The effect of two elementary school-based prevention interventions on being offered tobacco and the transition to smoking

Aims: This study sought to more precisely delineate the mechanisms by which two early elementary school-based, universal (i.e., applied to the entire population regardless of risk status) preventive interventions increased survival to first tobacco cigarette smoked. Specifically, we examined whether the interventions' effect on survival to first use was via the reduction of offers to smoke and/or through preventing the transition from first offer to smoking. Methods: A total of 678 urban first-graders were assigned randomly to the classroom-centered (CC), or the family-school partnership (FSP), or a control classroom condition. Youth were followed annually until 1 year beyond their anticipated high school graduation (mean age ∼18 years). Discrete-time survival analyses on 628 youth evaluated the impact of the CC and FSP interventions on first tobacco offer and initial tobacco smoking once offered. Findings: The risk of being offered tobacco was reduced among both CC and FSP intervention groups relative to the control group, although the reduction was only statistically significant for the CC intervention. Neither intervention condition reduced the transition to smoking once offered tobacco to smoke. Conclusion: The CC intervention appeared to have its effect on survival to first cigarette smoked by delaying the first offer to smoke. Preventive interventions focused on refusal skills during the middle school years may be necessary to reduce the likelihood of the transition to smoking once offered.