School-based smoking control: a research agenda

Within the context of a framework for cancer control, this article reviews evidence and suggests research directions for 3 types of school-based smoking interventions: elementary school prevention, secondary school interventions and interventions linking community and school. Directions for smoking research in elementary schools include improving adoption through the provision of effectiveness criteria, tailoring interventions to schools and training. Monitoring at micro and macro levels may help planning and implementation, but clearer evidence is required of its feasibility. Fundamental research should explore new options to understand why youth do not start smoking. Smoking intervention research at the secondary school level is less well established, with only 1 effectiveness trial reported. We recommend testing models that involve youth in developing their own solutions and examining the interaction of various control measures. Sustainability issues have led researchers to embed school-based smoking interventions in community-wide activities. Intervention research of this sort still needs to determine how to apply approaches (e.g., comprehensive school health) and what the appropriate roles are (such as technical assistance) for community agencies. All research using these school-community approaches needs to include process measures to explain potential failures to obtain significant differences between components. In addition, we call for research on the training of educators and health personnel, to increase the priority given to smoking prevention and improve the implementation of existing programs. Research on policy initiatives that lead to effective training needs to be explored. Finally, we argue that application of the principles incorporated into the cancer control framework (e.g., through participatory research methods) strengthens the research process and results.