Effects of an Advocacy Intervention to Reduce Smoking Among Teenagers
Abstract overview:
This study demonstrates the strength of approach when it comes to changing teen health behaviors. Stanford researchers discovered that involving students in the planning and implementation of anti-smoking advocacy campaigns helped more student smokers reduce their own cigarette use and sustain this behavior change longer than standard anti-drug and alcohol awareness programs.
The study involved students from ten continuation or alternative high schools in the San Francisco Bay area in a semester-long program. Half of the schools (randomly selected) were asked to participate in a new anti-tobacco advocacy campaign, while the other half were offered an established alcohol and drug abuse curriculum. A total of 367 students participated in the advocacy intervention (treatment) and 431 in the drug and alcohol abuse prevention intervention (control). Both treatment and control classes emphasized group participation and small group activities.
The advocacy program was a non-traditional intervention designed to increase student awareness of the cues in their school and community environments that promote cigarette use. First, students observed tobacco availability and promotion in their communities and studied advertising strategies used by tobacco companies to attract smokers. The students then designed advocacy projects aimed at curbing the use of tobacco and the influence of tobacco advertising. For example, some students formed a task force to enforce smoking bans at their high school. Other students worked to increase convenience store compliance with laws limiting tobacco ads on building exteriors. They worked to rid dental and medical offices in their communities of magazines with cigarette ads. Students also approached their city council members and asked them to decline campaign contributions from tobacco companies.
By contrast, the drug and alcohol prevention intervention that the five other schools participated in focused on health motivation, social skills and decision-making regarding drug and alcohol use. It was adapted from a highly regarded curriculum that had proven effective among continuation students.
The study has two major findings: (1) Among students who were regular smokers (a pack or more per week), those who participated in the anti-tobacco advocacy program significantly reduced their own cigarette use as compared to students who participated in the traditional drug and alcohol abuse prevention classes. (2) Six months after the interventions ended, researchers found a continued decrease in smoking among the students who participated in the anti-tobacco advocacy program.
Regular smokers in the anti-tobacco advocacy curriculum reported the most significant change: their smoking decreased by 3.8 percent at the end of the semester (from 25.1% to 21.3%) , during a vulnerable age when smoking rates usually increase. By comparison, the rate among regular smokers in the drug and alcohol abuse prevention curriculum increased by 1.5 percent at the end of the semester (from 25.2% to 26.7%). Follow-up with these students six months later showed that regular smokers who participated in the anti-tobacco advocacy program had further reduced their smoking rates by 1 percent, making their total decrease in smoking 4.8% . By contrast, the regular smokers who had participated in the traditional drug and alcohol abuse prevention classes showed a total increase in smoking of 0.4% six months after the intervention.
These statistics are even more important when considering that these students were enrolled at continuation high schools, which serve students who are at risk of failing or dropping out of regular school or have been removed from their school for other reasons, and who are at a much higher risk of smoking than their peers in regular public high schools.
The study results demonstrate that an advocacy curriculum was effective in achieving reductions in regular smoking. It was designed to engage high school students in activities related to the advertising, availability, and use of tobacco in their schools and communities, The results show that student engagement in advocacy activities can act as an effective learning tool that not only imparts knowledge, but translates into long-term behavior change.
Secondary findings of the study:
In addition to changing personal smoking habits, the students made an impact on policies in their schools and communities. They were successful in getting school officials to enforce smoking bans, in convincing owners of convenience stores to remove tobacco ads that covered shop windows, in getting dentists and doctors to remove magazines in waiting rooms that contained cigarette ads, and in persuading city council members to decline campaign contributions from tobacco companies.
The study did not show a decrease in smoking among light smokers in the advocacy curriculum compared with light smokers in the drug and alcohol abuse curriculum. It is possible that students who were light smokers (less than 1 pack a week) did not feel the need to quit because they did not perceive themselves as true smokers and/or as susceptible to advertising and promotions by tobacco companies.
Implications and recommendations from the study:
The significant decrease in regular smoking is encouraging, especially given the continued decrease at the six-month follow-up point. Given this information, interventions that actively engage students in community observation, social advocacy, and policy change may be an effective strategy for smoking prevention and cessation programs.
Proposed news articles and related information:
- How can this advocacy approach that involves teens in school and community activities that address smoking translate to other health issues important to teens such as quality of foods or availability of places to exercise in schools and communities?
- Associated Press; CDC: Teen Smoking no Longer Declining; April 1, 2005
- NPR – Minnesota; Anti-smoking Campaign is Gone; Teen Smoking is Up; May 13, 2004 by Lorna Benson
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Why might approaches that involve teens in anti-smoking advocacy activities be more effective than traditional “individually”-focused approaches that teach teens about the dangers of smoking or how to resist smoking? Given the preponderance of smoking messages found in the media, is it fair to say that smoking is far more than a personal choice?
- WebMD; Girls May Smoke to Stay Thin; April 2004 by Jeanie Lerche Davis
- NPR- New Hampshire; Many Factors Shape Teen Smoking Rates in New Hampshire; 2004 by Kerry Grens
- Tencati E, Kole S, Feighery EC, Winkleby M, Altman DA. Teens as Advocates for Substance Use Prevention: Strategies for Implementation. Health Promotion Practice, 2002;3:18-29.
- Winkleby M , Feighery EC, Altman DA, Kole S, Tencati E. Engaging Ethnically Diverse Teens in a Substance Use Prevention Advocacy Program. American Journal Health Promotion, 2001;15:433-436.
