Meta-analysis of adolescent psychosocial smoking prevention programs evaluated from 1978 to 1997 in the United States

Psychosocial smoking prevention studies have shown inconsistent results in (1) how successful the programs have been in general, (2) which theory-driven programs have been related to program success, and (3) what specific variables have influenced program effects. Meta analysis was used as the judgement tool for resolving these discrepancies of what did and did not work.; This meta-analysis examined 65 evaluation studies of school-based psychosocial smoking prevention programs that have been published in professional journals between 1978 and 1997 for junior high and high school (grades 6 to 12) in the United States. Studies were screened for methodological research rigor (including at least quasi-experimental design). Three modalities (social influence; cognitive behavior; and life skill) and two program settings (school-only; and school-community-incorporated) were identified as major a priori classifications. An independent study was the unit of analysis for this meta-analysis. Outcomes (knowledge; attitude; skill; and behavior) were statistically integrated across studies using Hedges' d-effect size.; The short-term (1 to 12 months) mean effect sizes were .19 (based on 53 studies) for behavior, .22 for skill, .53 for knowledge, and .22 for attitude. Smoking behavior effects (.18 based on 26 studies) were maintained for three years compared to skill (.09), knowledge (.19), and attitude (.10) effects. Social influence modality programs (.12) were less effective in reducing adolescent smoking behavior compared to the cognitive behavior (.21) and life skill (.29) modality programs for short-term effects. Furthermore, mean effect sizes were likely to increase by explanatory variables as follows: (a) 5 th--7th grade students who were non-white and from low SES level; (b) Studies with rigorous research methodology such as baseline equivalence and 10% or less attrition rates; (c) Programs using trained peer leaders, targeting cigarette smoking only, or implementing 10 or more treatment sessions/booster sessions.; Psychosocial smoking prevention programs were successful in maintaining the 7--8% reduction of adolescent smoking behavior for three years after program end. This meta-analysis suggested adolescent smoking reduction rates could be increased by many potential program factors such as program modality and setting, improved methodological rigor, and implementation strategies. Health promotion and education practitioners should consider adopting these improving factors and monitor long-term results of adolescent psychosocial smoking prevention programs.