Smoking prevention among urban minority youth: assessing effects on outcome and mediating variables.

We tested the effectiveness of a social resistance/competence enhancement approach to smoking prevention among predominantly Hispanic seventh graders (N = 3,153) from 47 New York City schools. After blocking on school type (public and parochial) and ethnic composition (percent Hispanic), schools were randomly assigned either to receive the 15-session prevention program or to serve as no-contact controls. Using the school as the unit of analysis, significant program effects were found for cigarette smoking, normative expectations concerning peer and adult smoking, smoking prevalence knowledge, social acceptability knowledge, and knowledge of smoking consequences. Using structural modeling techniques, a significant relation was found between the normative expectation and knowledge variables affected by the intervention and posttest smoking, suggesting that changes on these variables mediated the impact of the intervention on cigarette smoking. This study extends the results of previous prevention research and demonstrates the generalizability of this approach to predominantly Hispanic urban minority students.

Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: results of a 3-year study.

Students (N = 4,466) attending 56 schools in New York State were involved in a 3-year study testing the effectiveness of a cognitive-behavioral approach to substance abuse prevention. In a randomized block design, schools were assigned to receive (a) the prevention program with formal provider training and implementation feedback, (b) the prevention program with videotaped provider training and no feedback, or (c) no treatment. After pretest equivalence and comparability of conditions with respect to attrition were established, students who received at least 60% of the prevention program (N = 3,684) were included in analyses of program effectiveness. Significant prevention effects were found for cigarette smoking, marijuana use, and immoderate alcohol use. Prevention effects were also found for normative expectations and knowledge concerning substance use, interpersonal skills, and communication skills.

Smoking behavior of adolescents exposed to cigarette advertising.

The purpose of the study was to explore the relationship between the exposure of adolescents in the seventh and eighth grades to cigarette advertising and their being smokers. A survey questionnaire given to 602 adolescents assessed their exposure to cigarette advertising and provided measures of their smoking behavior, demographic characteristics, and some psychosocial variables. The results indicated that exposure to cigarette advertising and having friends who smoked were predictive of current smoking status. Adolescents with high exposure to cigarette advertising were significantly more likely to be smokers, according to several measures of smoking behavior, than were those with low exposure to cigarette advertising. The findings extend previous research identifying factors that may play a role in the initiation and maintenance of smoking among adolescents.

Prevention of alcohol misuse through the development of personal and social competence: a pilot study.

Seventh graders (N = 239) from two New York City junior high schools were involved in a 9-month study testing the efficacy of a broad-spectrum approach to prevention of alcohol misuse. The two schools were randomly assigned to experimental and control conditions. The seventh graders in the treatment school received a 20-session program targeted at the major cognitive, attitudinal, social and personality factors believed to promote the early stages of alcohol misuse. The program contained material on decision making, coping with anxiety, general social skills and assertiveness (including techniques for resisting peer pressure to drink) as well as information about the short- and long-term consequences of alcohol misuse. Complete pretest, posttest 1 and posttest 2 data were collected from 167 students (89 women). A significantly greater proportion of the students in the experimental group reported less frequent drinking (p less than .02), less drinking per occasion (p less than .04), and less frequent episodes of drunkenness (p less than .01) than the students in the control group.

A cognitive-behavioral approach to substance abuse prevention: one-year follow-up.

This study presents one-year follow-up data from an evaluation study testing the effectiveness of a cognitive-behavioral substance abuse prevention approach which emphasizes the teaching of social resistance skills within the larger context of an intervention designed to enhance general social and personal competence. The follow-up study involved 998 eighth graders from 10 suburban New York junior high schools. Two schools were assigned to each of the following conditions (a) peer-led intervention, (b) peer-led intervention with booster sessions, (c) teacher-led intervention, (d) teacher-led intervention with booster sessions, and (e) control. The original intervention was implemented in the seventh grade; the booster intervention was implemented during the eighth grade. Results indicate that this type of prevention strategy, when implemented by peer leaders in the seventh grade and when additional booster sessions are provided during the eighth grade, can reduce tobacco, alcohol, and marijuana use. Similar effects are evident for females when the prevention program is implemented with fidelity by classroom teachers. Moreover, the prevention program is also capable of producing a significant impact on several hypothesized mediating variables.

A cognitive-behavioral approach to substance abuse prevention.

