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resources. Because health promotion may not be seen as central to the school's mission, the development and implementation of smoking prevention programs have had to contend with many obstacles.

Despite these impediments, significant knowledge of how to prevent young people's tobacco use has been gained over the past two decades. School-based research programs have explored a variety of approaches, which have helped identify the most useful program elements. School-based smoking prevention efforts have also been made more effective when reinforced by broad-based community programs. Moreover, these methods are now being applied with success to preventing smokeless tobacco use.

Recent publication of the Centers for Disease Control and Prevention's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction1 and reviews calling for a national agenda for school health promotion2 give further impetus to supporting schools as the locus for tobacco prevention efforts. Comprehensive prevention and health promotion programs that prevent the initiation and use of tobacco products can assist in attaining Healthy People 2000 objectives. A review of school-based tobacco prevention programs and programs that integrate prevention into the context of a community effort to reduce tobacco use is a useful basis for developing the model for a comprehensive policy to prevent addiction to tobacco among children and youths.

Approaches to School-Based Prevention Research

Following the publication of the surgeon general's report in 1964, development of school-based programs to prevent tobacco use by youths grew incrementally, theoretical approach by theoretical approach, program concept by program concept, for two reasons. First, the limitations of behavioral research techniques made it difficult to measure the effect of more than one intervention component at a time. Second, prevention as a lifestyle behavioral concept was a new approach to public health. During this time, however, the most successful components were identified and, as the capacity to conduct multicomponent research among large populations advanced with experience and technology, the best behavioral approaches and program components were combined into more effective interventions. The following section highlights the promising approaches and their components for school-based prevention programs that are reinforced by community-based programs.

Information-Deficit Model. The 1964 surgeon general's report provided evidence to the public health community and to the general public that smoking contributes to mortal diseases. A significant percentage of adults acted on that information by quitting smoking. The information, however, had not been designed to reach children and youths. Public health professionals and educators assumed that youths who smoked would quit using tobacco if they were exposed



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