Evaluation of the effectiveness of a smoking prevention program based on the ‘Life Skills Training’ approach
Evaluation of the effectiveness of a smoking prevention program based on the 'Life Skills Training' approach
Mar´ıa Luna-Adame 1 2
Toma´s Jes u´s Carrasco-Gime´nez 1 2
Mar´ıa del Mar Rueda-Garc´ıa 0 1
0 Departamento de Estad ́ıstica e Investigacio ́n Operativa, Universidad de Granada , 18071-Granada , Spain
1 The Author 2013. Published by Oxford University Press. All rights reserved. Downloaded from https://academic.oup.com/her/article-abstract/28/4/673/700954 by guest on 09
2 Departamento de Personalidad, Evaluacio ́n y Tratamiento Psicolo ́gico, Universidad de Granada , 18071-Granada , Spain
Our objective was to verify the effectiveness of a program based on the Life Skills Training approach with a greater extent than usual, not applied by teachers and a very high degree of reliability regarding the implementation of the expected content. Twenty-eight secondary schools in Granada (Spain) were randomly assigned to the intervention or control group. The students in the intervention group received 21 one-hour sessions in the first year and 12 one-hour sessions in the second year, whereas those in the control group received no health education or preventive sessions. Students completed questionnaires before and after the first year of sessions, before and after the second year, and at 1 year after the program. All five questionnaires were completed by 77% of the 1048 students initially enrolled in the study. The results suggest that the program had no preventive effects either immediately or at 1 year after its application. Application of the Life Skills Training approach does not appear to prevent the onset of smoking but may prove effective for avoiding escalation of the consumption levels of tobacco or other problematic drugs.
Introduction
Tobacco consumption continues to be a major
cause of disease and death [
1
]. Over the past
40 years, the application of prevention programs
has been the main strategy for reducing the rate of
consumption among children and adolescents [
2
]. In
the 1970s and 1980s, most of these programs
adopted the so-called Social Influences Approach,
which focuses on endowing young people with
skills that allow them to resist the pressure to
smoke from their peers and the media [
3
]. The
poor results obtained by most of these programs
led to the emergence of a new approach, called
Life Skills Training, based on providing adolescents
with a wide range of skills to successfully meet the
challenges they face [
4
].
The effectiveness of school-based tobacco
prevention programs is currently under debate [
5
].
Various studies found little or no evidence of the
effectiveness of the life skills approach [
6–8
],
whereas others attributed the poor preventive
outcomes to an inadequate duration of the program,
which was usually 5–10 sessions [
9
], or to the
poor implementation of the program, most
frequently by teachers after a brief training period
[
10, 11
]. It has also been questioned whether
teachers are the best agents for applying preventive
programs, given the reluctance by some members
of the profession, some of whom are smokers, to
play this role and the consequent negative effects
on the reliability of the program implementation
[
11–13
]. The aim of this study was to examine
the possible adverse influence of these factors on
the effectiveness of a preventive program based on
life training skills by running a 2-year program to be
implemented by well-trained non-teachers with a
rigorous control over adherence to the
implementation protocol.
Methods
Sample selection
Twenty-eight secondary schools were randomly
selected from among all public and state-funded
private schools in the city of Granada (Spain).
Toward the end of the academic year before the
start of the preventive program, data were gathered
on the tobacco consumption of all pupils in the third
year of secondary education (equivalent to ninth
grade in the United States) at the selected schools,
as detailed below (see ‘Tobacco consumption
assessment’). Each school was assigned a ‘tobacco
consumption rate’, i.e. the sum of the mean
percentages of sporadic, monthly, weekly and daily
smokers among its ninth-grade students, and the
28 schools were ranked according to their rate.
The ‘alternate ranks’ [
14
] procedure was then
applied to assign schools to the intervention or
control group, randomly assigning the school with
the highest tobacco consumption rate to one of these
groups and then assigning the remaining schools
according to their ranking, using the formula
ABBAABBA. In the next academic year, all
seventh-grade classes in each selected school
participated in the study. Approval for the study was
obtained from the review board of the Ministry
of Education of the Autonomous Government of
Andalusia. The primary guardians were informed
of the objectives of the research and none refused
the participation of their child (a passive consent
procedure was used) (Fig. 1).
Participants
The sample co (...truncated)