CORRESPONDENCE

Re: Hutchinson Smoking Prevention Project: Long-Term Randomized Trial in School-Based Tobacco Use Prevention—Results on Smoking

Steve Sussman, William B. Hansen, Brian R. Flay, Gilbert J. Botvin

Affiliations of authors: S. Sussman, Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles; W. B. Hansen, Tanglewood Research, Greensboro, NC; B. R. Flay, Health Research and Policy Centers, University of Illinois at Chicago; G. J. Botvin, Weill Medical College of Cornell University, New York.

Correspondence to: Steve Sussman, Ph.D., Professor of Preventive Medicine and Psychology and Institute for Health Promotion and Disease Prevention Research, University of Southern California/IPR, 1000 S. Fremont, Unit #8, Rm. 4124, Bldg. A-4, Alhambra, CA 91803 (e-mail: ssussma{at}hsc.usc.edu).

The Hutchinson Smoking Prevention Project (HSPP), whose findings were published recently (1), was a well-designed trial that was conducted from 1984 to 1999. The intervention tested was social-influences based and was delivered to cohorts of youth from grades 3 to 10 in 20 of 40 randomly assigned school districts (n = 8388). No statistically significant differences were found in prevalence of smoking between students in program and control districts in the 12th grade and 2 years after high school. The editorial accompanying the article (2) and recent media accounts may lead people to conclude that the social-influence approach is ineffective. That conclusion is unwarranted in light of the larger prevention literature. A recent meta-analysis by Tobler et al. (3) of 207 universal school-based drug prevention programs, including 138 prevention programs that included social-influence components, provides strong support for the efficacy of social-influence programming at a 1-year follow-up. The results of HSPP must be interpreted within the context of all of these other studies, many of which were methodologically rigorous, included large sample sizes, and collectively provide compelling evidence that some school-based prevention approaches are effective.

To draw meaningful conclusions about HSPP findings and their implications, we need much more information about the study data and outcomes that is not contained in the current article. In the absence of such information, it is worth considering possible alternative interpretations of these data. For example, it is possible that social-influence approaches do not work equally well with all youth (e.g., HSPP was conducted at small schools in primarily rural settings with primarily white youth). It is possible that youth did not like this particular program, since no process data are reported from youth. It is not clear how representative the HSPP intervention is of other prevention approaches that include a focus on prosmoking social influence. In particular, there should have been immediate effects on variables specific to the social-influence process, such as reductions in tobacco prevalence overestimates or perceived acceptability of tobacco use, that are not discussed. Failure to affect these variables would reflect program failure, not the failure of the general social-influence approach.

Also, the HSPP curriculum did not include several currently discussed elements of the social-influences approach that might be important to the achievement of prevention effects, such as listening and communication skills, decision making, and making a commitment (4). HSPP appears to be an example of what Tobler et al. (3) label as "social-influence" programming (minus a public commitment component) rather than more comprehensive approaches, such as "comprehensive life skills programming" [e.g., Life Skills Training or Project Towards No Tobacco Use (4,5)] or "system-wide programming" [e.g., Project Northland (3)]. The effect sizes of non-social-influence programs are 0. While the effect sizes of programs that contain social-influence components are in the small-to-moderate range (mean effect size = .12 to .27; standard deviation = .25), comprehensive life skills programming (i.e., social influence plus life skills material) is 40% more effective than social influence-only programming. Furthermore, system-wide programming (i.e., social influence or social influence plus life skills programming, delivered through multiple community units) is 60% more effective than comprehensive life skills programming.

Most important, it is not clear whether the HSPP is the case of a program whose effects later decay or if no effects ever occurred. Maintenance of program effects is a central issue in prevention (5). The HSPP findings (1) provide convincing evidence that this program's approach was not effective in the long run. However, given that more than 400 000 people die of smoking-related diseases each year and 3000 youth begin smoking each day, the results of one study should not be allowed to deter efforts to promote the use of smoking-prevention approaches for which there is convincing evidence of effectiveness.

NOTES

G. J. Botvin is the copyright holder of the Life Skills Training program and has a publication agreement with Princeton Health Press.

REFERENCES

1 Peterson AV, Kealey KA, Mann SL, Marek PM, Sarason IG. Hutchinson Smoking Prevention Project: long-term randomized trial in school-based tobacco use prevention—results on smoking. J Natl Cancer Inst 2000;92:1979–91.[Abstract/Free Full Text]

2 Clayton RR, Scutchfield FD, Wyatt SW. Hutchinson Smoking Prevention Project: a new gold standard in prevention science requires new transdisciplinary thinking [editorial]. J Natl Cancer Inst 2000;92:1964–65.[Free Full Text]

3 Tobler NS, Roona MR, Ochshorn P, Marshall DG, Streke AV, Stackpole KM. School-based adolescent drug prevention programs: 1998 meta-analysis. J Prim Prev 2000;20:275–336.

4 Botvin GJ. Preventing drug abuse in schools: social and competence enhancement approaches targeting individual-level etiologic factors. Addict Behav 2000;25:887–97.[Medline]

5 Donaldson SI, Sussman S, MacKinnon DP, Severson HH, Glynn T, Murray DM, Stone EJ. Drug abuse prevention programming: do we know what content works? Am Beh Scientist 1996;39:868–83.


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