School-based tobacco prevention skill-building programs

School-based tobacco prevention skill-building programs teach students personal and social skills to help avoid tobacco use, such as problem solving, decision making, and coping methods for stress; techniques to improve self-esteem, self-control, and assertiveness; and methods to resist personal or media influences (Cochrane-Thomas 2015). Programs can be led by teachers, health educators, or students (Botvin 2015, Sussman 2014, MacArthur 2016) and can be implemented in elementary, middle, or high school settings (Botvin 2015, ). Some programs include a few sessions during one school year while others continue for several years (Cochrane-Thomas 2015). School-based tobacco prevention efforts can be independent programs or components of broad alcohol, tobacco, and other drug (ATOD) prevention programming (Botvin 2015, Sussman 2014).

Expected Beneficial Outcomes (Rated)

  • Reduced youth smoking

Evidence of Effectiveness

There is some evidence that school-based tobacco prevention skill-building programs reduce smoking among children ages 5 to 18 (Cochrane-Thomas 2015) for up to three years following program completion (Cochrane-Thomas 2015, Sussman 2014, , AHRQ-Ranney 2006). Additional evidence is needed to confirm effects, particularly as students age, and to determine which program components are most effective ().

School-based tobacco prevention skill-building programs led by teachers (Cochrane-Thomas 2015, Botvin 2015, , , ), trained adult facilitators (Sussman 2014), and health professionals () have been shown to reduce tobacco use among youth. Programs led by trained adult facilitators have been shown to reduce smoking among youth who attend Alternative High Schools (Sussman 2014). Peer-led programs in traditional schools may also reduce youth tobacco use (MacArthur 2016, ).

LifeSkills Training (LST), an example of a program that teaches social resistance skills along with general personal and social competence skills, often in middle schools, has been shown to prevent tobacco use among youth (, Botvin 2015). LST can also reduce daily use of alcohol, tobacco, and other drugs (ATOD) when used in high school settings (Botvin 2015).

Programs that combine social competence training (e.g., problem solving and decision making skills) with social influences training (e.g., skills to manage peer pressure) have been shown to reduce youth smoking (Cochrane-Thomas 2015). Programs that use a social influences approach without other skills-based components, such as the Drug Abuse Resistance Education (DARE) program, do not affect smoking rates among youth (Cochrane-Thomas 2015, Peterson 2000).

Impact on Disparities

No impact on disparities likely

Implementation Examples

LifeSkills Training (LST) is one example of a school-based tobacco prevention skill-building program that is used in many elementary, middle, and high schools (LST). Partnership for a Tobacco-Free Maine is an example of a statewide approach to support LST implementation with workshops for middle school teachers (ME DHHS-PTM).

Implementation Resources

LST - Botvin LifeSkills Training (LST). LST overview.

Child Trends-LST elementary - Child Trends. Life Skills Training (LST)—Elementary school version. 2012.

Child Trends-LST - Child Trends. Life Skills Training (LST). 2016.

Citations - Evidence

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Peterson 2000 - Peterson AV., Kealey KA, Mann SL, Marek PM, Sarason IG. Hutchinson Smoking Prevention Project: Long-term randomized trial in school-based tobacco use prevention - results on smoking. Journal of the National Cancer Institute. 2000;92(24):1979-1991.

MacArthur 2016 - MacArthur GJ, Harrison S, Caldwell DM, Hickman M, Campbell R. Peer-led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11-21 years: A systematic review and meta-analysis. Addiction. 2016;111(3):391-407.

Dobbins 2008* - Dobbins M, DeCorby K, Manske S, Goldblatt E. Effective practices for school-based tobacco use prevention. Preventive Medicine. 2008;46(4):289-297.

AHRQ-Ranney 2006 - Ranney L, Melvin C, Lux L, et al. Tobacco use: Prevention, cessation, and control. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2006.

Cochrane-Thomas 2015 - Thomas RE, McLellan J, Perera R. Effectiveness of school-based smoking prevention curricula: Systematic review and meta-analysis. BMJ Open. 2015;5(3):e006976.

Botvin 2015 - Botvin GJ, Griffin KW, Williams C. Preventing daily substance use among high school students using a cognitive-behavioral competence enhancement approach. World Journal of Preventive Medicine. 2015;3(3):48-53.

Botvin 2003* - Botvin GJ, Griffin KW, Paul E, Macaulay AP. Preventing tobacco and alcohol use among elementary school students through Life Skills Training. Journal of Child & Adolescent Substance Abuse. 2003;12(4):1-17.

Wang 2012a* - Wang Y, Storr CL, Green KM, et al. The effect of two elementary school-based prevention interventions on being offered tobacco and the transition to smoking. Drug and Alcohol Dependence. 2012;120(1-3):202-208.

Sussman 2014 - Sussman S, Arriaza B, Grigsby TJ. Alcohol, tobacco, and other drug misuse prevention and cessation programming for alternative high school youth: A review. Journal of School Health. 2014;84(11):748-758.

Botvin 1982* - Botvin GJ, Eng A. The efficacy of a multicomponent approach to the prevention of cigarette smoking. Preventive Medicine. 1982;11(2):199-211.

Citations - Implementation Examples

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LST - Botvin LifeSkills Training (LST). LST overview.

ME DHHS-PTM - Maine Department of Health and Human Services (ME DHHS). Partnership for a Tobacco-Free Maine (PTM). LifeSkills training.

Date Last Updated

Apr 12, 2017