Prevention Approach 4: Multicomponent School-Linked Community Approaches

The primary goal of this prevention approach is to discourage adolescent tobacco use by mobilizing community systems through school-based programs. Within this prevention approach, the research and practice evidence is divided into three clusters each with its own emphasis: parent involvement, student antitobacco activism, and media interventions.

CLUSTER 1: Parent Involvement

Rationale

Research demonstrates that multicomponent programs are more effective than single-component interventions for preventing tobacco use among adolescents. Adding parental involvement to a school-based prevention program should therefore increase the effectiveness of the school-based program.

Objectives of the Studies Reviewed

• To expose parents to antitobacco messages through multiple channels

• To increase parents' knowledge about tobacco problems and antitobacco attitudes and beliefs

• To increase parents' awareness of, receptivity to, and participation in smoking prevention efforts

• To encourage parents to discuss tobacco-related issues with their children

• To help families develop rules regarding tobacco use in the home

• To determine whether adding a parental component increases the effectiveness of school-based antitobacco programs

• To enlist parents in influencing the attitudes of educators and school administrators about adolescents' tobacco problems

• To help parents strengthen their children's refusal skills and to change family norms to nonuse of tobacco

Activities of the Studies Reviewed

• Parent surveys

• Take-home quizzes for parents and students

• Letters to parents

• Smoking cessation services and self-help materials for parents

• Television segments on smoking prevention and cessation

• Pamphlets for parents containing information about teen tobacco problems

• Educational materials for parents with tips on how to encourage their kids not to smoke

• Parent training

• Community organizing to develop school policies discouraging tobacco use and to institute drug prevention curricula

• Community organizing to promote community change regarding use of alcohol, tobacco, and illicit drugs by adolescents

• Media campaigns to support other program components

CLUSTER 2: Student Antitobacco Activism

Rationale

Research demonstrates that multicomponent programs are more effective than single-component interventions in preventing tobacco use among adolescents. Adding student antitobacco activism as a component to a school-based prevention program should, therefore, increase the effectiveness of the school-based program. Student antitobacco activism is defined as participation in planned and structured activities designed to raise awareness, provide education, or prompt social changes relating to tobacco use among youth.

Objectives of the Studies Reviewed

• To increase students' knowledge of problems associated with tobacco use

• To promote antitobacco education and attitudes among peers

• To teach students how to encourage their parents and others to quit smoking

• To create an antitobacco environment

• To counteract the promotional efforts of the tobacco industry

• To encourage students to play a prominent role in developing messages and designing activities that will have a positive effect on their peers

• To determine whether activism components attract and affect students at high risk for tobacco use

Activities of the Studies Reviewed

• Writing letters to:
  • Members of a favorite sports team, asking them not to use or endorse tobacco products

  • A restaurant manager or owner, advocating smoke-free restaurants

  • Film producers and magazine editors protesting tobacco advertising

• Holding poster contests

• Creating antitobacco art projects

• Making floats and participating in community parades and festivals

• Writing and singing antitobacco songs

• Revising school policies regarding tobacco use

• Planning and attending a culturally specific youth health day

• Designing and painting an antitobacco mural at a junior high school

• Participating in the production of antitobacco animated videos, in debates regarding tobacco issues, and in the development of a smoking education curriculum

CLUSTER 3: Media Interventions

Rationale

Research demonstrates that multicomponent programs are more effective than single-component interventions in preventing tobacco use among adolescents. Adding media-based interventions to a school-based prevention program should therefore increase the effectiveness of the school-based program.

Objectives of the Studies Reviewed

• To disseminate information about the hazards of tobacco use and the use of marketing techniques by the tobacco industry

• To counteract the influence of media campaigns by the tobacco industry

• To assess the effects of a print media campaign directed at adolescents and their parents

• To increase parents' negative attitudes toward adolescent tobacco use

• To provide adolescents with knowledge and skills to resist peer, family, and media influences to use tobacco

• To determine whether adding mass-media interventions to a school-based prevention program enhances the impact of the school program

Activities of the Studies Reviewed

• Mass-media events such as press conferences, interviews, talk shows, and articles

• Daily 5-minute television segments featuring smoking prevention that are coordinated with school curricula

• Curricula and other written information on the hazards of tobacco use for students, teachers, and parents

• Mass-media antitobacco advertisements and public service announcements

Lessons Learned From Reviewed Evidence

• Programs designed to enhance the effectiveness of school-based curricula result in increased family and student attention to antitobacco messages. However, there is limited evidence that these programs reduce tobacco use among youth.

• The effects of a fully implemented school- and community-based intervention (including parental involvement) to reduce adolescent tobacco use as part of a broader substance abuse prevention strategy may be limited by the community's view of tobacco use as a minor issue in relation to other forms of substance abuse and the likelihood that addressing adolescent tobacco use will not be considered a priority.

• The effectiveness of multicomponent prevention programs may be related to the multiplicative effect, that is, the net effect of a program may be greater than the sum of the individual effects of the program components. In other words, the ways in which program components interact with each other and their effects on each other are largely unknown. As a result, it may not be feasible to assess the independent contributions of each component.

• Students who voluntarily participate in school-based antitobacco activism projects may not be at high risk for using tobacco. The program, therefore, may be focused disproportionately on those who are already at low risk.