CENTER NEWS - THURS., DEC. 21, 2000

NEWS & FEATURES

Stubbed-out hopes Teaching youths to fight tobacco ads, peer pressure doesn't keep them from smoking, finds 15-year Hutch prevention trial By KRISTEN WOODWARD The smoking-prevention program sought to help youths identify and resist influences to smoke, many of which are presented in tobacco-industry ads targeted at teens. COLLAGE DETAIL COURTESY OF HSPP     The most ambitious smoking-prevention study of its kind has found that teaching youths how to identify and resist social influences to smoke the main focus of smoking-prevention education and research for more than two decades simply doesn't work. These findings, which appeared this week in the Journal of the National Cancer Institute, are based on a 15-year, federally funded smoking-prevention study conducted by the Hutchinson Center. The study, which involved nearly 8,400 students and more than 600 teachers throughout 40 school districts in Washington state, was the largest and longest study ever conducted in school-based smoking-prevention research. Social-influences approach The goal of the study, called the Hutchinson Smoking Prevention Project (HSPP), was to find out whether a school-based smoking-prevention program using a social-influences approach can keep youth from smoking throughout and beyond high school. The social-influences approach centers on countering the social influences to smoke, from peer pressure to tobacco advertising. Smoking Prevention Project establishes "a new standard for scientific rigor' The National Cancer Institute funded the $15 million study as part of a national research effort to address the increasing prevalence of daily smoking in youth. If the current trend is not reversed, an estimated 5 million of today's youth will die prematurely from smoking-related illnesses, according to the Centers for Disease Control and Prevention. The study began in 1984, and follow-up surveys were completed in 1999. Half of the study's 40 rural and suburban school districts were randomly assigned to the experimental group, which implemented the HSPP curriculum, and half served as comparison, or control, districts, teaching their usual health programs. Because smoking almost always begins during or before the teen years, HSPP intervention covered virtually the entire age range of smoking onset, starting early (third grade), and continuing into high school (10 th grade). Despite rigorous study design, faithful teaching of the program, and a high rate of follow-up of the study participants, HSPP found no difference in smoking behavior between the experimental and control groups. Nearly identical rates `It's disappointing, because we know that youth need our help to withstand the considerable forces that are out there the social pressures, whether from tobacco advertising, marketing, peer pressure. They need our help, and we were not able to identify a program that succeeded.' DR. ART PETERSON, LEAD INVESTIGATOR, HUTCHINSON SMOKING PREVENTION PROJECT     Questionnaires completed by the students during their senior year, and again two years after high school, showed almost identical rates of smoking. For example, among 12 th grade girls, 24.4 percent in the experimental group smoked daily, little different from 24.7 percent in the control group. For 12 th grade boys, the percentages for daily smoking were 26.3 percent experimental and 26.7 percent control. The project's lead investigator, Dr. Art Peterson of the Public Health Sciences Division, says the results clearly show the current approach to smoking prevention via school programs isn't enough to deter youth from smoking. "Surprisingly and disappointingly, we found a striking similarity in smoking prevalence between the experimental and control groups," says Peterson, also a professor of biostatistics at the University of Washington. "It's disappointing because we know that youth need our help to withstand the considerable forces that are out there the social pressures, whether from tobacco advertising, marketing, peer pressure. They need our help, and we were not able to identify a program that succeeded. "It's surprising because the social-influences approach is such an attractive one. Tobacco-prevention researchers and educators have pinned their hopes on it for the past 25 years without knowing for sure if it works." While unfortunate, the trial's results are definitive, Peterson says. "Because of the high degree of rigor achieved in this trial, the failure to observe reduced smoking prevalence in the experimental group can be attributed only to the failure of the intervention." To see the abstract or full text of the article from the Dec. 20 edition of the Journal of the National Cancer Institute, visit this web site: <http://jnci.oupjournals.org/cgi/content/abstract/> The director of the NCI, Dr. Richard Klausner, acknowledges the importance of this study. "Although the study demonstrated that this approach had no effect, it provides a valuable contribution to our knowledge about smoking behavior," he says. "Carefully conducted studies such as this one help us to understand what works and what does not in the area of youth smoking." The smoking-prevention program was designed not only to help youth identify and resist influences to smoke, but also to correct their inaccurate perceptions about smoking and motivate them to want to be smoke-free. The program was delivered by regular classroom teachers who had been trained for the task by Hutch staff. Cam Huynh, HSPP program assistant, processes cotton dental rolls of student participants' saliva, a percentage of which were analyzed for cotinine, a derivative of nicotine, for cross-checking with questionnaire results.     Lessons engaged students in a variety of activities. Examples include third-graders making paper-bag puppets and performing a play about the dangers of second-hand smoke and the value of breathing clean air; seventh- and eighth-graders using role-play and coaching exercises to practice new skills for countering offers of tobacco; and ninth-graders re-enacting testimony from landmark tobacco-liability trials to discover the industry's attempts to conceal the deadly consequences of smoking. "Teachers did their darndest, and the educational materials were top-notch," Peterson says. Peterson and colleagues conclude that a wholly new approach to smoking prevention may be needed, one that incorporates different theories, intervention strategies, venues and/or providers. "The fact that the intervention didn't have an effect means that it is time for researchers to go back to the drawing board to re-examine the smoking-onset process in children and develop new strategies for reaching youth," he says. Sharp research stimulus "We expect that the results of the study will be a sharp stimulus to researchers to redouble their efforts to find the key to effective smoking prevention among youth. Certainly, this study has shown that rigorous, school-based research is possible and practical for testing new approaches." Peterson praises the interest and cooperation of the 40 participating school districts. "This was truly a team effort involving many thousands of people across the state," he says. "This study experienced great cooperation from students, parents, teachers, administrators and staff. We are so grateful to them." Project collaborators included Kathleen Kealey, intervention manager; Sue Mann, data operations manager; Pat Marek, database manager; health psychologist Dr. Deborah Bowen of PHS and an affiliate assistant professor of psychology at UW; and economic analyst Dr. Nicole Urban of PHS and an associate professor of health services at UW. Also collaborating on the study was UW psychology professor Dr. Irwin Sarason. Over its 15 years, HSPP has employed about 50 staff, up to 28 of whom worked on the project at any one time. The NCI-funded trial was supported in part by the Northern Life Insurance Company.