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Outcome expectancies have been related to smoking behavior among adults, but less attention has been given to expectancies about smoking among adolescents at differing levels of smoking experience. The present study reports the psychometric properties and predictive validity of a brief expectancy scale across two samples of adolescents. Sample 1 (N = 349) consisted of high school students (54% female) who were regular smokers enrolled in a cessation program. Sample 2 (N = 273) consisted of 8th- and 10th-grade early experimenters (54% female) involved in a natural history study of smoking trajectories. In both samples, a principal component analysis of a 13-item expectancy scale yielded four factors (taste, weight control, boredom relief, and negative affect management), each with high internal consistency (coefficient alphas >.77) and accounting for 73% and 80% of the total variance for each sample, respectively. Expectancies were significantly higher among current smokers than among early initiators. In Sample 1, boredom relief and weight management expectancies predicted smoking status 6 months later. In Sample 2, students whose smoking increased over 18 months had higher overall expectancies at baseline compared with those who tried smoking and did not escalate. These findings support the predictive validity of expectancies in predicting escalation and cessation. Implications for the importance of expectancies in understanding adolescent smoking behavior are considered.

The multilevel thresholds of change model is used to analyze the effect of a smoking cessation intervention on stage of readiness to quit across a 2-year follow-up period. The intervention, targeted to females with high school or less education, consisted of a televised component and a written manual. Any exposure to the intervention had a significant effect on stages that precede quitting but not on quitting; participation in the intervention had significant effects at all levels of change, including quitting. The written component had a stronger independent effect than the televised component. Intervention effects were strongest within women who were initially precontemplative.

I provide a review and critique of meta-analyses and systematic reviews of school-based smoking prevention programs that focus on long-term effects. Several of these reviews conclude that the effects of school-based smoking prevention programs are small and find no evidence that they have significant long-term effects. I find that these reviews all have methodological problems limiting their conclusions. These include severe limiting of the studies included because of performance bias, student attrition, non-reporting of ICCs, inappropriate classification of intervention approach, and inclusion of programs that had no short-term effects. The more-inclusive meta-analyses suggest that school-based smoking prevention programs can have significant and practical effects in both the short- and the long-term. Findings suggest that school-based smoking prevention programs can have significant long-term effects if they: 1) are interactive social influences or social skills programs; that 2) involve 15 or more sessions, including some up to at least ninth grade; that 3) produce substantial short-term effects. The effects do decay over time if the interventions are stopped or withdrawn, but this is true of any kind of intervention. [ABSTRACT FROM AUTHOR]

I provide a systematic review of trials of school-based smoking prevention programs that had at least 15 sessions, preferably with some in high school, that reported significant short-term effects, and that included long-term follow-up. This is supplemented with a description of some other programs that produce short-term effects that portend large long-term effects. I conclude that school-based programs can have long-term effects of practical importance it they: include 15 or more sessions over multiple years, including some in high school; use the social influence model and interactive delivery methods; include components on norms, commitment not to use, intentions not to use, and training and practice in the use of refusal and other life skills; and use peer leaders in some role. School-based programs of this type can reduce smoking onset by 25- 30%, and school plus community programs can reduce smoking onset by 35-40% by the end of high school. Some early childhood programs that do not have smoking prevention as their main aim, including home nursing, the Good Behavior Game, the Positive Action program and others, seem to change the developmental trajectories of children so that they are less likely to engage in multiple problem behaviors, including smoking, as adolescents. This review makes it clear that effective school-based smoking prevention programs exist and can be adopted, adapted and deployed with success - and should be. [ABSTRACT FROM AUTHOR]

Objectives. We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. Methods. We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. Results. We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was $2000. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. Conclusions. There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence. [ABSTRACT FROM AUTHOR]

Abstract: We compared the relative effectiveness of four different conditions of self-help and social support provided to people attempting to quit smoking in conjunction with a televised cessation program: Smokers ready to quit were able to request written manuals from hardware stores to accompany a televised program. At worksites we provided the written manual to all workers. At a random half of the worksites, we also provided training to discussion leaden who subsequently led discussions among smokers attempting to quit with the program. At health maintenance organization sites we invited smokers who had requested program materials to participate in similar group discussions at health centers. In this paper we report one year follow-up results for the above four groups and compare them with previously reported results of a self-help manual alone. Results for the television plus manual condition were better than those of past studies (25 percent nonsmoking prevalence and 10 percent continuous cessation one year after the program) and considerably better than the manual alone. None of the other conditions designed to supplement the manual plus television produced better long-term outcomes; we explore the reasons for this. The program did encourage and help over 50,000 Chicago smokers to attempt quitting with the American Lung Association manual, 100 times as many as would have done so without the televised program. At least 15 other similar programs implemented since 1984 multiply this effect. [ABSTRACT FROM AUTHOR]

