Objectives: To test whether high school students’ par- ticipation in advocacy activities related to the advertis- ing, availability, and use of tobacco in their communi- ties would prevent or reduce their own tobacco use.
Design: Ten continuation high schools in northern Cali- fornia, randomly assigned to a semester-long program in which students either carried out advocacy activities to counter environmental-level smoking influences in their communities (treatment) or learned about drug and al- cohol abuse prevention (control).
Participants: Eleventh and 12th grade high school stu- dents; 5 (advocacy) treatment and 5 control schools over 4 semesters from 2000 through 2002.
Main Outcome Measures: Self-reported smoking defined as nonsmokers (those who had never smoked tobacco or those who were former smokers), light smokers (those who smoked 1 pack per week), or regular smokers (those who smoked 1 pack per week), and confirmed by carbon monoxide level read- ings. The following 3 constructs related to social cog- nitive theory— perceived incentive value, perceived
self-efficacy, and outcome expectancies—were assessed.
Results: There was a significant net change from base- line to the end of the semester (after the intervention) between treatment and control schools for students who were regular smokers, but not for students who were non- smokers or light smokers. Regular smoking decreased 3.8% in treatment schools and increased 1.5% in con- trol schools (P .001). Regular smoking continued to de- crease at 6 months after the intervention in treatment schools, with a total change in prevalence from 25.1% to 20.3%. Involvement in community-advocacy activi- ties and the 3 social constructs—perceived incentive value, perceived self-efficacy, and outcome expectancies— also showed significant net changes between treatment and control schools (all P values .01).
Conclusion: Student engagement in community- advocacy activities that addressed environmental influ- ences of cigarette smoking resulted in significant de- creases in regular smoking.
Arch Pediatr Adolesc Med. 2004;158:269-275