Fifteen‐month follow‐up results of a school‐based life‐skills approach to smoking prevention
Health Education Research
Fifteen-month follow-up results of a school-based life-skills approach to smoking prevention1
Reiner Hanewinkel
0 Department of Child and Adolescent Psychiatry, University of Hamburg , 20246 Hamburg , Germany
1 Institute for Therapy and Health Research, IFT-Nord , 24105 Kiel
The life-skills approach to smoking prevention was tested in this study. In total, 1024 pupils (mean age 11.4 years, SD = 0.90) from Austria, Denmark, Luxembourg and Germany were recruited as an experimental group, and a sample of 834 matched pupils served as a control group. While the pupils from the control group received no speci®c intervention, the pupils in the experimental group participated in an intervention programme which was based on the life-skills approach and consisted of 21 sessions. The aims of the programme were to promote fundamental social competencies and coping skills. In addition, speci®c information on cigarette smoking was given and skills for resisting social in¯uences to smoke were rehearsed. The programme was conducted by trained school teachers during a course of 4 months. Anonymous questionnaires were administrated (1) before the programme was implemented and (2) 15 months after the programme had started. Teachers as well as pupils showed a high level of satisfaction with the programme idea and the materials. With regard to the outcome variables, the programme had no differential effect on current smoking (4-week prevalence). The programme showed a weak effect (P < 0.1) on lifetime smoking prevalence and experimental smoking. There was also an effect of the programme on smoking knowledge, on the social competences of the pupils as well as on the classroom climate. No effects were found on susceptibility to smoking among never-smokers, attitudes towards smoking and the perceived positive consequences of smoking. The results indicate that prevention programmes that are run for only a few months can have a positive impact on variables considered to be protective with regard to smoking uptake.
-
1,3
and Martin Aûhauer
2
Introduction
Smoking remains the leading preventable cause of
premature disease and death worldwide
(WHO,
1997)
. It is estimated that in the next 20±30 years,
10 million people per year will die from
tobaccorelated diseases such as cancer, cardiovascular
disease, chronic obstructive pulmonary disease and
others
(Satcher, 2001)
.
Epidemiological studies indicate that smoking
prevalence among youth underwent a sustained
and substantial decline in the 1970s and 1980s, but
during the 1990s smoking prevalence increased
among adolescents in the US
(Ferrence et al.,
2000)
and also in Europe
(WHO, 2000)
. In
addition, little progress has been made over the
years in improving cessation rates among smokers
and relapse is still the rule rather than the exception
in treatment studies. Thus, effective primary
prevention programmes for youth smoking are
urgently required. Over the past decades several
different educational models for smoking
prevention have been established and evaluated
(US
Department of Health and Human Services, 2000)
.
The earliest evaluated programmes designed to
prevent children and adolescents from beginning to
smoke were based on an information de®cit model
(US Department of Health and Human Services,
1994)
. The assumption of this approach is that
adolescents would refrain from smoking if they
were supplied with adequate information regarding
the harmful effects of smoking. Factual
information concerning the nature, pharmacology and
harmful consequences of tobacco is given based
on the belief that once individuals are aware of the
hazards of using tobacco, they will develop
antitobacco attitudes, and make a rational and logical
decision not to use tobacco. Reviews and
metaanalysis indicate that this approach leads to an
increase in knowledge, but neither affects the
attitudes towards smoking nor the actual behavior
(Hansen, 1992; Bruvold, 1993; Tobler and
Stratton, 1997; Tobler et al., 2000)
.
Recognizing the limitations of this approach,
other educational interventions have been
developed in order to prevent youth smoking
(Durlak,
1995)
. The underlying assumption of the affective
education model is that reduced levels of perceived
self-esteem, and poor attitudes towards family,
school and community cause smoking initiation.
Therefore, a broad range of educational strategies
were established in order to clarify values, build up
self-esteem and develop skills for decision making.
Several evaluations of this prevention approach
show that it is not more effective in in¯uencing
adolescents attitudes and behaviors than
programmes which are based on the information
de®cit model
(Lynch and Bonnie, 1994; Vartiainen
et al., 1994)
.
Beginning in the 1970s, new approaches to
smoking prevention have been developed, which
mostly use psychological inoculation techniques
and behavioral rehearsal to strengthen attitudes and
skills that aid in r (...truncated)