Evaluations of 40 mass media programs/campaigns designed to influence cigarette smoking were reviewed. Information/motivation programs/campaigns generally produced changes in awareness, knowledge, and attitudes. Extensive national campaigns also produced meaningful behavioral change. Programs/ campaigns designed to promote some specific smoking-related action produced mixed results, depending in large part on the type of promotion involved. Mass media cessation clinics were found to be effective, with media plus social support being more effective than viewing plus printed material, and either combination being more effective than viewing alone. It was concluded that mass media health promotion programs can be more effective than many academics may have thought, but that the knowledge necessary to ensure such success is seriously lacking. Research studies, rather than simple evaluations, are needed to improve our knowledge base and build a science of mass media health promotion. [ABSTRACT FROM AUTHOR]

Objectives. We present 1-year follow-up data from a school-based tobacco use prevention project designed to test the effectiveness of three main components of social influence programs. The components teach refusal skills, awareness of social misperceptions about tobacco use, and misconceptions about physical consequences. Methods. Four different curricula were developed and tested in a randomized experiment involving 48 junior high schools. The outcome variables examined were changes in initial and weekly cigarette and smokeless tobacco use 1 year after the intervention. Results. Analysis indicated that each of the component programs were effective in decreasing both the initial and the weekly use of cigarettes except for the curriculum in which refusal skills were taught. Also, each curriculum was effective in decreasing the initial use of smokeless tobacco except for the one aimed at correcting social misperceptions. Only the combined curriculum showed an effect on the weekly use of smokeless tobacco. Conclusions. The combined intervention was the most effective overall in reducing the initial and weekly use of cigarettes and smokeless tobacco. This suggests that different reasons for use exist and need to be counteracted simultaneously. However, since single programs were also effective in reducing all but weekly smokeless tobacco use, any of these components may be worth-while prevention tools. [ABSTRACT FROM AUTHOR]

Objectives. As smoking decreases in the population, the remaining smoking population will change, and cessation initiatives will have to incorporate strategies designed for these smokers. Methods. To study patterns of response to a cessation intervention composed of 20 televised segments and the American Lung Association Freedom from Smoking in 20 Days manual, this study compared cessation rates over 24 months in a cohort of smokers who registered for a cessation program with those in a cohort selected from the smoking population at large. Results. At post intervention, multiple point prevalence of cessation among participants, adjusted for baseline smoking, was 14% among registrants and 6% and 2%, respectively. Heavy smokers benefited more than light smokers, and there was a consistent dose-response relationship between extent of exposure to the intervention and cessation. Conclusion. The effects of the intervention were strongest for those who read the manual and watched the programs daily. Manual use was important, and those who did not read it did not appear to benefit. Compared to the population and given full participation, heavy smokers benefited more than lighter smokers. [ABSTRACT FROM AUTHOR]

Recently, applied social researchers have shown an increased interest using focus groups as a method of generating ideas and solutions pertaining to various social problems. However, caution in the use of this methodology is warranted because focus groups may induce certain group effects which might bias responses. The present study investigated whether an extended focus group procedure resulted in a polarization of attitudes (a group influence bias effect) or a greater pool of ideas than those generated by its members at pretest (brainstorming, a favorable group effect). Southern California and Illinois high school students involved in a total of 31 focus groups were administered pretest and posttest questionnaires. These groups addressed the perceived utility of self-generated strategies designed to recruit adolescent tobacco users into a high school based tobacco use cessation clinic Support was obtained for a group polarization effect, which was replicated across grades, regions, tobacco use status, and specific strategy type. Specifically, after participating in a focus group, the students rated all self-generated cessation clinic recruitment strategies as being more likely to be successful. Moreover, they reported that it was more likely that these strategies would lead them to join a program themselves, if they were tobacco users. However, little support was obtained for the brainstorming effect. In the present context, focus groups do not appear to elicit reporting of new types of strategies but do instill more favorable attitudes regarding self-generated solutions to a problem. Practical implications of these data are discussed. [ABSTRACT FROM AUTHOR]

The article focuses on an evaluation of the effectiveness of classroom and mass media for the delivery of a psychosocial smoking prevention program and an accompanying smoking cessation program. It evaluates: the acceptance of the program by teachers, students and parents; program implementation level and quality; and program effectiveness. The program consisted of four distinct components: television prevention segments, a classroom curriculum, a home booklet and television cessation segments. The results of the article suggest that school-based and television social influences prevention programming are moderately acceptable to schools and very acceptable to students and parents.

The article presents a report on a large-scale television-based smoking cessation project that was implemented for 20 days during January 1985. Forty-three corporations agreed to participate in this project. Group participants used the manual's activities and the televised news program in their effort to stop smoking. The researchers used a multiple regression analysis for predicting the prevalence of abstinence at the 12-month follow-up. It was concluded that freedom from smoking is particularly important at the worksite as smoking causes increased health care expenses and worker absenteeism due to smoking-related illness, reduced productivity and lost wages.