The effect of two elementary school-based prevention interventions on being offered tobacco and the transition to smoking

Abstract

Aims This study sought to more precisely delineate the mechanisms by which two early elementary school-based, universal (i.e., applied to the entire population regardless of risk status) preventive interventions increased survival to first tobacco cigarette smoked. Specifically, we examined whether the interventions’ effect on survival to first use was via the reduction of offers to smoke and/or through preventing the transition from first offer to smoking. Methods A total of 678 urban first-graders were assigned randomly to the classroom-centered (CC), or the family-school partnership (FSP), or a control classroom condition. Youth were followed annually until one year beyond their anticipated high school graduation (mean age ~18 years). Discrete-time survival analyses on 628 youth evaluated the impact of the CC and FSP interventions on first tobacco offer and initial tobacco smoking once offered. Findings The risk of being offered tobacco was reduced among both CC and FSP intervention groups relative to the control group, although the reduction was only statistically significant for the CC intervention. Neither intervention condition reduced the transition to smoking once offered tobacco to smoke. Conclusion The CC intervention appeared to have its effect on survival to first cigarette smoked by delaying the first offer to smoke. Preventive interventions focused on refusal skills during the middle school years may be necessary to reduce the likelihood of the transition to smoking once offered.

The role of neighborhood in urban black adolescent marijuana use

“…Classroom and family-centered interventions were limited to 1 st grade and targeted early learning and aggression. Prior work has examined the impact of these interventions on other risk behaviors (Ialongo et al, 1999; Storr et al, 2002; Bradshaw et al, 2009; Wang et al, 2012). One publication examined onset of marijuana use between 6 th and 8 th grades and found no intervention effects (Furr-Holden et al, 2004).…”

Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood

“…(For more information on intervention effects, see [23,24,36,55]). The initial sample of 678 children was representative of students entering first grade in one of nine Baltimore City public schools in the fall of 1993.…”

Steppingstone and gateway ideas: A discussion of origins, research challenges, and promising lines of research for the future

“…Here also the focus is on environmental conditions or circumstances, experimentally assigned at random so as to bring suspected confounding variables into balance – in lieu of a focus on individual-level differences that may never be understood with any completeness. In this context, it is important to note a just-published study suggesting early impact of a primary prevention program on the timing of the first chance to try tobacco, with no additional impact on the actual first tobacco smoking experience – i.e., impact via ‘exposure opportunity’ circumstances (Wang et al, 2012). …”

“…I think that a more fruitful line of investigation has been launched in prevention research experiments (Furr-Holden et al, 2004; Wang et al, 2012) when randomization has been used to study sequential drug outcomes. Furr-Holden et al (2004) worked from experimental evidence on prevention of tobacco smoking reported by Kellam and Anthony (1998), and completed a partial replication study.…”