the 1970s. Systematic reviews 1985–2006 were considered, building on previous syntheses and spanning tobacco control and prevention efforts to date. Practitioners' experience was drawn upon to supplement research evidence.

Methods

A systematic, comprehensive approach was used to synthesize published literature evaluating the effectiveness of school-based tobacco use prevention interventions. Systematic reviews conducted on all populations published in English, peer-reviewed journals were included. Reviews were screened for relevance and assessed for methodological quality using pre-tested, standardized tools. The best available evidence was extracted and integrated with experiential evidence from individual interview and focus group results from practitioners involved in tobacco use prevention programming.

Results

Considerable consensus among the three evidence sources indicates that school-based tobacco use prevention interventions are effective in reducing smoking prevalence, reducing smoking initiation and intended smoking intentions in the short term. There is adequate evidence from over three decades of research and years of experience to recommend ongoing implementation of school-based tobacco use prevention interventions.

Conclusion

There is strong evidence that school-based tobacco use prevention programs are largely effective for most tobacco use related outcomes, at least in the short term.

Introduction

Tobacco use is the leading cause of preventable death (Department of Health and Human Services, 2004, Office on Smoking and Health, 2001) killing 50% of all lifetime users (Mackay and Eriksen, 2002) and has been clearly established as the cause of numerous cancers and chronic diseases (Kuper et al., 2002)(Department of Health and Human Services, 2004). Since roughly 90% of regular adult users start smoking prior to age 18 (American Lung Association, 2006), it is essential to target young people with prevention efforts. The decreasing age of tobacco initiation is concerning because those who start smoking before 18 years of age more likely to become established heavy users and are less likely to be able to quit (Kuper et al., 2002).

In the United States, the 2005 National Survey on Drug Use and Health found that 2.4% of 12 or 13 year olds, 9% of 14 or 15 year olds, and 21% of 16 or 17 year olds were current smokers (Substance Abuse and Mental Health Services Administration, 2006). Similar rates have been reported in Canada (Health Canada, 2005). Public health efforts need to be directed at promoting smoking prevention among children and youth (Kuper et al., 2002). The purpose of this research is to evaluate the effectiveness of school-based tobacco use prevention strategies for preventing tobacco use in children and youth.

Section snippets

Methods

A search for systematic reviews and meta-analyses was undertaken. The literature review was accompanied by in-depth interviews and a focus group conducted with a sample of Canadian decision makers in tobacco use prevention programming.

Description of included reviews

This review represents primary studies published between 1970 and 2007. The search strategy identified 10,163 titles. Of those, 92 were judged to be potentially relevant and assessed for relevance. Of these, 31 were judged as relevant. The most common reason reviews were judged not relevant was that the intervention was not focused on tobacco use prevention and/or was not school based.

Interventions were delivered in elementary and high schools, with some activities conducted in communities and

Discussion

Overall, findings from each of the three data sources consistently demonstrated that school-based tobacco use prevention interventions are effective in reducing smoking behavior, initiation, and intention to smoke, at least in the short term. However, these effects were not maintained until age 18 in the absence of ongoing intervention. There is sufficient evidence at this time to recommend ongoing implementation of school-based tobacco use prevention interventions as a means of preventing

Conclusions

Triangulation of the scientific published literature and the opinions of experts demonstrated the effectiveness of tobacco use prevention. Generally, there is reason for optimism regarding the effectiveness of prevention programs on smoking behavior and initiation, albeit in the short term. Although there are still a number of unanswered questions, convincing evidence indicates that multi-faceted and comprehensive programs are effective at reducing youth smoking initiation rates and overall

Acknowledgments

This research was funded by the Canadian Tobacco Control Research Initiative in partnership with the Social Sciences and Humanities Research Council. At the time of this work, the primary author held a postdoctoral fellowship from the Canadian Health Services Research Foundation and currently holds an Ontario Ministry of Health and Long-Term Care Career Scientist Award. Manske's involvement was supported by the Centre for Behavioural Research and Program Evaluation, a national program of the

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