Re: Hutchinson Smoking Prevention Project: Long-Term Randomized Trial in School-Based Tobacco Use Prevention—Results on Smoking
Journal of the National Cancer Institute
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1 Affiliations of authors: S. Sussman, Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles; W. B. Hansen, Tanglewood Research , Greensboro, NC; B. R. Flay , Health Research and Policy Centers, University of Illinois at Chicago; G. J. Botvin, Weill Medical College of Cornell University, New York. Professor of Preventive Medicine and Psychology and Institute for Health Promotion and Disease Prevention Research, University of Southern California/IPR , 1000 S. Fremont, Unit , USA
2 (1) Peterson AV, Kealey KA, Mann SL, Marek PM, Sarason IG. Hutchinson Smoking Prevention Project: long-term randomized trial in school-based tobacco use prevention-results on smoking. J Natl Cancer Inst 2000; 92: 1979-91. (2) Clayton RR, Scutchfield FD , Wyatt SW. Hutchinson Smoking Prevention Project: a new gold standard in prevention science requires new transdisciplinary thinking [editorial]. J Natl Cancer Inst 2000; 92:1964-65. (3) Tobler NS, Roona MR, Ochshorn P, Marshall DG, Streke AV , Stackpole KM. School-based adolescent drug prevention programs: 1998 meta-analysis. J Prim Prev 2000;20:275-336. (4) Botvin GJ. Preventing drug abuse in schools: social and competence enhancement approaches targeting individual-level etiologic factors. Addict Behav 2000;25:887-97. (5) Donaldson SI, Sussman S, MacKinnon DP, Severson HH, Glynn T, Murray DM, Stone EJ. Drug abuse prevention programming: do we know what content works? Am Beh Scientist 1996;39:868-83
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The Hutchinson Smoking Prevention
Project (HSPP), whose findings were
published recently (
1
), was a
welldesigned trial that was conducted from
1984 to 1999. The intervention tested
was social-influences based and was
delivered to cohorts of youth from grades 3
to 10 in 20 of 40 randomly assigned
school districts (n 8388). No
statistically significant differences were found
in prevalence of smoking between
students in program and control districts in
the 12th grade and 2 years after high
school. The editorial accompanying the
article (
2
) and recent media accounts
may lead people to conclude that the
social-influence approach is ineffective.
That conclusion is unwarranted in light
of the larger prevention literature. A
recent meta-analysis by Tobler et al. (
3
) of
207 universal school-based drug
prevention programs, including 138 prevention
programs that included social-influence
components, provides strong support for
the efficacy of social-influence
programming at a 1-year follow-up. The results
of HSPP must be interpreted within the
context of all of these other studies,
many of which were methodologically
rigorous, included large sample sizes,
and collectively provide compelling
evidence that some school-based
prevention approaches are effective.
To draw meaningful conclusions
about HSPP findings and their
implications, we need much more information
about the study data and outcomes that
is not contained in the current article. In
the absence of such information, it is
worth considering possible alternative
interpretations of these data. For
example, it is possible that social-influence
approaches do not work equally well
with all youth (e.g., HSPP was
conducted at small schools in primarily
rural settings with primarily white youth).
It is possible that youth did not like this
particular program, since no process
data are reported from youth. It is not
clear how representative the HSPP
intervention is of other prevention
approaches that include a focus on
prosmoking social influence. In particular,
there should have been immediate
effects on variables specific to the
socialinfluence process, such as reductions in
tobacco prevalence overestimates or
perceived acceptability of tobacco use,
that are not discussed. Failure to affect
these variables would reflect program
failure, not the failure of the general
social-influence approach.
Also, the HSPP curriculum did not
include several currently discussed
elements of the social-influences approach
that might be important to the
achievement of prevention effects, such as
listening and communication skills,
decision making, and making a commitment
(
4
). HSPP appears to be an example of
what Tobler et al. (
3
) label as
“socialinfluence” programming (minus a
public commitment component) rather than
more comprehensive approaches, such
as “comprehensive life skills
programming” [e.g., Life Skills Training or
Project Towards No Tobacco Use (
4,5
)] or
“system-wide programming” [e.g.,
Project Northland (
3
)]. The effect sizes of
non-social-influence programs are 0.
While the effect sizes of programs that
contain social-influence components are
in the small-to-moderate range (mean
effect size .12 to .27; standard
deviation .25), comprehensive life skills
programming (i.e., social influence plus
life skills material) is 40% more
effective than social influence-only
program (...truncated)