COLUMBUS, Ohio -- Active participation in learning how to "just say no" to cigarettes is much more effective than simply lecturing teenagers on the long-term health consequences of smoking.
Recent research shows that actively involving students in a skills-based program can increase their confidence in refusing an offer to smoke. These skills can also increase a student's expectation that his peers will accept the decision -- without the fear of dire social consequences.
"The smoking prevention programs that work go beyond the simple delivery of health information," said Rick Petosa, co-author of the study and an associate professor of health promotion at Ohio State University. "The successful programs focus on social pressures and on developing the skills necessary to resist those pressures.
"Other researchers have found that these kinds of programs can cut the rate at which adolescents begin to smoke by 30 to 50 percent. In light of the recent tobacco settlements, policy makers would be wise to note that it is the skills-based programs that work to prevent smoking."
Many states will receive a portion of the multi-billion dollar tobacco settlement. Part of the money is required to go toward smoking prevention efforts.
About 25 percent of ninth graders smoke, Petosa said. Eighty-five percent of all smokers begin the habit before the age of 18. The research appeared in a recent issue of the Journal of School Health.
Petosa and his colleagues examined the effectiveness of the Minnesota Smoking Prevention Program, a six-lesson program that addresses the social pressures to smoke. Students from five sixth-grade classes attended 45-minute sessions twice a week for three weeks. During each session, student leaders facilitated small group discussions and activities with other classmates. The students evaluated cigarette advertisements and role-played various peer-pressure situations.
For comparison, five other sixth-grade classes received at least one lecture during the same time period on the health consequences of smoking.
One week before treatment began, all students completed a questionnaire focusing on their skills and beliefs about pressures to smoke. Students filled out the same questionnaire four weeks after the intervention period ended.
The researchers assessed four objectives: the students' ability to resist positive images of smoking; how confident they were in their ability to say no; if they thought saying no would be accepted by their peers, and therefore have a positive social outcome; and, finally, if they believed the social impact would be a negative one if they refused an offer to smoke.
"The smoking prevention program had a significant impact on the students' confidence in their abilities to say no," Petosa said of the students involved in the prevention program. "It also increased their belief that their peers would think that the decision not to smoke was an acceptable one."
Yet the intervention had little effect on the students' ability to objectively evaluate favorable images of smoking they saw in the media. And although the program helped students see positive social outcomes from refusing to smoke, the results showed students still anticipated and worried about negative consequences.
"Kids have real social concerns about the negative consequences of refusing an offer from their peers," Petosa said. "While this program was not able to change that, it did reinforce students' existing levels of skill and confidence in refusing cigarettes."
The comparison classes dropped in confidence levels and in their expectations for acceptance by their peers when refusing a cigarette. Also, there was no significant change in their ability to objectively evaluate positive images of smoking or their fears of negative social outcomes.
"Lecturing to teenagers about the health risks of smoking does not discourage them from smoking," Petosa said. "Social influence programs, on the other hand, focus specifically on the things that adolescents worry about. These programs address the social meaning behind smoking. It's more appropriate to teach teenagers about short-term consequences."
In all classes, students reported feeling most confident when saying "no" to a best friend; that being hassled to smoke was the hardest type of pressure to resist; and that saying "no" at a friend's house was more difficult than turning down an offer of cigarettes at school.
Petosa co-authored the study with Marietta Langlois of Middletown Regional Hospital in Franklin, Ohio, and Jeffrey Hallam, an assistant professor of health, human performance and recreation at Baylor University.
Contact: Rick Petosa, (614) 292-8345; Petosa.1@osu.edu
Written by Holly Wagner, (614) 292-8310; Wagner.235@osu.edu
Journal
Journal of School Health