Kara Lichtman

Effects of a Social-Network Method for Group Assignment Strategies on Peer-Led Tobacco Prevention Programs in Schools

OBJECTIVES Our study tested the effectiveness of network methods for identifying opinion leaders and for constructing groups. METHODS Three conditions-random, teacher, and network--ere randomly assigned to 84 6th-grade classrooms within 16 schools. Pre- and postcurriculum data on mediators of tobacco use were collected from 1961 students. Peer leaders in the network condition were identified by student nominations, and those leaders were matched with the students who nominated them. RESULTS Students in the network condition relative to the random condition liked the prevention program more and had improved attitudes (beta = -0.06; P <.01), improved self-efficacy (beta = -0.10; P <.001), and decreased intention to smoke (adjusted odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.38, 0.55). CONCLUSIONS The network method was the most effective way to structure the program. Future programs may refine this technique and use it in other settings.

Effects of Thirty-Four Adolescent Tobacco Use Cessation and Prevention Trials on Regular Users of Tobacco Products

Since 1991, adolescent tobacco use rates have increased while adult use has steadily decreased. The failure of adolescent tobacco use cessation and prevention programs to reduce this overall smoking rate indicates that research must be advanced in this area. As a start, the current status of cessation and prevention research that targets adolescent regular tobacco users should be stated. This paper contributes to that goal by reviewing the last two and a half decades of research in this area. A total of 34 programs, equally divided between cessation and prevention (targeting regular tobacco users), are presented and relevant data are provided for each. Among the cessation studies, an emphasis of programming on immediate consequences of use, and instruction in coping strategies, may have led to relatively successful programs. Prevention studies arguably may have achieved lower success rates but were applied to a larger sample with a longer follow-up period. Despite showing some success, it is apparent that the scientific status of cessation research is less refined than prevention research. More research is needed to define the most successful approaches for cessation of adolescent tobacco use.

Factors in Marijuana Cessation among High-Risk Youth

The rise in marijuana use among high school students has generated considerable concern. The apparent failure of current marijuana control efforts may be due in part to ignorance about why students use marijuana and what influences them to consider quitting. This article utilized both open-ended and multiple-choice surveys as well as health educator-led focus groups to assess issues related to marijuana use and cessation among a population of high-risk youth. A total of 842 students participated, assessed as two separate samples from eleven continuation high schools in southern California. Approximately 70 percent of the students are current marijuana users. Interpreting results across both samples, it is apparent that interest in quitting marijuana use among continuation high school students is high. Over half of the marijuana users surveyed have tried to quit and failed. Still, several social images associated with marijuana smokers are positive and subjects express a lack of confidence in the efficacy of marijuana cessation clinic programs. Subjects believe that either self-help or punitive methods are the most effective types of marijuana cessation activities. A reportedly high rate of failed quit attempts suggests that effective marijuana cessation programs are needed in this population. Future programs must address both reasons users resist change, including use of marijuana as a stress reliever, and the particular motivations that subjects report regarding why they desire to quit using marijuana, including legal, vocational, and health consequences.

Project FLAVOR: 1-Year Outcomes of a Multicultural, School-Based Smoking Prevention Curriculum for Adolescents

To evaluate a multicultural smoking prevention curriculum, 16 schools were randomized to receive the multicultural curriculum or a standard curriculum and program effects on 1-year smoking initiation among 1430 never smokers were assessed. Hispanic boys who received the multicultural curriculum were less likely to initiate smoking than were those who received the standard curriculum; effects were insignificant among other groups. The prevention effect among Hispanic boys is encouraging, but additional research is needed to improve prevention effects among other groups.