Perry CL, Kelder SH, Murray DM, Klepp KI. (1992). Communitywide smoking prevention: long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study. American Journal of Public Health, 82, 1210-1216.
Designed to prevent tobacco use among students in grades 4-12, this school-based intervention consists of classroom sessions in which students engage in small-group discussions about the short-term consequences of smoking, normative tobacco use data, and the reasons why adolescents smoke; practice skills to resist social influences to smoke; and make pledges to abstain from smoking. The study showed lower smoking prevalence.
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Despite the decline in cigarette smoking rates over the past 25 years, according to the Centers for Disease Control and Prevention (CDC), about 20% of high school students report that they smoke. This is of great concern since cigarette smoking is thought to be the primary cause of premature morbidity and mortality in the United States. The peak time of smoking onset occurs in the 6th to 9th grades, so it is important to educate students regarding the health consequences of cigarette smoking before this critical period.
Previous smoking prevention programs targeting adolescents have been school-based. While they have been found to be effective in delaying the onset of cigarette smoking, none has demonstrated positive outcomes after 3 years. It was hypothesized that the effects of a school-based smoking prevention program with young adolescents would more likely be maintained if the program was part of a larger behavioral health program implemented throughout communities where adults within the family, schools, and community were all involved in the intervention efforts.
The Model Smoking Prevention Program (MSPP) is a school-based curriculum consisting of six classroom sessions appropriate for grades 6-8. Originally designed for 7th graders, the program has been expanded to include curricula for grades 4-8 with four classroom booster sessions (offered each year) for grades 9-12. Each session is 45 to 50 minutes. Through small group discussions, students are taught to identify the short-term consequences of smoking (e.g., smelling bad). Students are then shown normative data to provide them with a realistic understanding of how few of their peers actually smoke. The students then explore reasons why adolescents smoke, and how these associations are established in our culture through both advertising and peer and adult role models. The students practice skills to resist social influences to smoke, they create antitobacco advertisements and skits around possible social encounters, and they make pledges to abstain from cigarette smoking. Many of these activities are led by trained same-age peer leaders who have proven to be effective communicators for the social and psychological messages intrinsic to the program. MSPP was originally implemented as the Class of 1989 Study to test the efficacy of a smoking prevention program being combined with the community-wide Minnesota Heart Health Program (MHHP). The latter was a population-wide, community-based cardiovascular disease prevention program. The MHHP included seven strategies to promote heart-healthy behaviors and values: (1) population based risk factor screening for cardiovascular disease, in which more than 60% of adults participated in a 1-hour health assessment and direct education program for healthy eating, exercise, and smoking; (2) grocery and restaurant heart-health point-of-purchase food labeling education; (3) community organization and citizen task forces to develop annual risk factor education campaigns (such as the Quit & Win smoking cessation contest); (4) continuing education of health professionals to promote understanding of the nature of cardiovascular disease risk and prevention; (5) mass media education via television, radio, newsprint, etc.; (6) adult education in work sites, churches, workshops, and other organizations; and (7) youth education.
Below are the following time requirements to administer the MSPP:
-- For teachers to read and prepare for each lesson (about 45 minutes/lesson) by reading the teacher's manual
-- For teachers to hold elections and train peer leaders to co-teach each lesson (15 minutes for election and tally; 10-15 minutes/lesson for each of two peer leader training sessions)
-- For teachers and students to participate in the classroom program (45-50 minutes/lesson)
-- For parents to read the Talking About Tobacco booklet (15 minutes) and to talk with their child about the content of the booklet (15 minutes)
-- For a community coordinator to organize community task forces to initiate community-level changes; time varies by intensity of efforts and whether this is a paid or unpaid position (this component is optional)
The original audience for MSPP was 7th-grade students. The program is appropriate for students in all regions of the United States, including urban and rural, in all socioeconomic groups, and across a diverse ethnic population.
The MSPP was originally developed for 7th-grade classrooms. Newer versions of the program are now available for grades 4 through 12. It is designed to be administered in schools, homes, and community settings.
The MSPP toolkit includes the following materials:
-- Peer leadership guide
-- Booster session materials for high school students
-- Reproducible student handouts, IDs, and certificates
-- Parent booklets
-- Facilitator's guide with a set of game posters
-- Community action guide (optional)
About the Study
The entire population of three cities in the north-central United States participated in the MHHP (the original cardiovascular disease prevention program). Three similar cities, also in the north-central portion of the United States, served as control communities. Participants in the Class of 1989 Study who received MSPP were 7th-grade students from two of the MHHP communities (two received the MHHP program, and one additional community served as a no-intervention reference community). The average age of participants was 12, and there were equal numbers of males and females. They were primarily White and represented a variety of socioeconomic levels. Students in the intervention community received the intervention, while students in the reference community served as controls. No school- or community-based smoking prevention programs were implemented in the reference community during the study period. Baseline surveys were conducted in the first year. There were no significant differences between the groups at baseline.
The MSPP was implemented in the fall of 1984, when the cohort of participants was in the 7th grade (Class of 1989 Study). Outcome evaluations were assessed through annual surveys from 1983 to 1989, conducted in the classrooms by survey staff from the MHHP who were trained for classroom administration. All students in the Class of 1989 Study were surveyed, for a total of approximately 2,000 students annually. Participation rates of 93-94% were achieved in each of the survey years.
- At final follow-up in 1989, the mean smoking prevalence over the past month was 14.6% for the intervention group versus 24.1% for the control group (p<.01).
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