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American Journal of Public Health logoLink to American Journal of Public Health
. 1993 Jun;83(6):872–880. doi: 10.2105/ajph.83.6.872

A meta-analysis of adolescent smoking prevention programs.

W H Bruvold 1
PMCID: PMC1694752  PMID: 8498627

Abstract

OBJECTIVES. A large number of studies evaluating adolescent smoking prevention programs have been published. Systematic quantitative reviews of this literature are needed to learn what does and does not work. The present meta-analysis focuses on the efficacy of school-based programs. METHODS. Evaluations of 94 separate interventions were included in the meta-analysis. Studies were screened for methodological rigor and those with weaker methodology were segregated from those with more defensible methodology; major analyses focused on the latter. RESULTS. Behavioral effect sizes were found to be largest for interventions with a social reinforcement orientation, moderate for interventions with either a developmental or a social norms orientation, and small for interventions with the traditional rational orientation. Attitude effect sizes followed the same pattern, but knowledge effect sizes were similar across all four orientation categories. CONCLUSIONS. Because behavioral effect represents the fundamental objective of programs for prevention of adolescent tobacco use, the present results indicate that school-based programs should consider adopting interventions with a social reinforcement, social norms, or developmental orientation.

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Selected References

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  1. Allendorff S., Sunseri A. J., Cullinan J., Oman J. K. Student heart health knowledge, smoking attitudes, and self-esteem. J Sch Health. 1985 May;55(5):196–199. doi: 10.1111/j.1746-1561.1985.tb04119.x. [DOI] [PubMed] [Google Scholar]
  2. Andrews R. L., Hearne J. T. Effects of primary grades health curriculum project on student and parent smoking attitudes and behavior. J Sch Health. 1984 Jan;54(1):18–20. doi: 10.1111/j.1746-1561.1984.tb08748.x. [DOI] [PubMed] [Google Scholar]
  3. Arciti C., Santi L. An Italian program of information and education on cancer prevention and the hazards of smoking: a 3-year report. Cancer Detect Prev. 1986;9(5-6):421–427. [PubMed] [Google Scholar]
  4. Arkin R. M., Roemhild H. F., Johnson C. A., Luepker R. V., Murray D. M. The Minnesota smoking prevention program: a seventh-grade health curriculum supplement. J Sch Health. 1981 Nov;51(9):611–616. doi: 10.1111/j.1746-1561.1981.tb02246.x. [DOI] [PubMed] [Google Scholar]
  5. Bangert-Drowns R. L. The effects of school-based substance abuse education--meta-analysis. J Drug Educ. 1988;18(3):243–264. doi: 10.2190/8U40-WP3D-FFWC-YF1U. [DOI] [PubMed] [Google Scholar]
  6. Battjes R. J. Prevention of adolescent drug abuse. Int J Addict. 1985 Jun-Jul;20(6-7):1113–1134. doi: 10.3109/10826088509047767. [DOI] [PubMed] [Google Scholar]
  7. Bernstein D. A. Modification of smoking behavior: an evaluative review. Psychol Bull. 1969 Jun;71(6):418–440. doi: 10.1037/h0027367. [DOI] [PubMed] [Google Scholar]
  8. Best J. A., Thomson S. J., Santi S. M., Smith E. A., Brown K. S. Preventing cigarette smoking among school children. Annu Rev Public Health. 1988;9:161–201. doi: 10.1146/annurev.pu.09.050188.001113. [DOI] [PubMed] [Google Scholar]
