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School Programs to Prevent Smoking:

The National Cancer Institute Guide to Strategies that Succeed: Action Summary


Based on a comprehensive review of available research results, experts have identified eight strategies and program characteristics that have helped schools succeed with their smoking prevention efforts. Each is essential to overall program success.
  1. Give smoking prevention significant attention in your curriculum-at least five classroom sessions in each of 2 years and booster sessions in senior high school. Include information about the social influences on tobacco use and about tobacco's short-term effects on the body. Teach students how to refuse.
  2. Schedule the smoking program to fit into your existing curricula-programs can be delivered effectively in a variety of sequences and classes.
  3. Begin your program during the transition year from elementary to middle school or junior high, if not earlier.
  4. Involve students in presenting smoking prevention programs, but have teachers lead the sessions.
  5. Get parent support for smoking prevention programs, Active parent participation is not essential.
  6. Train teachers thoroughly-ideally for a full day.
  7. Use a smoking prevention approach that fits in with established community norms and needs so that it will be readily adopted.


These eight recommendations can help you plan and offer a smoking prevention program that will get results. if you already include smoking prevention in your curriculum, this guide can help you review your approach and perhaps suggest modifications that will make your programs more effective.
  1. Give smoking prevention significant attention in your curriculum.

    Smoking is one of the many health issues schools address. Fortunately, it is not necessary for a health-related curriculum to focus only on smoking to succeed. Smoking can be part of a broader health curriculum as long as a minimum of jive classroom sessions in eacb of 2years are devoted to the topic. (Ten sessions per year for 3 years would be preferable, but may not be realistic in all settings.) A 1 -year program is not enough. Additionally, booster sessions in subsequent years appear essential for sustained program effects. In addition, health behavior concepts that help prevent smoking are important for other health topics such as drug abuse prevention and nutrition. Grouping relate d topics is an efficient way to present the information as long as smoking prevention strategies are featured prominently.

  2. Include information about the social influences on tobacco use and about tobacco's short-term effects on the body. Teach students how to refuse.

    Students need to recognize that their decisions about smoking are often influenced subtly by peers, parents, and the media. They also need to become aware that smoking is not the norm for people their age. Adolescents seem to respond to learning about the immediate physical effects of smoking (e.g., shortness of breath, stained iceill). '['his topic should receive higher priority than information about the long-term health effects of smoking (e.g., cancer, hean disease). Developing the skills to make decisions, solve problems, and refuse cigarettes is another key aspect of smoking prevention. These are complex skills that require practice through techniques such as modeling and role play; they involve more than the 'just say no' approach. These three topics represent a "minimum' list of program contents. Many other issues are appropriate for a comprehensive effort.

  3. Schedule the smoking program to fitt into your existing curriculum. .

    Smoking prevention programs can be offered in consecutive five-session blocks or spread over the school year with no difference in effectiveness. The plan may also change from year to year. For example, smoking programs can be offered in a block one year and in a spread-out fashion the next. A 10-session program could even be spread over 4 years: eight total sessions in years I and 2 and one booster session in each of years 3 and 4. The sessions can be offered with equal impact through health, physical education, science, English, or social studies classes. A school's commitment to a program is more important than how the program is configured.

  4. Begin your program during the transition year from elemen tary to middle school or junior high, if not earlier.

    Ideally, smoking prevention programs should be offered in all grades, including elementary school. Where this approach is not feasible, program efforts should begin at the time smoking most often begins: in grades 6 or 7, whichever is the first year after elementary school. Programs should continue at least through grade 9. The sixth-to-ninth-grade period is when adolescents seem to be most vulnerable to smoking iniattion. It is also the opportunity to provide information about smoking to those who may drop out of school after the ninth grade.

  5. Involve students In presenting smoking prevention programs, but have teachers at the sessions

    The most effective programs are led by teachers with students assisting in program delivery. It is important to train the student assistants adequately to ensure that they present information accurately. It is also important to involve teachers who are comfortable working with student teachers. The students may be selected by the teacher or administrator, appointed by a student organization, or elected by class members. As role models and opinion leaders, these students can also be expected to have ongoing influence on nonsmoking norms outside the classroom.

  6. Get parent support for smoking prevention programs. Active parent participation is not essential

    Research shows that it is not necessary for program success to involve parents actively in school smoking prevention efforts. In programs for students in junior high school and above, parent participation may actually be counterproductive. It is imponant, however, that parents recognize the value of such programs and support the school's nonsmoking goal, especially the development of school-wide nonsmoking pol,.icies.

  7. Train teachers thoroughly.

    A key to program success is presenting a prevention curriculum accurately, it must Ix faithful to the major goals and content of the original evaluated program. Teachers need thorough training to accomplish this objective. Although training may involve costs and logistical problems, research shows that the investment is critical to program impact. Ideally, training should last a full day and include opportunities for role play and interaction with student assistants.

  8. Use a smoking prevention approach that fits in with established community norms and needs so that It is readily adopted.

    It will be easier to implement a program that accommodates the perspectives and real-ide situations of students, parents, educators, school administrators, and community residents. For example, in a community in which drug abuse is a pressing public issue, a health cuff iculum that focuses only or principally on smoking might not be accepted. A substance abuse program that includes both topic-cigarette smoking and drug abuse-might be easier to institute. Other issues to consider include administrative perspectives on program costs, teacher interest and enthusiasm, existing school smoking policies, and smoking patterns among youth in the community at large.

    Available Resources

    A sampling of school-based smoking prevention programs is available. Many of the programs listed were developed and tested with NCI supporl Other programs were supported by other Federal agencies or are products of private or voluntary health organizations. By providing this listing, NCI informs professionals who develop, authorize, or implement smoking prevention prograins for youths that such programs are available. NCI does not necessarily endorse all p listed. individuals aware of other appropriate programs are encouraged to provide a brief description to NCI for inclusion In future editions of this guide.
    Growing Healthy - Nina Rizzo- (212) 689-1886
    Know Your Body School Health Program - Donna Cross- (212) 953-1900
    Life Training Skills - Dr. Gilbert Botvin - (212) 746-1270
    Lungs are for Life- Mr. Rodger Schmidt- (212) 315-8700
    Minesota Smoking Prevention Program - Verena Walton - 1-800-257-7800
    Project PATH - Leslie Zoref- (503) 484-2123
    Project SHOUT- Dr. John Elder - (619) 594- 1976
    Project Smart - William Hansen- (818) 405- 0472
    Risk and Youth: Smoking RAY:S - Herbert Their- (415) 642- 8718