Assessing skills for refusing cigarettes and smokeless tobacco

A Smoking Intervention Program for Primary Four Students in Hong Kong: What it can and cannot achieve

The study aimed to assess the feasibility of a smoking prevention intervention program in primary schools in Hong Kong; increase awareness of the purpose of tobacco advertising; record any changes in attitude towards smoking; and measure the effects of the program on the children's knowledge of the harmful effects of smoking on health. Six classes from two primary schools in Hong Kong were involved in the study. The sample of 205 pupils in Primary 4, aged 9-10 years, were presented with a smoking prevention program of three lessons, including homework assignments.

The intervention was evaluated by the analysis of pre-and post-test results and through personal interviews with the teachers. There were statistically significant changes in the responses of the children between pre-and post-tests, with a reduction in “don't know” answers and increase, in most cases, in correct responses. There were more improvements in knowledge than in attitude. There were no significant changes in the responses to questions about current behavior or future intention to smoke.

School-based smoking prevention programs for primary schools in Hong Kong should be further developed and evaluated. Additional studies with larger numbers of children need to be conducted and implementation should occur quickly once efficacy has been demonstrated by evaluation. We hypothesize that a longer, spiral curriculum spanning Primary 4, 5 and 6 would be more effective in preventing the uptake of smoking, although this shorter program is a feasible and acceptable alternative to the absence of any program.

Preadolescent drug use resistance skill profiles, substance use, and substance use prevention

The aims of the current study were threefold: (1) specify the skills component of social influence prevention interventions for preadolescents, (2) examine the relationship between resistance skill profiles and substance use among preadolescents, and (3) evaluate whether subgroups of preadolescents based on their resistance skills and refusal confidence may be differentially impacted by the kiR prevention program. Latent class analysis showed a four-class model of 5th grader resistance skill profiles. Approximately half of preadolescents (53%) were familiar with four prototypical resistance skills and showed confidence to apply these skills in real-world settings (highly competent profile); 15% were familiar with resistance skills but had little confidence (skillful profile); 18% were confident yet had little knowledge (confident profile); while 15% had low knowledge and confidence (low competence profile). These skill profiles significantly predicted 8th grade recent substance use (2LL = -2,262.21, df = 3, p = .0005). As predicted by theory, the highly competent skill profile reported lower mean recent substance use than the population sample mean use. Latent transition analysis showed that although patterns of transiting into the highly competent skill profile over time were observed in the expected direction, this pattern was not significant when comparing treatment and control. Identifying skill profiles that predict recent substance use is theoretically consistent and has important implications for healthy and substance-free development.

Smoking initiation and personal characteristics of secondary students in Hong Kong

AIM

To explore the relationship between personal characteristics and smoking initiation among adolescents in Hong Kong.

BACKGROUND

Adolescents have been initiating cigarette smoking at an increasing rate in recent years. Preventing tobacco use among young children has become one of the most effective strategies to reduce the harmful effects of tobacco use.

DESIGN

A cross-sectional study.

METHODS

Secondary students were recruited by convenience sampling from schools in the New Territories of Hong Kong in 2010. Questionnaires were used to collect information relating to their demographic and personal characteristics, including behavioural control, coping styles, sociability, locus of control, rebelliousness, self-esteem, emotional distress, and intention to smoke.

RESULTS

A total of 644 secondary students were recruited. The prevalence of having ever tried smoking was 19·4% and that of regular smoking was 3·9% among these students. The results of this study show that secondary students who were living in public housing and had lower behavioural control and higher smoking intention were more likely to have tried smoking or to be regular smokers, indicating that these factors contribute to smoking initiation among secondary students.

CONCLUSIONS

The personal characteristics of secondary students do play a role in smoking initiation. Parents and school personnel should work together to help young people to improve their self-esteem and behavioural control and to overcome their rebelliousness. The causes of smoking intention should also be explored to stop young people from picking up their first cigarette.

Refusal skill ability: an examination of adolescent perceptions of effectiveness

This pilot study examined whether refusal assertion as defined by a proven drug prevention program was associated with adolescent perceptions of effectiveness by comparing two sets of coded responses to adolescent videotaped refusal role-plays (N = 63). The original set of codes was defined by programmatic standards of refusal assertion and the second by a group of high school interns. Consistency with programming criteria was found for interns' ratings of several indicators of verbal and non-verbal assertiveness. However, a strategy previously defined by the program as effective was perceived as ineffective by adolescents while another deemed ineffective and problematic by intervention developers was viewed as effective. Interns endorsed presenting detailed and reasonable arguments as an effective refusal strategy while short, simple statements were deemed ineffective. This study suggests the importance of including adolescent perspectives in the design, delivery, and evaluation of drug prevention strategies.

Why do effective smoking prevention programs work? Student changes in social cognitive theory constructs

Psychosocial smoking prevention programs can decrease adolescent smoking initiation. This study determined if the theoretical variables targeted in a psychosocial smoking prevention program can be improved significantly by participation in a smoking prevention program. The Social Cognitive Theory constructs examined included behavioral capability to resist positive images of smoking, refusal skill-efficacy, total positive refusal expectations and importance, and total negative refusal expectations and importance. The smoking prevention program had a significant impact on student refusal skill-efficacy and total positive refusal expectations and importance. However, the program did not affect behavioral capability to resist positive images of smoking and total negative refusal expectations and importance. Results from the study can be used to improve the impact of psychosocial prevention programs on targeted Social Cognitive Theory constructs and support the continued practice of cigarette refusal strategy role-plays, addressing various types of pressure and emphasizing positive outcomes from cigarette refusals.

Tobacco-refusal skills and tobacco use among high-risk adolescents

Psychosocial tobacco use prevention programs are based on the assumption that refusal skills training will have a suppressive effect on the onset of use by enabling non-using adolescents to refuse offers of cigarettes and smokeless tobacco. The present study investigated this assumption with 389 high-risk junior high-school students involved in a prevention program during their seventh, eighth, and ninth-grade years. Direct behavioral measures of refusal skills were taken by having subjects respond to audiotaped offers of tobacco and then rating the quality of their responses. These ratings were then linked to tobacco use measures obtained at the end of each of the 3 study years. Results showed that the comprehensive prevention program produced a favorable trend in delaying or preventing the onset of tobacco use. However, the refusal skills training, which was carried out throughout the 3-year intervention period, produced significant differences in overall refusal skill quality only at the seventh grade. Moreover, refusal skill quality was not related to overall tobacco use or cigarette use at any grade.