  9. Biglan A., Severson H., Ary D., Faller C., Gallison C., Thompson R., Glasgow R., Lichtenstein E. Do smoking prevention programs really work? Attrition and the internal and external validity of an evaluation of a refusal skills training program. J Behav Med. 1987 Apr;10(2):159–171. doi: 10.1007/BF00846424. [DOI] [PubMed] [Google Scholar]
  10. Botvin G. J., Baker E., Renick N. L., Filazzola A. D., Botvin E. M. A cognitive-behavioral approach to substance abuse prevention. Addict Behav. 1984;9(2):137–147. doi: 10.1016/0306-4603(84)90051-0. [DOI] [PubMed] [Google Scholar]
  11. Botvin G. J., Eng A. A comprehensive school-based smoking prevention program. J Sch Health. 1980 Apr;50(4):209–213. doi: 10.1111/j.1746-1561.1980.tb07378.x. [DOI] [PubMed] [Google Scholar]
  12. Botvin G. J., Eng A. The efficacy of a multicomponent approach to the prevention of cigarette smoking. Prev Med. 1982 Mar;11(2):199–211. doi: 10.1016/0091-7435(82)90018-4. [DOI] [PubMed] [Google Scholar]
  13. Botvin G. J., Eng A., Williams C. L. Preventing the onset of cigarette smoking through life skills training. Prev Med. 1980 Jan;9(1):135–143. doi: 10.1016/0091-7435(80)90064-x. [DOI] [PubMed] [Google Scholar]
  14. Botvin G. J., Renick N. L., Baker E. The effects of scheduling format and booster sessions on a broad-spectrum psychosocial approach to smoking prevention. J Behav Med. 1983 Dec;6(4):359–379. doi: 10.1007/BF00846324. [DOI] [PubMed] [Google Scholar]
  15. Callner D. A. Behavioral treatment approaches to drug abuse: a critical review of the research. Psychol Bull. 1975 Mar;82(2):143–164. doi: 10.1037/h0076529. [DOI] [PubMed] [Google Scholar]
  16. Christenson P. D. An evaluation of quantitative and qualitative assessment techniques on the impact of the SERR curriculum. J Sch Health. 1985 May;55(5):200–204. doi: 10.1111/j.1746-1561.1985.tb04120.x. [DOI] [PubMed] [Google Scholar]
  17. Clarke J. H., MacPherson B., Holmes D. R., Jones R. Reducing adolescent smoking: a comparison of peer-led, teacher-led, and expert interventions. J Sch Health. 1986 Mar;56(3):102–106. doi: 10.1111/j.1746-1561.1986.tb05707.x. [DOI] [PubMed] [Google Scholar]
  18. Coe R. M., Crouse E., Cohen J. D., Fisher E. B., Jr Patterns of change in adolescent smoking behavior and results of a one year follow-up of a smoking prevention program. J Sch Health. 1982 Aug;52(8):348–353. doi: 10.1111/j.1746-1561.1982.tb07133.x. [DOI] [PubMed] [Google Scholar]
  19. Connell D. B., Turner R. R., Mason E. F. Summary of findings of the School Health Education Evaluation: health promotion effectiveness, implementation, and costs. J Sch Health. 1985 Oct;55(8):316–321. doi: 10.1111/j.1746-1561.1985.tb05656.x. [DOI] [PubMed] [Google Scholar]
  20. Connell D. B., Turner R. R. School Health Education Evaluation. The impact of instructional experience and the effects of cumulative instruction. J Sch Health. 1985 Oct;55(8):324–331. doi: 10.1111/j.1746-1561.1985.tb05657.x. [DOI] [PubMed] [Google Scholar]
  21. Cook R. J., Olsen L. K. Assessment of the cognitive effect of a prototype health education unit on sixth grade students. J Sch Health. 1975 Sep;45(7):390–393. doi: 10.1111/j.1746-1561.1975.tb04500.x. [DOI] [PubMed] [Google Scholar]
  22. DeJong W. A short-term evaluation of project DARE (Drug Abuse Resistance Education): preliminary indications of effectiveness. J Drug Educ. 1987;17(4):279–294. doi: 10.2190/N2JC-9DXB-BLFD-41EA. [DOI] [PubMed] [Google Scholar]
