In order to assess as early as possible the effectiveness of these research efforts and their readiness to be applied on a larger scale, the STCP consulted on a regular basis with the various investigators to maximize cross-fertilization. As each trial area concluded, the STCP convened the principal investigators and their key staff. These meetings resulted in a series of consensus statements based on the empirical research, which have been used to select specific prevention and cessation activities to be further explored in the second and third phases of the program.
One example of the studies conducted during the first phase was school-based interventions, of which NCI funded 10 program trials. They covered both public and private schools, from elementary to high school levels. Some aimed at developing new curricula, some at revising existing curricula, and some at conducting long-term follow-up evaluations. When the investigators convened after the trials concluded, they agreed that school-based smoking prevention programs had had consistently positive effects, although the effects were modest and limited in scope.
The programs have been particularly effective in delaying the onset of tobacco use, but less successful in targeting use by high-risk and minority groups (Glynn, 1989). This should perhaps come as no surprise, given the barrage of advertising and media exposure that children steadily receive. For example, a recent study concluded that by the time U.S. children are six years old, they can just as easily identify “Old Joe the Camel,” a cartoon character frequenting cigarette advertisements, as they can identify the logo for Mickey Mouse (Fischer, Schwartz, and Richards, 1991). Educational strategies to overcome such influences and boost success rates remain to be investigated, but may include earlier intervention and more frequent interventions throughout the junior high and high school years.
The second phase is a $45 million effort called the Community Intervention Trial for Smoking Cessation (COMMIT). Beginning in October 1988, a number of comprehensive community-based interventions (incorporating lessons from the first-phase studies) are being tested in 11 communities in North America, against the same number of control communities. The third phase, which will incorporate findings from the first two, will be the American Stop Smoking Intervention Trial for Cancer Prevention (ASSIST). This $150 million effort is set to begin in the fall of 1993. It will introduce large-scale interventions, emphasizing coalition development and policy change, in 17 states (reaching more than 50 million people), with work being carried out by state and local health departments. NCI believes that this sharply focused and coordi-