The promise of long-term effectiveness of school-based smoking prevention programs: a critical review of reviews

Researchers and others have developed many school-based tobacco prevention programs over the past 30 years. Early approaches to smoking prevention went through several phases: informational, affective/motivational and psychosocial. Thompson [1], in a review of all English language papers on smoking prevention between 1960 and 1976, concluded that most methods evaluated up to that time, i.e., informational and affective approaches, were not effective and this was echoed by Beattie [2]. Many programs can change knowledge, but such change is not, by itself, enough to alter behavior [3] and, in any case, quickly decays [4]. Sometimes, information can actually make behavior worse [3,5] as can some affective programs [6]. U.S. Government agencies concluded during the late 1980's and early 1990's that traditional approaches (informational and affective) were largely ineffective and that the approaches based on social-psychological models [7,8] were modestly effective across a variety of settings, times and populations [9-12].Over a dozen reviews of approaches to tobacco control or substance abuse prevention published since the early 1990's have included school-based smoking prevention within their realm [9,11,13-27]. Some of these reviews were broad-based and non-systematic, and some were very systematic. Earlier reviews of this type always included school-based smoking prevention as a critical component of effective broad-based tobacco control. Many of the later reviews, especially after Lantz et al [18] tended not to include school-based prevention as an important component in broad-based tobacco control. Lantz et al [18] concluded that "The long term impact of school based educational interventions is of concern" (page 49). However, they then emphasize the need to combine school-based prevention with media programming, other tobacco control efforts, and other problem behavior prevention efforts. Dobbins et al [28] recently concluded that "there is reason for optimism re