  23. Del Greco L., Breitbach L., Rumer S., McCarthy R. H., Suissa S. Four-year results of a youth smoking prevention program using assertiveness training. Adolescence. 1986 Fall;21(83):631–640. [PubMed] [Google Scholar]
  24. Denson R., Stretch S. Prevention of smoking in elementary schools. Can J Public Health. 1981 Jul-Aug;72(4):259–263. [PubMed] [Google Scholar]
  25. Dielman T. E., Lorenger A. T., Leech S. L., Lyons A. L., Klos D. M., Horvath W. J. Fifteen-month follow-up results of an elementary school based smoking prevention project. Resisting pressures to smoke. Hygie. 1985 Dec;4(4):28–35. [PubMed] [Google Scholar]
  26. Dupont P. J., Jason L. A. Assertiveness training in a preventive drug education program. J Drug Educ. 1984;14(4):369–378. doi: 10.2190/9MVU-RKDQ-H9ML-TE2E. [DOI] [PubMed] [Google Scholar]
  27. Flay B. R., Koepke D., Thomson S. J., Santi S., Best J. A., Brown K. S. Six-year follow-up of the first Waterloo school smoking prevention trial. Am J Public Health. 1989 Oct;79(10):1371–1376. doi: 10.2105/ajph.79.10.1371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Flay B. R. Psychosocial approaches to smoking prevention: a review of findings. Health Psychol. 1985;4(5):449–488. doi: 10.1037//0278-6133.4.5.449. [DOI] [PubMed] [Google Scholar]
  29. Flay B. R., Ryan K. B., Best J. A., Brown K. S., Kersell M. W., d'Avernas J. R., Zanna M. P. Are social-psychological smoking prevention programs effective? The Waterloo study. J Behav Med. 1985 Mar;8(1):37–59. doi: 10.1007/BF00845511. [DOI] [PubMed] [Google Scholar]
  30. Gersick K. E., Grady K., Snow D. L. Social-cognitive skill development with sixth graders and its initial impact on substance use. J Drug Educ. 1988;18(1):55–70. doi: 10.2190/TPND-4H44-HL8U-453T. [DOI] [PubMed] [Google Scholar]
  31. Gillies P. A., Wilcox B. Reducing the risk of smoking amongst the young. Public Health. 1984 Jan;98(1):49–54. doi: 10.1016/s0033-3506(84)80060-8. [DOI] [PubMed] [Google Scholar]
  32. Glynn T. J. Essential elements of school-based smoking prevention programs. J Sch Health. 1989 May;59(5):181–188. doi: 10.1111/j.1746-1561.1989.tb04698.x. [DOI] [PubMed] [Google Scholar]
  33. Greenberg J. S., Deputat Z. Smoking intervention: comparing three methods in a high school setting. J Sch Health. 1978 Oct;48(8):498–502. doi: 10.1111/j.1746-1561.1978.tb05257.x. [DOI] [PubMed] [Google Scholar]
  34. Hansen W. B., Evans R. I. Feedback versus information concerning carbon monoxide as an early intervention strategy in adolescent smoking. Adolescence. 1982 Spring;17(65):89–98. [PubMed] [Google Scholar]
  35. Hansen W. B., Johnson C. A., Flay B. R., Graham J. W., Sobel J. Affective and social influences approaches to the prevention of multiple substance abuse among seventh grade students: results from project SMART. Prev Med. 1988 Mar;17(2):135–154. doi: 10.1016/0091-7435(88)90059-x. [DOI] [PubMed] [Google Scholar]
  36. Hansen W. B., Malotte C. K., Fielding J. E. Evaluation of a tobacco and alcohol abuse prevention curriculum for adolescents. Health Educ Q. 1988 Spring;15(1):93–114. doi: 10.1177/109019818801500109. [DOI] [PubMed] [Google Scholar]
  37. Hurd P. D., Johnson C. A., Pechacek T., Bast L. P., Jacobs D. R., Luepker R. V. Prevention of cigarette smoking in seventh grade students. J Behav Med. 1980 Mar;3(1):15–28. doi: 10.1007/BF00844911. [DOI] [PubMed] [Google Scholar]
