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Marilyn A. Winkleby, PhD, MPH; Ellen Feighery, MS; Meredith Dunn, MA; Sara Kole, MPH; David Ahn, PhD; Joel D. Killen, PhD

Arch Pediatr Adolesc Med. 2004;158:269-275.

Objectives  To test whether high school students' participation in advocacy activities related to the advertising, availability, and use of tobacco in their communities would prevent or reduce their own tobacco use.

Design  Ten continuation high schools in northern California, 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 alcohol abuse prevention (control).

Participants  Eleventh and 12th grade high school students; 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 readings. The following 3 constructs related to social cognitive theory— perceived incentive value, perceived self-efficacy, and outcome expectancies—were assessed.

Results  There was a significant net change from baseline 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 nonsmokers or light smokers. Regular smoking decreased 3.8% in treatment schools and increased 1.5% in control schools (P<.001). Regular smoking continued to decrease 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 activities 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 influences of cigarette smoking resulted in significant decreases in regular smoking.

From the Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, Calif.

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