Smoking Among Youth
Conditions
Keywords
smoking prevention, tobacco use prevention, adolescent tobacco use, prevention intervention
Brief summary
The Hutchinson Smoking Prevention Project is a 16-year, group-randomized trial to determine the extent to which a school-based (grades 3-10), theory-based, social-influences tobacco use prevention intervention can deter youth tobacco use throughout and beyond high school.
Detailed description
Cigarette smoking remains the number one cause of preventable premature death in the U.S., annually killing more than 400,000 Americans. Without reversal of adolescent smoking trends, five million of today's youth will die prematurely of smoking-related illnesses. The 16-year Hutchinson Smoking Prevention Project (HSPP) was conducted in 1984-1999 to (1) address challenges of trial design and execution in school-based smoking prevention by developing the most rigorous school-based randomized trial possible, and (2) use the trial to answer the scientific questions, To what extent can a theory-based, social-influences smoking prevention intervention spanning elementary, middle and high school grades reduce smoking among youth at 12th grade and two years post-high-school? The HSPP trial used a group-randomized, matched pair design with the school district as the experimental unit. Of 40 participating school districts, 20 were randomly assigned to the experimental (intervention) condition and 20 were assigned to the control (no HSPP intervention) condition. No restrictions were placed on the health promotion or tobacco use prevention activities of the control districts, thus enabling schools to continue whatever health curricula were normally offered. Main endpoints were daily smoking at 12th grade and 2 years after high school (Plus-2). Study participants (N=8,388) were two consecutive third grade enrollments in each of the 40 school districts. All third graders were followed to endpoint, including those who dropped out of school or otherwise left their school districts. The study achieved a 94% follow-up rate at the Plus-2 endpoint. The HSPP intervention was a teacher-led, grades 3-10 tobacco use prevention curriculum plus unit-specific teacher training. There were 65 classroom lessons in the HSPP curriculum: 9 lessons in each of grades 3-5, 10 lessons in each of grades 6-7, 8 lessons in grade 8, and 5 lessons in each of grades 9-10, for a total number of 46.75 hours of classroom instruction time in grades 3-10. The HSPP uses an enhanced social influences approach that includes the 15 NCI-endorsed essential elements for school-based tobacco prevention and meets the CDC's best practices guidelines. The intervention's behavioral components featured skills for identifying and resisting social influences to smoke, correcting erroneous normative perceptions regarding smoking, promoting tobacco-free norms, and building self-efficacy for tobacco-free lifestyle choices. The intervention was developed to be practical for the school setting, emphasizing ease of use by teachers, good fit into school routines and with schools' existing educational objectives, and incorporation of topics/activities that are interesting, engaging and developmentally-appropriate for students.
Interventions
BEHAVIORALSocial-influences
grades 3-10, school-based social influences tobacco use prevention curriculum
Sponsors
National Cancer Institute (NCI)
Fred Hutchinson Cancer Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
7 Years to 9 Years
Healthy volunteers
No
Inclusion criteria
* All students enrolled in third grade in one of two consecutive classes of third graders in an HSPP participating Washington school district (1984-85; 1985-86; 1986-87).
Exclusion criteria
* Enrolled but classified by participating school district as developmentally unable to learn.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Smoking Daily at 12th Grade | 12th grade | Response 1 to 3 cigarettes per day, 4 to 10 cigarettes per day, 11 to 20 cigarettes per day, or More than 20 cigarettes per day to the Item How often do you currently smoke cigarettes? |
| Whether or Not Smoking Daily at 2 Years After High School | 2 years after high school | Response (from the 2-years-after-high school questionnaire) Daily: 1 to 10 cigarettes a day, Daily: 11 to 20 cigarettes a day, Daily: more than a pack a day to the Item How often do you currently smoke cigarettes? |
Countries
United States
Participant flow
Recruitment details
Study participants were recruited as 3rd graders in the consecutive years from 40 collaborating school districts in Washington State. The study participants were recruited in 3 waves: Wave I, 6 school districts (1984 and 1985); Wave II, 14 school districts (1985 and 1986); and Wave III, 20 school districts (1986 and 1987).
Pre-assignment details
Forty-two (42) children were not eligible for the study because they were considered by their schools to be developmentally unable to learn.
Participants by arm
| Arm | Count |
|---|---|
| No-intervention Control No-intervention control group | 4,211 |
| Social Influences School-based Smoking Prevention Curriculum Social influences school-based smoking prevention curriculum group | 4,177 |
| Total | 8,388 |
Baseline characteristics
| Characteristic | No-intervention Control | Social Influences School-based Smoking Prevention Curriculum | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 4211 Participants | 4177 Participants | 8388 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment United States | 4211 participants | 4177 participants | 8388 participants |
| Sex: Female, Male Female | 2058 Participants | 2073 Participants | 4131 Participants |
| Sex: Female, Male Male | 2153 Participants | 2104 Participants | 4257 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 4,211 | 0 / 4,177 |
| serious Total, serious adverse events | 0 / 4,211 | 0 / 4,177 |
Outcome results
Primary
Number of Participants Smoking Daily at 12th Grade
Response 1 to 3 cigarettes per day, 4 to 10 cigarettes per day, 11 to 20 cigarettes per day, or More than 20 cigarettes per day to the Item How often do you currently smoke cigarettes?
Time frame: 12th grade
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| No-intervention Control | Number of Participants Smoking Daily at 12th Grade | 995 participants |
| Social Influences School-based Smoking Prevention Curriculum | Number of Participants Smoking Daily at 12th Grade | 976 participants |
Primary
Whether or Not Smoking Daily at 2 Years After High School
Response (from the 2-years-after-high school questionnaire) Daily: 1 to 10 cigarettes a day, Daily: 11 to 20 cigarettes a day, Daily: more than a pack a day to the Item How often do you currently smoke cigarettes?
Time frame: 2 years after high school
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| No-intervention Control | Whether or Not Smoking Daily at 2 Years After High School | 1132 participants |
| Social Influences School-based Smoking Prevention Curriculum | Whether or Not Smoking Daily at 2 Years After High School | 1103 participants |