  38. Iammarino N., Heit P., Kaplan R. School Health Curriculum Project: long term effects on student cigarette smoking and behavior. Health Educ. 1980 Mar-Apr;11(2):29–31. [PubMed] [Google Scholar]
  39. Jason L. A., Mollica M., Ferrone L. Evaluating an early secondary smoking prevention intervention. Prev Med. 1982 Jan;11(1):96–102. doi: 10.1016/0091-7435(82)90008-1. [DOI] [PubMed] [Google Scholar]
  40. Johnson C. A., Hansen W. B., Collins L. M., Graham J. W. High-school smoking prevention: results of a three-year longitudinal study. J Behav Med. 1986 Oct;9(5):439–452. doi: 10.1007/BF00845132. [DOI] [PubMed] [Google Scholar]
  41. Kim S. Feeder area approach: an impact evaluation of a prevention project on student drug abuse. Int J Addict. 1982 Feb;17(2):305–313. doi: 10.3109/10826088209071014. [DOI] [PubMed] [Google Scholar]
  42. Kozlowski L. T., Coambs R. B., Ferrence R. G., Adlaf E. M. Preventing smoking and other drug use: let the buyers beware and the interventions be apt. Can J Public Health. 1989 Nov-Dec;80(6):452–456. [PubMed] [Google Scholar]
  43. Lammers J. W., Kreuter M. W., Smith B. C. The effects of the SHCP on selected aspects of decision-making among fifth graders. Health Educ. 1984 Mar-Apr;15(2):14–17. [PubMed] [Google Scholar]
  44. Leventhal H., Cleary P. D. The smoking problem: a review of the research and theory in behavioral risk modification. Psychol Bull. 1980 Sep;88(2):370–405. doi: 10.1037/0033-2909.88.2.370. [DOI] [PubMed] [Google Scholar]
  45. Lotecka L., MacWhinney M. Enhancing decision behavior in high school "smokers". Int J Addict. 1983 May;18(4):479–490. doi: 10.3109/10826088309033032. [DOI] [PubMed] [Google Scholar]
  46. Luepker R. V., Johnson C. A., Murray D. M., Pechacek T. F. Prevention of cigarette smoking: three-year follow-up of an education program for youth. J Behav Med. 1983 Mar;6(1):53–62. doi: 10.1007/BF00845276. [DOI] [PubMed] [Google Scholar]
  47. MacPherson B. V., Ashikaga T., Dickstein M. S., Jones R. P., Jr Evaluation of a respiratory health education program. J Sch Health. 1980 Dec;50(10):564–567. doi: 10.1111/j.1746-1561.1980.tb02057.x. [DOI] [PubMed] [Google Scholar]
  48. Marcus A. C., Wheeler R. C., Cullen J. W., Crane L. A. Quasi-experimental evaluation of the Los Angeles Know Your Body program: knowledge, beliefs, and self-reported behaviors. Prev Med. 1987 Nov;16(6):803–815. doi: 10.1016/0091-7435(87)90020-x. [DOI] [PubMed] [Google Scholar]
  49. McAlister A. L., Perry C., Maccoby N. Adolescent smoking: onset and prevention. Pediatrics. 1979 Apr;63(4):650–658. [PubMed] [Google Scholar]
  50. McAlister A., Perry C., Killen J., Slinkard L. A., Maccoby N. Pilot study of smoking, alcohol and drug abuse prevention. Am J Public Health. 1980 Jul;70(7):719–721. doi: 10.2105/ajph.70.7.719. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Mitchel M. E., Hu T. W., McDonnell N. S., Swisher J. D. Cost-effectiveness analysis of an educational drug abuse prevention program. J Drug Educ. 1984;14(3):271–292. doi: 10.2190/LYPB-TMR5-P7H0-NGJP. [DOI] [PubMed] [Google Scholar]
  52. Moskowitz J. M., Malvin J. H., Schaeffer G. A., Schaps E. An experimental evaluation of a drug education course. J Drug Educ. 1984;14(1):9–22. doi: 10.2190/R977-NCC7-9ET5-3PLX. [DOI] [PubMed] [Google Scholar]
