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School Anti-Smoking Programs Don't Work

By age 18, kids exposed to programs were as likely to smoke as those who weren't

THURSDAY, March 3, 2005 (HealthDay News) -- Anti-smoking programs in schools are not enough to keep kids from lighting up later on down the road, Indiana University researchers say.

A review of eight studies that followed more than 25,000 mostly middle-school-age children who attended anti-smoking classes during the school day found that by their senior year in high school, there was no difference in the smoking habits of the children who'd attended classes compared to those who'd hadn't. Both groups reported that more than half of them had smoked recently.

"It was very discouraging. These were eight well-done studies and only one had a positive result. Based on this evidence, money to promote anti-smoking would be more effectively spent on other areas, including media and tax-based intervention," said study author Dr. Sarah Wiehe, an assistant professor of pediatrics at Indiana University School of Medicine in Indianapolis.

The study appears in the March issue of the Journal of Adolescent Health.

The in-school programs, which included lectures on the health risks of cigarettes, talks by other children about the dangers of smoking, and role-modeling sessions (where kids would act out ways to resist peer pressure to smoke) were 30 percent to 70 percent effective in curbing smoking for up to three years after the completion of the classes, Wiehe said.

But by their senior year in high school, when most of the children were 18, those who had participated in the classes were smoking just as much as those who hadn't taken the classes. This is important, Wiehe said, because the smoking habits of 18-year-olds are predictive of adult smoking habits. About one-quarter of teens in this age group are already regular smokers, she said.

K. Michael Cummings, a smoking expert at Roswell Park Cancer Institute, in Buffalo, said he isn't surprised by the findings because, without reinforcement outside of the classroom, these programs are unlikely to succeed. None of the programs examined in the study included components outside school.

"If you don't have a good strong community program, like counter-advertising, or taxes on cigarettes, all the time and efforts in the school-based program aren't going to be reinforced," he said. "Any school-based program, no matter how well-implemented, is not likely to be termed effective given the other clutter in the environment that tends to work to promote smoking."

The Indiana study comes at a time when states are receiving millions of dollars a year to fund anti-smoking programs from tobacco companies as a result of a 1998 settlement with these companies. However, recent data suggests many states aren't spending this windfall on anti-smoking initiatives.

For example, a study in last month's American Journal of Public Health found states are spending only 2.7 percent of the tobacco-settlement money on anti-smoking programs -- a 27 percent decline in what was spent on these programs in 2001, and far below the 8 percent spending the U.S. Centers for Disease Control and Prevention recommends as necessary to lower smoking rates.

Wiehe said that, with this decline in spending on anti-smoking initiatives, her team's study becomes even more important because it isolates school-based education programs -- a key part of many multi-pronged anti-smoking initiatives -- and shows they may be largely ineffective.

"With limited funding, you need to concentrate the money in the area where you know it's going to pay off, which is not this area," she said.

More information

A look back at the history of anti-smoking campaigns can be found at The National Library of Medicine.

SOURCES: Sarah Wiehe, M.D. M.P.H., assistant professor, pediatrics, Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis; K. Michael Cummings, Ph.D., M.P.H., Department of Cancer Prevention, Epidemiology and Biostatistics, Roswell Park Cancer, Institute, Buffalo, N.Y.; March 2005 Journal of Adolescent Health
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