School-based tobacco prevention skill-building programs

Evidence Rating  
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Decision Makers
Date last updated

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 influences1. Programs can be led by teachers, health educators, or students2, 3, 4 and can be implemented in elementary, middle, or high school settings, often as universal programs2, 5. Some programs include a few sessions during one school year while others continue for several years1. School-based tobacco prevention efforts can be independent programs or include components of broader alcohol, tobacco, and other drug (ATOD) prevention programming2, 3.

Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Reduced youth smoking

What does the research say about effectiveness?

There is some evidence that school-based tobacco prevention skill-building programs reduce smoking among children ages 5 to 181 for up to three years following program completion1, 3, 6, 7. Additional evidence is needed to confirm effects, particularly as students age, and to determine which program components are most effective6.

School-based tobacco prevention skill-building programs led by teachers1, 2, 5, 6, 8, 9, trained adult facilitators3, and health professionals6 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 schools3. Peer-led programs in traditional schools may also reduce youth tobacco use4, 6. A study of a Northern Ireland-based smoking prevention program suggests that cooperative learning with peer interactions may be a component of successful prevention programs8.

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 youth2, 10. LST can also reduce daily use of alcohol, tobacco, and other drugs (ATOD) when used in high school settings2.

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 smoking1. Programs that use a social influences approach without other skills-based components, such as the Drug Abuse Resistance Education (DARE) program1, 11, and programs implementing universal school-based resilience interventions focused on individual or environmental protective factors do not affect youth smoking rates12.

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

LifeSkills Training (LST) is one example of a universal school-based substance prevention skill-building program that is used in many elementary, middle, and high schools to teach skills around drug resistance, personal self-management, and general social skills13. Another example, Too Good for Drugs, can also be used in elementary, middle, and high schools to teach students skills to make healthy choices, develop self-efficacy, and resist peer pressure14.

Project ALERT is a free substance abuse prevention program for 7th and 8th graders that equips students with the skills to resist drugs and cultivates attitudes and beliefs against drug use15.

Maine’s statewide approach to school-based prevention programs, Prevention for ME, features various substance prevention programs specific to grades k-5, grades 6-8, and grades 9-1216.

Implementation Resources

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

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

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

Too Good for Drugs - Too Good. Substance abuse prevention: Too Good for Drugs.


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1 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.

2 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.

3 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.

4 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.

5 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.

6 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.

7 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.

8 Thurston 2019 - Thurston A, Dunne L, Kee F, et al. A randomized controlled efficacy trial of a smoking prevention programme with Grade 8 students in high schools. International Journal of Educational Research. 2019;93:23-32.

9 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.

10 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.

11 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.

12 Hodder 2017 - Hodder RK, Freund M, Wolfenden L, et al. Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis. Preventive Medicine. 2017;100:248-268.

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

14 Too Good for Drugs - Too Good. Substance abuse prevention: Too Good for Drugs.

15 Project ALERT - Project ALERT. Substance abuse prevention for grades 7 & 8.

16 Prevention for ME - Maine Department of Health and Human Services (ME DHHS). Prevention for ME. School-based programs.