  53. Moskowitz J. M., Malvin J., Schaeffer G. A., Schaps E. Evaluation of a junior high school primary prevention program. Addict Behav. 1983;8(4):393–401. doi: 10.1016/0306-4603(83)90040-0. [DOI] [PubMed] [Google Scholar]
  54. Moskowitz J. M., Schaps E., Schaeffer G. A., Malvin J. H. Evaluation of a substance abuse prevention program for junior high school students. Int J Addict. 1984 Jul;19(4):419–430. doi: 10.3109/10826088409057192. [DOI] [PubMed] [Google Scholar]
  55. Murray D. M., Davis-Hearn M., Goldman A. I., Pirie P., Luepker R. V. Four- and five-year follow-up results from four seventh-grade smoking prevention strategies. J Behav Med. 1988 Aug;11(4):395–405. doi: 10.1007/BF00844938. [DOI] [PubMed] [Google Scholar]
  56. Murray D. M., Pirie P., Leupker R. V., Pallonen U. Five- and six-year follow-up results from four seventh-grade smoking prevention strategies. J Behav Med. 1989 Apr;12(2):207–218. doi: 10.1007/BF00846551. [DOI] [PubMed] [Google Scholar]
  57. Murray D. M., Richards P. S., Luepker R. V., Johnson C. A. The prevention of cigarette smoking in children: two- and three-year follow-up comparisons of four prevention strategies. J Behav Med. 1987 Dec;10(6):595–611. doi: 10.1007/BF00846657. [DOI] [PubMed] [Google Scholar]
  58. Murray M., Rona R. J., Morris R. W., Tait N. The smoking and dietary behaviour of Lambeth schoolchildren. I. The effectiveness of an anti-smoking and nutrition education programme for children. Public Health. 1984 May;98(3):163–172. doi: 10.1016/s0033-3506(84)80041-4. [DOI] [PubMed] [Google Scholar]
  59. Murray M., Swan A. V., Clarke G. Long term effect of a school based antismoking programme. J Epidemiol Community Health. 1984 Sep;38(3):247–252. doi: 10.1136/jech.38.3.247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Pederson L. L., Baskerville J. C., Lefcoe N. M. Change in smoking status among school-aged youth: impact of a smoking-awareness curriculum, attitudes, knowledge and environmental factors. Am J Public Health. 1981 Dec;71(12):1401–1404. doi: 10.2105/ajph.71.12.1401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Perry C. L., Killen J., Slinkard L. A., McAlister A. L. Peer teaching and smoking prevention among junior high students. Adolescence. 1980 Summer;15(58):277–281. [PubMed] [Google Scholar]
  62. Perry C., Killen J., Telch M., Slinkard L. A., Danaher B. G. Modifying smoking behavior of teenagers: a school-based intervention. Am J Public Health. 1980 Jul;70(7):722–725. doi: 10.2105/ajph.70.7.722. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Peterson A. J., Clark A. W. Using group decision to reduce adolescent girls' smoking. Psychol Rep. 1986 Feb;58(1):179–185. doi: 10.2466/pr0.1986.58.1.179. [DOI] [PubMed] [Google Scholar]
  64. Piper G. W., Jones J. A., Matthews V. L. The Saskatoon Smoking Study. Results of the first year. Can J Public Health. 1971 Sep-Oct;62(5):432–441. [PubMed] [Google Scholar]
  65. Piper G. W., Jones J. A., Matthews V. L. The Saskatoon smoking study: results of the second year. Can J Public Health. 1974 Mar-Apr;65(2):127–129. [PubMed] [Google Scholar]
  66. Puska P., Vartiainen E., Pallonen U., Salonen J. T., Pöyhiä P., Koskela K., McAlister A. The North Karelia youth project: evaluation of two years of intervention on health behavior and CVD risk factors among 13- to 15-year old children. Prev Med. 1982 Sep;11(5):550–570. doi: 10.1016/0091-7435(82)90068-8. [DOI] [PubMed] [Google Scholar]
