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Morbidity and Mortality Weekly Reports (MMWRs)

Effectiveness of School-Based Programs as a Component of a Statewide Tobacco Control Initiative—Oregon 1999–2000

August 10, 2001 / Vol. 50 / No. 31

• Highlights
• Use and Effectiveness of Comprehensive School-Based Programs
• Information

MMWR Highlights

Highlights

• The Oregon Health Division found that between spring 1999 and spring 2000, smoking rates among eighth graders declined by 21.7 percent (from 16.6 to 13 percent) in a self–selected sample of schools funded to implement school tobacco prevention guidelines recommended by the Centers for Disease Control and Prevention (CDC). By comparison, smoking rates declined by 7.6 percent (from 17 to 15.7 percent) in a comparison group of non-funded schools.
• Overall, Oregon students in the sample of funded schools in 2000 were about 20 percent less likely to smoke than students in non-funded schools (13 versus 15.7 percent).
• Among the funded schools in the Oregon study, a strong dose-response effect was observed between how fully schools implemented CDC’s guidelines and how much smoking rates declined. Between 1999 and 2000 rates declined by 42.2 percent (from 14.2 to 8.2 percent) in schools with the highest implementation scores, 21.9 percent (from 17.8 to 13.9 percent) in schools with middle scores, and 6.6 percent (from 17.1 to 15.6 percent) in schools with the lowest scores.
• Students in schools with the highest implementation scores in 2000 were only half (47.4 percent) as likely to smoke as students in schools with the lowest implementation scores (8.2 versus 15.6 percent).

• Eighth grade smoking rates in 2000 were virtually identical in non-funded schools and in funded schools with the lowest implementation scores (15.7 and 15.6 percent).

• Oregon’s Tobacco Prevention and Education Program, funded by a November 1996 voter-initiated ballot measure to increase the state cigarette excise tax by 30 cents, has implemented a counter-marketing campaign, a statewide quitline, tobacco control coalitions in all Oregon counties, and competitive grants to community groups, tribal associations, and school districts. Twenty-three school districts or consortia of districts, representing about one-third of students in Oregon, were funded to implement CDC’s guidelines.

Use and Effectiveness of Comprehensive School-Based Programs

• An extensive body of research documented in the 2000 Surgeon General’s Report, Reducing Tobacco Use, shows that comprehensive school-based programs, combined with community and media-based activities, can effectively prevent or postpone smoking onset in 20 to 40 percent of U.S. adolescents.
• Existing data suggest that evidence-based curricula and national guidelines have not been widely adopted. In 1994, the most recent year of published data available, less than 5 percent of schools nationwide were implementing the major components of CDC’s Guidelines for School Health Programs to Prevent Tobacco Use and Addiction, which recommends schools should
  1. Develop and enforce a school policy on tobacco use.
  2. Provide instruction about the short- and long-term effects of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills.
  3. Provide tobacco-use prevention education in kindergarten through 12th grade, with especially intensive instruction in junior high or middle school.
  4. Provide program-specific training for teachers.
  5. Involve parents and families in support of school-based programs to prevent tobacco use.
  6. Support cessation efforts among students and school staff who use tobacco.
  7. Assess the tobacco-use prevention program at regular intervals.
• Programs with the most educational contacts during the critical years for smoking adoption (age 11 to 15 years) are more likely to be effective, as are programs that address a broad range of educational needs.
• Educational curricula that address social influences (of friends, family, and media) that encourage tobacco use among youth, have shown consistently more effectiveness than programs based on other models.
• Two middle school programs that have demonstrated effectiveness in reducing tobacco use behaviors in youth have been identified by CDC as programs that work. They are Life Skills Training Program and Project Toward No Tobacco (TNT). These curricula use a social influences approach supplemented with training in life skills and refusal skills. To receive state funding, Oregon schools were required to select one of these curricula as part of their school-based tobacco prevention programs.
• A major research trial funded by the National Cancer Institute, the Hutchinson Smoking Prevention Project, demonstrated that the implementation of a single-modality program (in this case, the delivery of a classroom curriculum) may be ineffective without attempting to change the social and policy environment in which the program is delivered.
• Educational strategies to prevent tobacco use must become more consistent and comprehensive. This will require continuing efforts to build strong, multiyear prevention units into school health education curricula. It will also require expanded efforts to make use of school policies, the mass media, parents, and community resources. Schools cannot bear the sole responsibility for preventing tobacco use.

Information

For more information, visit CDC’s Office on Smoking and Health Web site at http://www.cdc.gov/tobacco and for more information on CDC’s school health program activities, visit the Division of Adolescent and School Health Web site at http://www.cdc.gov/HealthyYouth/index.htm.

1. Centers for Disease Control and Prevention. Effectiveness of School-Based Programs as a Component of a Statewide Tobacco Control Initiative—Oregon, 1999–2000 [cited 2006 Sep 27]. MMWR 2001;50.
2. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.
3. Peterson AV Jr., Kealey KA, Mann SL, Marek PM, Sarason IG. Hutchinson Smoking Prevention Project: long-term randomized trial in school-based tobacco use prevention—results on smoking. J National Cancer Inst 2000;92:1979–91.

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