Targeting early antecedents to prevent tobacco smoking: findings from an epidemiologically based randomized field trial.

OBJECTIVES: This study examined whether interventions aimed at aggressive/disruptive classroom behavior and poor academic achievement would reduce the incidence of initiation of smoking. METHODS: An epidemiologically based, universal randomized preventive trial involved 2311 children in 2 classroom-based preventive interventions or controls. Each intervention was directed at 1 of the aforementioned 2 antecedents over first and second grades in 19 urban schools. RESULTS: Smoking initiation was reduced in both cohorts for boys assigned to the behavioral intervention. CONCLUSIONS: Targeting early risk antecedents such as aggressive behavior appears to be an important smoking prevention strategy.