© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 16, 1267-1268,
August 15, 2001
© 2001 Oxford University Press
CORRESPONDENCE |
Re: Hutchinson Smoking Prevention Project: Long-Term Randomized Trial in School-Based Tobacco Use Prevention—Results on Smoking
Affiliations of authors: R. Cameron (Canadian Cancer Society/National Cancer Institute of Canada Centre for Behavioural Research and Program Evaluation), K. S. Brown (Statistics and Actuarial Science), University of Waterloo, ON, Canada; J. A. Best, Centre for Clinical Epidemiology and Evaluation, Vancouver Hospital and Health Sciences Centre, BC, Canada.
Correspondence to: Roy Cameron, Ph.D., Canadian Cancer Society/National Cancer Institute of Canada Centre for Behavioural Research and Program Evaluation, Lyle Hallman Institute, University of Waterloo, 200 University Ave., W., Waterloo, ON N2L 3G1, Canada (e-mail: cameron{at}healthy.uwaterloo.ca).
Peterson et al. (1) found no evidence for the long-term effectiveness of a school-based social-influences approach to smoking prevention. Appropriately, this finding received considerable media attention. It will, and should, have an impact on decision makers responsible for directing smoking-prevention initiatives. As Clayton et al. (2) noted in an accompanying editorial, the results from the Hutchinson Smoking Prevention Project (HSPP) are compelling because of the quality of the design and implementation.
Does the HSPP study mean that school-based social-influences smoking prevention programs should be abandoned? Or do programs of this type still have a place in a comprehensive approach to smoking prevention? If so, under what circumstances are they useful? These are key questions for both research and practice.
In their editorial, Clayton et al. (2) noted that we must reorient the prevention field away from asking "the main effects question (what works?) to the moderated model question (what works, for whom, under what conditions, how, and why?)." This call echoes the previously expressed concern (3) that outcomes of prevention programs be examined not only as a function of program content but also in relation to other variables that may affect outcomes (notably, characteristics of program participants, providers, and settings).
Setting factors may be very important in determining the impact of an intervention. For instance, in a recent study of a school-based social-influences smoking prevention program, we found no significant differences in smoking rates between students in the intervention and comparison conditions at the end of grade 8 if data were pooled across all schools within conditions (4). But a more fine-grained analysis revealed a different picture. Smoking norms vary widely across school settings, and to avoid confounding treatment conditions with school-level risk, we had, therefore, stratified schools on the basis of "risk" (high-risk schools were characterized by a relatively high prevalence of smoking among grade-8 students when the intervention cohort was in grade 6). This stratification, which made it possible to examine the interaction between intervention and school risk, revealed that the intervention had a substantial impact in reducing smoking in high-risk schools but not in other schools (4).
Our data thus tangibly illustrate the importance of Clayton et al.'s call for more nuanced examination of intervention effects. If the results of our study (4) are robust, they suggest that selective deployment of school-based programs in high-risk settings may be a valuable component of a comprehensive smoking-prevention strategy.
Policy questions about tobacco prevention are too important to base on any single study, no matter how well designed. We urgently need a careful, balanced review of the evidence and practice recommendations.
REFERENCES
1
Peterson AV, Kealey KA, Mann SL, Marek PM. Hutchinson Smoking Prevention Project: long-term randomized trial in school-based tobacco use prevention–results on smoking. J Natl Cancer Inst 2000;92:1979–91.
2
Clayton RR, Scutchfield FD, Wyatt SW. Hutchinson Smoking Prevention Project: a new gold standard in prevention science requires transdisciplinary thinking [editorial]. J Natl Cancer Inst 2000;92:1964–5.
3 Best JA, Thomson SJ, Santi SM, Smith EA, Brown KS. Preventing cigarette smoking among school children. Ann Rev Public Health 1988:9;161–201.[Web of Science][Medline]
4
Cameron R, Brown KS, Best JA, Pelkman CL, Madill CL, Manske SR, et al. Effectiveness of a social influences smoking prevention program as a function of provider type, training method, and school risk. Am J Public Health 1999;89:1827–31.
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