A meta-analysis of adolescent smoking prevention programs.

OBJECTIVES: A large number of studies evaluating adolescent smoking prevention programs have been published. Systematic quantitative reviews of this literature are needed to learn what does and does not work. The present meta-analysis focuses on the efficacy of school-based programs. METHODS: Evaluations of 94 separate interventions were included in the meta-analysis. Studies were screened for methodological rigor and those with weaker methodology were segregated from those with more defensible methodology; major analyses focused on the latter. RESULTS: Behavioral effect sizes were found to be largest for interventions with a social reinforcement orientation, moderate for interventions with either a developmental or a social norms orientation, and small for interventions with the traditional rational orientation. Attitude effect sizes followed the same pattern, but knowledge effect sizes were similar across all four orientation categories. CONCLUSIONS: Because behavioral effect represents the fundamental objective of programs for prevention of adolescent tobacco use, the present results indicate that school-based programs should consider adopting interventions with a social reinforcement, social norms, or developmental orientation.

Evaluation of an educational intervention upon knowledge, attitudes, and behavior concerning drinking/drugged driving.

The Contra Costa County educational program for juveniles found guilty of driving under the influence (DUI) was evaluated. Over 600 juveniles convicted of DUI from 1983 to 1988 formed the study group for this research and of these over 100 participated in the educational program. Assessment of program participants was conducted for knowledge, attitudes and behavior. Participants demonstrated increased knowledge, stronger attitudes against driving under the influence, and less risky alcohol and automobile related behaviors. County juvenile records analyzed by the logit procedure showed that class participants had a significantly lower number of repeat offenses compared to non-program participants that could not be explained by race, offense severity, age or gender.

Maintenance and relapse after weight loss in women: behavioral aspects.

Obese women who regained weight after successful weight reduction (relapsers, n = 44); formerly obese, average-weight women who maintained weight loss (maintainers, n = 30); and women who had always remained at the same average, nonobese weight (control subjects, n = 34) were interviewed. Most maintainers (90%) and control subjects (82%) exercised regularly, were conscious of their behaviors, used available social support (70% and 80%, respectively), confronted problems directly (95% and 60%, respectively), and used personally developed strategies to help themselves. Few relapsers exercised (34%), most ate unconsciously in response to emotions (70%), few used available social support (38%), and few confronted problems directly (10%). These findings suggest the advisability of development and prospective evaluation of individualized treatment programs designed to enhance exercise, coping skills, and social support.

A meta-analysis of the California school-based risk reduction program.

Prominent nonquantitative reviews of research evaluating school-based interventions designed to deter adolescents from the use of tobacco, alcohol and other drugs found the methodology to be flawed and thus little evidence existed that the interventions had the desired impact. Recent meta-analytic reviews indicate that information-focused interventions have more impact upon knowledge but less upon attitudes and behavior whereas alternative interventions have less impact upon knowledge but more upon attitudes and behavior. This result is replicated by the current meta-analysis performed upon eight risk-reduction programs meeting six standard methodological requirements for evaluation research.

An initial cross-cultural assessment of attitudes toward the elderly.

As the proportion of elderly persons comprising the population of developing and industrialized countries continues to increase, issues involving the elderly and attitudes toward the elderly will become more salient. The structure and components of attitudes held regarding the elderly need to be better understood. This need calls for instruments capable of measuring attitudes about the elderly across cultural contexts. The present paper reports an investigation of attitude structure and the development of two attitude scales using Likert scaling techniques combined with factor analysis. A pool of items was generated in English and in Spanish and subsequently endorsed by 396 individuals, 202 English and 194 Spanish native speakers. Factor analysis performed separately on results from the two language groups produced consistent results: one group of items loaded on a factor called positivity toward the elderly and the other group loaded on a factor called negativity toward the elderly. Theoretical implications of these findings were discussed and equivalent forms of positivity and negativity scales in English and Spanish were presented for use in further research.

A meta-analysis of school-based smoking and alcohol use prevention programs.

Tobacco and alcohol use among adolescents continue at historically high rates, and school-based interventions designed to deter students from smoking and drinking are increasingly being implemented. This study reports a meta-analysis of 47 smoking and 29 alcohol school-based intervention programs published after 1970. Results indicate that, in general, smoking and alcohol interventions have equally modest effects on immediate behavioral outcomes. Smoking interventions, however, have been more successful than alcohol interventions at altering students' long term behavior. All of the alcohol programs and all but one of the smoking programs reviewed successfully increased knowledge regarding the risks of these behaviors. Attitude change appears to be more difficult to achieve. Twenty-nine of 33 smoking studies and only 19 of 31 alcohol studies successfully changed students' attitudes. Finally, the data indicate that for immediate smoking outcomes and long-term alcohol outcomes innovative interventions relying upon social reinforcement, social norms, and developmental behavioral models are more effective than traditional "awareness" programs designed to inform adolescents about the health risks associated with tobacco and alcohol use. The implications of these findings for future of school-based health promotion programs are discussed.

Vocational predictions compared with present vocational status of 60 young adults with cerebral palsy.

A group of 97 cerebral-palsied students between the ages of seven and 16 years were assessed in the 1960s and 1970s, and predictions were made as to their vocational status as adults. In 1983, 60 of the 76 over 18 years of age were contacted. 39 had been employed at some time since leaving high-school, but only 17 were employed at the time of the survey. Of those who had worked, over half had achieved or exceeded their vocational predictions. Those in competitive employment were more likely to be mildly disabled, to have higher IQs and to have been educated in integrated schools. Those who had never been employed were older and less independent in self-care and travel in the community. However, intelligence was not a major factor in distinguishing the employed from the never-employed. Recommendations are made for integrated education and job training in competitive settings, for community-based assessments and for family involvement in all aspects of planning to improve the vocational prospects of cerebral-palsied children.

Effect of nutritional supplementation in pregnancy. II. Effect on diet.

Women judged to be at high risk of delivering low-birth-weight infants were assigned to one of three supplements--high-protein beverage, low-protein beverage, or a vitamin-mineral preparation--to determine: (a) The acceptability of a liquid dietary supplement to pregnant women. (b) The effect of the dietary supplement on diets normally eaten by pregnant women. Acceptance of the high-protein beverage by the women in this study was low. Fifty per cent of the dropouts indicated a dislike for the beverage because of either poor flavor or an inability to tolerate it. The women generally consumed "adequate" diets, although there were variations. Increases in intakes of calories and protein in Group 1 were statistically significant, suggesting the high-protein beverage served as a supplement for both calories and protein; that is, these nutrients were added to the women's existing intake. For the low-protein beverage women (Group 2), statistics revealed the beverage was used as a substitute.

A new technique for measuring preferences in demographic studies.

In this article, we introduce an alternative technique to the single-sentence question for measuring preferences for number of children, age at marriage, length of first birth interval, length of employment, and years of schooling. This new measurement procedure utilizes a graphic scale rather than verbal responses, and it places family size decisions within the context of several other major life cycle decisions. One month reliability data for the measurement technique were obtained from a sample of 107 school children. Reliability results are compared to data from a previous study of teenagers.