![]() ![]() ![]() Just as school-based programs in middle school require booster sessions in high school to maintain their effects, for example, so must mass media programs be repeated or continued to maintain their effects. However, as will be shown in this report, the effects of nearly all kinds of preventive efforts decay over time if they are not maintained. Both approaches are covered in this chapter, but since 1994 the emphasis on policy and environmental approaches has increased ( Warner 2007a, b). In the United States, some researchers and practitioners have focused on individuals, while others have emphasized policies and programs operating at the societal level ( Giovino 2007). Other ecologically driven efforts involve reducing youth access to tobacco products, increasing taxes on tobacco, enacting clean indoor air policies, and reducing images of smoking in movies. Thus, some research during the last 18 years has focused on involving families in educational efforts, and on changing family dynamics, to protect young people against smoking. For example, as documented in Chapter 4, families can have a major impact on the likelihood of smoking by young people. ![]() In addition, social and environmental factors are recognized as increasing risk for, or providing protection against, smoking by young people and are used as venues for prevention. Since then, social-cognitive approaches have been elaborated, and some approaches focused on changing normative beliefs have also been tried. The 1994 Surgeon General’s report, which reviewed the history of prevention initiatives ( USDHHS 1994), concluded that early informational and affective approaches were not effective in preventing smoking among youth, and that approaches based on social-cognitive theory that focused on the teaching of social and self-management skills held the greatest promise. The coordinated use of all the strategies reviewed in this chapter can help to protect youth from the psychosocial risk factors discussed in Chapter 4, “Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth” and the promotional efforts of the tobacco industry discussed in Chapter 5, “The Tobacco Industry’s Influences on the Use of Tobacco Among Youth.” The remaining sections, which review the evidence for the effectiveness of prevention, are divided into (1) large social environments, such as community and statewide programs and mass media campaigns (2) regulatory and policy-driven approaches, such as the Synar Amendment to the ADAMHA Reorganization Act (1992), which seeks to limit the access of youth to tobacco products ( Substance Abuse and Mental Health Services Administration 2011), and policies that affect product labeling, create smoke-free environments, restrict advertising, and raise tobacco taxes (3) small social environments, such as families, clinical settings, and schools and (4) special issues, such as preventing the use of smokeless tobacco and other tobacco products, conducting preventive efforts with vulnerable populations, and implementing cessation interventions for youth. Department of Health and Human Services 1994), including summaries of scientific evidence on strategies to reduce youth smoking, the theories underlying prevention efforts, various approaches to prevention, and the criteria for judging the evidence of the effectiveness of prevention strategies. The first section provides background on changes in prevention strategies since the 1994 Surgeon General’s report on preventing tobacco use among young people ( U.S. This chapter examines the history and effectiveness of efforts to prevent and reduce tobacco use among young people, with an emphasis on those under 18 years of age. ![]()
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