The effectiveness of a 20 session cognitive-behavioral approach to substance abuse prevention was tested on seventh grade students (n = 1,311) from 10 suburban New York junior high schools. The prevention strategy attempted to reduce intrapersonal pressure to smoke, drink excessively, or use marijuana by fostering the development of general life skills as well as teaching students tactics for resisting direct interpersonal pressure to use these substances. Additionally, this study was designed to compare the relative effectiveness of this type of prevention program when implemented by either older peer leaders or regular classroom teachers. Results indicated that the prevention program had a significant impact on cigarette smoking, excessive drinking, and marijuana use when implemented by peer leaders. Furthermore, significant changes were also evident with respect to selected cognitive, attitudinal, and personality predisposing variables in a direction consistent with non-substance use. These results provide further support for the efficacy of a broad-spectrum smoking prevention strategy and tentative support for its applicability to the prevention of other forms of substance abuse.

Correlates and predictors of smoking among black adolescents.

Little is known about the etiology of cigarette smoking among minority populations. This study examines the correlates and predictors of smoking among inner-city black seventh graders (N = 608). Enhanced self-reports of cigarette smoking were collected along with data concerning demographic, social, and psychological factors hypothesized to promote smoking initiation. Results indicate that social environmental factors, such as the smoking status of friends and siblings, and individual factors, such as refusal assertiveness, general assertiveness, and age are predictive of current smoking. Similarly, the smoking status of friends, attitudes concerning the harmful effects of smoking, and low self-esteem concerning schools are predictive of behavioral intention to smoke in the future. Overall, the factors that were the most salient predictors of smoking for the black adolescents in this study are generally congruent with the existing literature for other populations.

Factors promoting cigarette smoking among black youth: a causal modeling approach.

A longitudinal model of Black adolescent smoking was tested using 223 seventh-grade students attending public schools in northern New Jersey. Interpersonal and intrapersonal factors were hypothesized to have an impact on Black seventh graders' decision to smoke. After conducting an exploratory Principal Factor Analysis (PFA) using a varimax rotation with the Time 1 data, a structural equation model was developed and refined through successive iterations. The final model revealed friends' smoking to be the most significant predictor of Black adolescent smoking at Time 1, but perceived smoking norms and intrapersonal factors such as decision making, self-efficacy, and self-esteem at home and at school exerted an important influence on smoking at Time 2. These results suggest that social influence factors may be important early in the smoking initiation process, but factors such as perceived smoking norms and intrapersonal factors may play an important role in maintaining the smoking habit in Black adolescents.

The false consensus effect: predicting adolescents' tobacco use from normative expectations.

A longitudinal sample of 916 adolescents was examined to assess the extent to which the perceived smoking prevalence of adults' or peers' smoking was related to cigarette smoking. Questionnaires were distributed to junior high school students in Grade 7 and again in Grade 9. Prevalence of perceived peers' smoking and prevalence of perceived adults' smoking were significantly related to cigarette smoking both cross-sectionally and longitudinally. Adolescents who believed that half or more than half of all adults or peers smoked cigarettes showed the most smoking involvement, and those who believed that fewer than half of adults or peers smoked were least involved. These findings provide further evidence that adolescent normative expectations about cigarette smoking are an important determinant of smoking initiation.

Adolescent cigarette smoking: prevalence, causes, and intervention approaches.

Cigarette smoking continues to be a major public health problem that specifically affects the adolescent population. This chapter discusses current prevalence rates, recent trends, and the etiology of adolescent smoking, as well as strategies for preventing or reducing it. The authors highlight the prevention approaches demonstrated to effectively influence smoking behavior, such as those that teach adolescents social resistance skills and antismoking norms alone or in combination with teaching overall personal and social skills.

Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population.

OBJECTIVE: To evaluate the long-term efficacy of a school-based approach to drug abuse prevention. DESIGN: Randomized trial involving 56 public schools that received the prevention program with annual provider training workshops and ongoing consultation, the prevention program with videotaped training and no consultation, or "treatment as usual" (ie, controls). Follow-up data were collected 6 years after baseline using school, telephone, and mailed surveys. PARTICIPANTS: A total of 3597 predominantly white, 12th-grade students who represented 60.41% of the initial seventh-grade sample. INTERVENTION: Consisted of 15 classes in seventh grade, 10 booster sessions in eighth grade, and five booster sessions in ninth grade, and taught general "life skills" and skills for resisting social influences to use drugs. MEASURES: Six tobacco, alcohol, and marijuana use self-report scales were recorded to create nine dichotomous drug use outcome variables and eight polydrug use variables. RESULTS: Significant reductions in both drug and polydrug use were found for the two groups that received the prevention program relative to controls. The strongest effects were produced for individuals who received a reasonably complete version of the intervention--there were up to 44% fewer drug users and 66% fewer polydrug (tobacco, alcohol, and marijuana) users. CONCLUSIONS: Drug abuse prevention programs conducted during junior high school can produce meaningful and durable reductions in tobacco, alcohol, and marijuana use if they (1) teach a combination of social resistance skills and general life skills, (2) are properly implemented, and (3) include at least 2 years of booster sessions.