The study is a randomized controlled smoking prevention trial to evaluate quality of implementation and effectiveness, as a function of provide type (school teacher vs. nurse) and training (mediated vs. interactive). This continuation proposal adds to the three year, junior high, design a two arm comparison between high schools either receiving or not receiving a school-wide, community, intervention. The new high school intervention responds to both recent evidence of long term decay in junior high program effectiveness, and a trend toward greater high school smoking onset most notably among females. Secondary objectives for this Demonstration and Education research include (a) a test of the hypothesis that higher levels of implementation are associated with better outcomes; (b) preparation for diffusion of a complete set of curriculum, provider training, program implementation, and evaluation methods and materials; and (c) study of the effects of school environment on program effectiveness. One hundred junior high schools were randomly selected and assigned, 20 per condition, and some 5,000 Grade 6 youth with approximately the same number of females and males, recruited to cohort which will participate in intervention and evaluation through the end of Grade 10. The second year of the project has just been completed-the intervention was refined, evaluation methods developed, the communities and cohort recruited, some 160 providers trained, the Grade 6 intervention delivered, and the first year of data collected. The junior high curriculum will be delivered to all volunteers in each intervention school in Grades 6, 7, and 8. All participants will be tested five times: midway through Grade 6 before the intervention begins, and at the end of Grades 7, 8, 9 and 10. The primary endpoint will be self-reported smoking status at the ends of Grades 8 and 10, 2 1/2 and 4 1/2 years after the intervention began. The validity of smoking reports will be enhanced with collection of breath carbon monoxide samples from all subjects at all test points. The new high school intervention will integrate three approaches: attitude-behavior change strategies derived from social psychological research on dissonance, self-perception, values, social norms, and commitment; organizational/cultural change strategies using student- driven participatory planning and multilevel change methods; and mobilization strategies adapted from the current NCI-funded Community Intervention Trial for Smoking Cessation (COMMIT). A comprehensive implementation evaluation will use direct observation, multiple sources of self-report, program records, and cost data to assess the relationships between implementation, outcome, and cost- effectiveness; to provide direct measures of training and mobilization effects; and to develop feasible implementation evaluation methodology for future diffusion studies.
| Brown, K Stephen; Cameron, Roy; Madill, Cheryl et al. (2002) Outcome evaluation of a high school smoking reduction intervention based on extracurricular activities. Prev Med 35:506-10 |
| Cameron, R; Brown, K S; Best, J A et al. (1999) Effectiveness of a social influences smoking prevention program as a function of provider type, training method, and school risk. Am J Public Health 89:1827-31 |
| Santi, S M; Best, J A; Payne, M E et al. (1992) A comparison between instructional experience and performance of teachers and nurses delivering a smoking prevention program. Can J Public Health 83:433-6 |
