At the individual level, findings suggest that counseling and pharmacological therapies are effective (AHCPR, 1996; Tobacco Use and Dependence Clinical Practice Guideline Panel, 2000). The U.S. Public Health Service issued a Clinical Practice Guideline (Tobacco Use and Dependence Clinical Practice Guideline Panel, 2000) based upon the recommendations of an expert panel. They reviewed nearly 6,000 peer-reviewed articles and recommended that all tobacco users should be offered treatment since effective treatments exist: institutionalizing consistent identification, documentation, and treatment of all tobacco users; brief treatment is effective; greater intensity of counseling is more effective; three types of counseling and five pharmacotherapies were found to be effective. This approach was evaluated for tobacco cessation, but in modified form might also be effective for prevention.

Many community-based interventions have shown variable success. Many of them have been directed toward youth in the belief that they would have the greatest impact for the future. One exemplary study of school-based smoking prevention, the Hutchinson Smoking Prevention Project (HSPP) (Peterson et al., 2000) sponsored by the National Cancer Institute, is described above. This 15-year study, in 40 school districts of Washington state that were randomly assigned to intervention or control groups, involved 8,388 third graders who were followed to 2 years after high school with 94% follow-up. The authors concluded “there is no evidence from this trial that a school-based social-influences approach is effective in the long-term deterrence of smoking among youth.”

Similarly, an assessment of policy interventions in a school setting was found to have limited impact. Based on the observation that organizational smoking policy may be a potentially effective way to influence smoking behavior in worksites (Borland et al., 1990), Bowen et al. (1995) surveyed 239 schools as to their smoking policies. They identified three types of policies: a ban on smoking on school grounds; smoking allowed on school grounds; and smoking allowed in designated areas in the building. Their conclusion was: “current smoking policies may have limited ability to reduce student smoking.”

A scholarly review of government level approaches to tobacco use prevention and cessation by the Advocacy Institute (2000) found that although single approaches via clean air laws, price increases, counter-advertising, enforcement of existing laws restricting youth access and others may be effective with some people. However, a combination of these approaches has the greatest possibility of success.



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