  67. Rabinowitz H. S., Zimmerli W. H. Effects of a health education program on junior high school students' knowledge, attitudes, and behavior concerning tobacco use. J Sch Health. 1974 Jun;44(6):324–330. doi: 10.1111/j.1746-1561.1974.tb07646.x. [DOI] [PubMed] [Google Scholar]
  68. Rhodes J. E., Jason L. A. The retrospective pretest: an alternative approach in evaluating drug prevention programs. J Drug Educ. 1987;17(4):345–356. doi: 10.2190/1LNK-BH22-F201-8JE3. [DOI] [PubMed] [Google Scholar]
  69. Sarvela P. D., McClendon E. J. An impact evaluation of a rural youth drug education program. J Drug Educ. 1987;17(3):213–231. doi: 10.2190/VK1A-D6WV-7GX7-DH6N. [DOI] [PubMed] [Google Scholar]
  70. Schinke S. P., Gilchrist L. D. Preventing substance abuse with children and adolescents. J Consult Clin Psychol. 1985 Oct;53(5):596–602. doi: 10.1037//0022-006x.53.5.596. [DOI] [PubMed] [Google Scholar]
  71. Schinke S. P., Gilchrist L. D. Preventing tobacco use among young people. Health Soc Work. 1986 Winter;11(1):59–65. doi: 10.1093/hsw/11.1.59. [DOI] [PMC free article] [PubMed] [Google Scholar]
  72. Schinke S. P., Gilchrist L. D. Primary prevention of tobacco smoking. J Sch Health. 1983 Sep;53(7):416–419. doi: 10.1111/j.1746-1561.1983.tb03151.x. [DOI] [PubMed] [Google Scholar]
  73. Schinke S. P., Gilchrist L. D., Snow W. H., Schilling R. F., 2nd Skills-building methods to prevent smoking by adolescents. J Adolesc Health Care. 1985 Nov;6(6):439–444. doi: 10.1016/s0197-0070(85)80049-8. [DOI] [PubMed] [Google Scholar]
  74. Schinke S. P., Gilchrist L. D., Snow W. H. Skills intervention to prevent cigarette smoking among adolescents. Am J Public Health. 1985 Jun;75(6):665–667. doi: 10.2105/ajph.75.6.665. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Shaffer H., Beck J. C., Boothroyd P. The primary prevention of smoking onset: an inoculation approach. J Psychoactive Drugs. 1983 Jul-Sep;15(3):177–184. doi: 10.1080/02791072.1983.10471946. [DOI] [PubMed] [Google Scholar]
  76. Stone E. J. The effects of a fifth grade health education curriculum model on perceived vulnerability and smoking attitudes. J Sch Health. 1978 Jan;48(1):667–671. doi: 10.1111/j.1746-1561.1978.tb03781.x. [DOI] [PubMed] [Google Scholar]
  77. Tell G. S., Klepp K. I., Vellar O. D., McAlister A. Preventing the onset of cigarette smoking in Norwegian adolescents: the Oslo youth study. Prev Med. 1984 May;13(3):256–275. doi: 10.1016/0091-7435(84)90083-5. [DOI] [PubMed] [Google Scholar]
  78. Thompson E. L. Smoking education programs 1960-1976. Am J Public Health. 1978 Mar;68(3):250–257. doi: 10.2105/ajph.68.3.250. [DOI] [PMC free article] [PubMed] [Google Scholar]
  79. Vartiainen E., Pallonen U., McAlister A., Koskela K., Puska P. Four-year follow-up results of the smoking prevention program in the North Karelia Youth Project. Prev Med. 1986 Nov;15(6):692–698. doi: 10.1016/0091-7435(86)90074-5. [DOI] [PubMed] [Google Scholar]
  80. Zoller U., Maymon T. Effectiveness evaluation of smoking, drug, and alcohol education courses via actual relevant behavior (the smoking education curriculum MSACS as an illustrative case study). J Drug Educ. 1986;16(1):1–12. doi: 10.2190/1MB5-90W1-TPHP-2HCM. [DOI] [PubMed] [Google Scholar]

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