The Hutchinson Smoking Prevention Project: Questions and Answers
- What is the Hutchinson Smoking Prevention Project? The Hutchinson Smoking Prevention Project (HSPP) was a 15-year randomized trial conducted by the Fred Hutchinson Cancer Research Center in Seattle, Washington, and supported by the National Cancer Institute (NCI) in Bethesda, Md. (Question 1)
- Who participated in the trial? Forty school districts in Washington state took part in the project from 1984 to 1999; 20 districts were randomly assigned to implement the HSPP intervention and 20 continued their health promotion and tobacco prevention activities already in place, to serve as a means of comparison (control). (Question 2)
- How many of the students were followed until the end of the study? Of the 8,388 students who were enrolled as third-graders, 7,798 (93 percent) completed a grade 12 survey and 7,865 (94 percent) completed a Plus Two survey. (Question 3)
- What were the results of the study? The intervention did not show any impact on youth smoking, either at grade 12 or at Plus Two. The number of both boys and girls who smoked or who started to smoke during the project, as well as their ages when they started to smoke, were approximately the same between the intervention counties and the control counties. (Question 5)
1. What is the Hutchinson Smoking Prevention Project?
The intervention used a social-influences approach and included HSPP-developed anti-smoking curriculum units taught by HSPP-trained classroom teachers for students in grades three through 10. Supplemental high school components were implemented and available to students in grades nine through 12. These included motivational and self-help cessation materials, faculty training on how to encourage and support teen smoking cessation efforts, as well as posters and school newspaper advertisements with anti-smoking elements.
The primary outcomes of the trial were the number of participants in the control and intervention groups who smoked daily at grade 12 and at two years after high school (Plus Two).
2. Who participated in the trial?
Researchers enrolled 8,388 third-grade students in these 40 collaborating districts. The students in the intervention school districts received HSPP curriculum or materials from the third through the 12th grade.
The 40 school districts were situated in demographically and geographically diverse communities in rural or suburban settings. Intervention and control districts were similar at baseline for all child and parent characteristics that were measured, including child's early experimentation with cigarettes, parent's education level, parent's smoking, and single-parent households.
3. How many of the students were followed until the end of the study?
4. How were the smoking outcomes measured?
Because the surveys were based on self-report, and misreporting of tobacco use is a possibility among teens, each 12th-grader was also asked to provide a saliva specimen for cotinine analysis. Students were provided with an explanation of the saliva cotinine test and a demonstration of its collection. Cotinine is made in the body from nicotine, which is found in cigarette smoke. Since cotinine can only be made from nicotine, cotinine measurements from blood, urine, or saliva can show how much cigarette smoke enters the body.
5. What were the results of the study?
A small difference was found in the number of cigarettes smoked per day among daily smokers: 10.4 by students in districts without the intervention and 9.6 in the intervention districts. The authors concluded that the HSPP intervention had little or no impact on smoking prevalence.
6. What do these results tell us?
Other approaches, such as Life Skills Training, have been shown to be more effective in preventing smoking among youth. Smoking prevention approaches that have demonstrated effectiveness should be encouraged in the context of a comprehensive tobacco control program that includes strictly enforced school tobacco-free policies, active parent and community involvement, cessation services for students and staff, and coordination with community and media efforts to reduce tobacco use.
7. What is a social-influences approach to youth smoking prevention?
The HSPP began 16 years ago, in 1984. When the NCI and the Centers for Disease Control and Prevention (CDC) developed recommendations for effective school-based prevention programs in 1987 and 1994, respectively, researchers sought to include recommended curriculum elements from those guidelines in the HSPP curriculum. However, both the CDC and the NCI stressed that those recommendations were based on the best prevention knowledge at that time and emphasized the need for continued research.
8. Why are studies such as the Hutchinson Smoking Prevention Project important?
9. How much did the study cost?
10. Is the Hutchinson study the first and last of its kind? Does NCI have plans to support a similar, long-term intervention study of any other tobacco control prevention strategy?