The diffusion of school-based tobacco-use prevention programs: project description and baseline data

Introduction Evaluation studies indicate that school-based smoking prevention programs can be effective in preventing the initiation of smoking by adolescents. However, the potential impact of these programs has been limited because few schools use programs which have been shown to be effective. Efforts to increase adoption of these programs by schools are needed. This paper presents the rationale, theoretical basis, intervention strategies and initial findings from one of two federally funded studies to develop and evaluate interventions to enhance the diffusion of tested prevention programs. Survey results at baseline indicate that school administrators and teachers have a high receptivity for adopting a tobacco-use prevention program, but the reported use of evaluated curricula was low. The majority of school districts develop their own teaching programs which may not contain important elements of successfully evaluated programs. Most school districts had smoking policies, but few applied restrictions to groups other than students. These data and other conditions indicate a supportive climate as well as the need to develop and evaluate strategies to encourage the diffusion of tobacco-use prevention programs. Center for Health Promotion Research and Development School of Public Health, University of Texas Health Science Center at Houston, PO Box 20186 and 'The University of Texas M.D.Anderson Cancer Center, Houston, TX 77225, USA Currently, Vice President for Health Promotion Programs, Henry J. Kaiser Family Foundation, Menlo Park, CA, USA National priorities and objectives for health promotion and disease prevention have been clearly established (USDHEW, 1979; USDHHS, 1980, 1986). To pursue these objectives, many risk reduction and disease prevention interventions have been developed, implemented, and their effectiveness evaluated through research and demonstration programs. Unfortunately, the diffusion of programs beyond the demonstration sites is often slow. As a consequence, the potential for significant public health benefit is lost. This situation is particularly evident for programs aimed at preventing the use of tobacco among adolescents. Schools are the logical site in which to conduct tobacco-use prevention programs. Nearly 95% of all children and youth are in elementary or secondary schools (Iverson and Kolbe, 1983), and most schools either mandate or endorse school health education (Kolbe and Iverson, 1984). Many of these programs include tobacco as an integral component. The National School Board Association (1987) estimates that anti-smoking education programs are part of the curriculum in the majority of school districts in the country and are present in nearly two-thirds of middle and junior high schools. The 1987 School Health in America Study found that 20 states (40%) mandate tobacco-use prevention education and that 22 states (44%) have a law or regulation that restricts smoking in public schools (Lovato et al., 1989). Unfortunately, many school-based smoking prevention efforts often are didactic, one-shot efforts, are not integral to the curriculum or to school policies, and do not reflect state-of-the-art behavior change strategies. © IRL Press 111 by gest on A ril 2, 2011 her.oxjournals.org D ow nladed fom