Waterloo Smoking Prevention Project

In 1979, the Waterloo Smoking Prevention Project represented one of the first rigorous efforts to evaluate a ''social influences'' approach to smoking prevention. Based in Waterloo, Canada, this project made use of a school-based curriculum to help students become aware of the social pressures to smoke and to practice ways of resisting those pressures.

The first curriculum component of the Waterloo Project consisted of two sessions in Grade 6 that were intended to provide information on the consequences of SMOKING. This was done with a method pioneered by the ancient Greek philosopher Socrates, who posed questions and then used the answers and discussion to shed light on difficult problems. In the Waterloo sessions, the Socratic method was used to stimulate the development in students of beliefs, attitudes, and intentions regarding smoking. Information obtained during the discussion was repeated in later work by the instructors and also via videotapes, poster making, and class discussions, so as to increase students' understanding and recall of the material.

The second and probably most important component of the project was the focus on the social influences that cause one to smoke (e.g., family, media, peers) and the development of skills to resist such pressures. Ideas were again elicited from students and repeated in a variety of ways. Students then practiced using the skills by role-playing what they could do when someone wanted them to smoke.

The third component of the program concerned decision making and public commitment. Students were asked to pull together the information learned earlier and to consider the social consequences of smoking in their own social environment. Each student then made a decision about smoking and announced it to the rest of the class, along with the reasons for the decision. ''Booster'' sessions were used to strengthen the students' skills. After the sixth-grade curriculum, students in Waterloo schools were given two booster sessions in Grade 7 and one booster session in Grade 8. All curriculum sessions were delivered by advanced graduate-school students who were on the research staff.

The Waterloo Project research team completed a very rigorous experiment to evaluate the short-term and long-term impact of this smoking-prevention curriculum and its booster sessions in grades six to eight. Out of twenty-two participating schools, eleven were designated at random to receive the Waterloo Project curriculum; the other eleven schools did not use any social-influences curriculum.

After tracking virtually all of the students in the participating schools, the research team used questionnaires to ask them whether and when they had started to smoke tobacco. There seemed to be a beneficial impact of the program before students reached Grade 9: Students who had received the curriculum were less likely to have started smoking. These early effects were not maintained during the high school years, however: The smoking levels of students who had received the curriculum were just as high as those of students who had not received it.

The value of the social-influences approach in preventing the onset of regular smoking by the end of high school needs further study. Results from the Waterloo Project and from other studies suggest that program effects obtained in junior high school might gradually decay during the following years and totally disappear by Grade 12. This kind of outcome may mean that high school booster sessions are necessary.

The apparent lack of effects of social-influence programs in preventing students from smoking by the time they reach Grade 12 should not be overinterpreted. First, it is possible that boosters in early high school years might help to maintain substantial early effects. Second, there is a much better understanding in 2000 than there was in the late 1970s and early 1980s of the essential components of effective prevention programs (Glynn, 1989). These improvements might well mean that current versions of social-influence programs might produce more durable effects. Third, society at large has changed since 1979, and social values are now more supportive of nonsmoking.

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