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Ending the Tobacco Problem: A Blueprint for the Nation
multiple prior studies and a meta-analysis (e.g., Drug Awareness and Resistance Education), which are discussed further below.
The Hutchinson project (conducted at the Fred Hutchinson Cancer Center, University of Washington) was designed to be a multiyear (grades 3–10) social influences tobacco prevention program. A large randomized trial (20 school groups per condition) produced no significant effects at the end of grade 12 or 2 years later (Peterson et al. 2000). These findings are impossible to interpret, because the investigators have not reported what effects there were or were not at any other time, including prior to entering high school (when most other programs report short-term results) or at the end of the program (grade 10). Certainly, one cannot use these results to conclude that the social influences approach to smoking prevention is ineffective in the long-term deterrence of smoking among youth (Peterson et al. 2000). These results must be interpreted in the context of many other studies on the social influences approach in the literature (Botvin et al. 2001; Botvin et al. 2001; Sussman et al. 2001).
The DARE (Drug Awareness and Resistance Education) Program was developed by the Los Angeles Police Department (LAPD) and the Los Angeles Unified School District (LAUSD) in the early 1980s. They essentially took the two variants of Project SMART (Self Management and Resistance Training) that were being tested with 7th grade students in LAUSD schools at the time (Graham et al. 1990), combined them, and added a great deal of information about drugs for police officers to deliver to 5th and 6th grade students. The results of a randomized trial of the two SMART variants found that the resistance skills program was effective, albeit with small effects, and that the self-management program actually led to increased drug use relative to control group students (Graham et al. 1990; Hansen et al. 1988a). These results, combined with our knowledge that information does not often greatly influence behavior and that the police officers who used are not usually highly skilled teachers, make it no great surprise that DARE was not be effective. Although early nonrandomized studies suggested that DARE sometimes had small effects for elementary school students, multiple randomized trials have shown that DARE has little or no impact on drug use in the short term and no impact in the long term (Clayton et al. 1925; Dukes et al. 1996; Ennett et al. 1994a; Lynam et al. 1999; Rosenbaum et al. 1994; Rosenbaum and Hanson 1998). For a summary, see the meta-analysis by Ennett and colleagues (1994b). In response, DARE has developed programs for junior and senior high school students; the junior high program also has been shown not to be effective (Perry et al. 2003).
Another program that has been promoted as being an effective prevention program, but that has no medium-term effects on smoking is the Michigan Health Education Model. It consists of 30 lessons taught during grades 5–8, some of which include resistance skills training. Although it produced an 82 percent relative reduction (RR) in ever smoking at the end of the program (Shope et al. 1996), no significant effects on smoking behavior remained by the end of grade 12—indeed, boys became more likely to smoke (Shope et al. 1998). It seems that the prevention content of this program was not intensive or long enough to produce permanent effects, that additional programming might have been needed when the students were adolescents, or that some content may even have had a negative effect as some older informational programs did (Goodstadt 1978).
Other studies included in the Wiehe and colleagues (2005) meta-analysis were early studies of the social influences approach (Flay et al. 1989; Shean et al. 1994)1 that, in retrospect, one should never have expected to have long-term—or even medium-term—effects (Wiehe et al.
A similar study that reported 12th grade data, but was not included by Wiehe and colleagues (2005), was the early Minnesota smoking prevention program that many others were modeled after (Murray et al. 1989).