Original article
A systematic review of school-based smoking prevention trials with long-term follow-up

https://doi.org/10.1016/j.jadohealth.2004.12.003Get rights and content

Abstract

Background

Several systematic reviews of school-based smoking prevention trials have shown short-term decreases in smoking prevalence but have not examined long-term follow-up evaluation. The purpose of this study was to conduct a systematic review of rigorously evaluated interventions for school-based smoking prevention with long-term follow-up data.

Methods

We searched online bibliographic databases and reference lists from review articles and selected studies. We included all school-based, randomized, controlled trials of smoking prevention with follow-up evaluation to age 18 or 12th grade and at least 1 year after intervention ended, and that had smoking prevalence as a primary outcome. The primary outcome was current smoking prevalence (defined as at least 1 cigarette in the past month).

Results

The abstracts or full-text articles of 177 relevant studies were examined, of which 8 met the selection criteria. The 8 articles included studies differing in intervention intensity, presence of booster sessions, follow-up periods, and attrition rates. Only one study showed decreased smoking prevalence in the intervention group.

Conclusions

Few studies have evaluated the long-term impact of school-based smoking prevention programs rigorously. Among the 8 programs that have follow-up data to age 18 or 12th grade, we found little to no evidence of long-term effectiveness.

Section snippets

Data sources

We conducted searches on the MEDLINE database (January 1966 to July 2003), the Cochrane Clinical Trials Registry (as of July 2003), as well as CINAHL, Embase, ERIC, and PsycInfo (all as of July 2003). Search terms used included: (smok* OR cigarette* OR tobacco) AND (school* OR class* OR teach*) AND (adolescen* OR minor OR student* OR child* OR teen* OR girl OR boy OR juvenile*). All searches were limited to randomized controlled trials. In addition, the bibliographies of relevant review

Results of literature search

The online MEDLINE search yielded 255 articles. Searches of CINAHL, Embase, ERIC, and PsycINFO yielded 9,270 articles. No additional studies were located from the Cochrane Controlled Trials Registry or the Medical Editors Trial Amnesty. The most common reasons for exclusion were that follow-up was inadequate or the study was not randomized. Eight studies met all inclusion criteria [25], [26], [27], [28], [29], [30], [31], [32].

Characteristics of included studies

There were variations in study populations, type and intensity of

Discussion

Few randomized controlled studies have evaluated the long-term impact of school-based smoking prevention programs rigorously. Among the 8 studies we analyzed, only 1 showed statistically significant results, suggesting that school-based intervention effects resulted in decreased monthly smoking prevalence at 12th grade or age 18 [25]. It is possible that the Life Skills Program is effective and others are not because it used a relatively high degree of interaction and participation. Because

Conclusion

Based on the available data in 1999, the Centers for Disease Control and Prevention recommended a comprehensive tobacco control program [64] that included a school-based component. In addition, Congress mandated that schools seeking Title IV funds use research-based prevention programs. Despite this, as shown in this systematic review, there is little evidence to suggest that existing programs produce long-term decreases in smoking prevalence.

Acknowledgments

Supported by a grant from the Robert Wood Johnson Foundation. The opinions are those of the authors and not the Robert Wood Johnson Foundation.

The authors wish to thank the authors of the 8 studies included in this review for making available unpublished data from their research. The authors also wish to thank Richard E. Wiehe for his thoughtful review of the manuscript and Thomas D. Koepsell, MD, MPH, for his assistance with data interpretation and analysis.

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