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o smoking and make public commitments to not smoke. Of these, nine showed some positive effect on students’ smoking prevalence.

“There is some evidence that school programs incorporating social influence models can affect smoking behavior in the short term,” the reviewers wrote. But when they pooled the results of the social influence interventions, they were not statistically significant.

Combined programs used both social competence and influence methods in their anti-smoking interventions. One study found significantly decreased the prevalence of student smoking; another study indicated that the smoking intervention decreased student smoking, but only when health educators provided the smoking education, as opposed to students receiving information via self-instruction.

Of the four studies that evaluated multi-modal programs, which combined school-based programs with parent and community initiatives, three showed that the programs effectively reduced the prevalence of smoking in students.

The Cochrane review also mentioned the largest and most rigorous tobacco education study, the Hutchinson Smoking Prevention Project, which took place in 40 school districts in Washington state. The study found that an intensive eight-year program had no long-term effect on student smoking behavior when students were reassessed two years after high school.

The reviewers said that over the past three decades, efforts to influence youth smoking have focused on schools. Today, about 70 percent of U.S. middle school students and 50 percent of U.S. high school students receive tobacco prevention education in the classroom, according to the background information.

“The key problem for future research is whether more of the social influences programs can be improved so that they are effective,” Thomas said.

The reviewers also concluded that when educators and parents examine smoking education programs, e
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