Buller DB, Borland R, Woodall WG, Hall JR, Hines JM, Burris-Woodall P, Cutter GR, Miller C, Balmford J, Starling R, Ax B, Saba L. Health Education and Behavior. 2008. 35(2): 260-281. PMID: 17114331.
Summary: This randomized controlled trial compared the efficacy of Consider This with usual health education to prevent smoking in adolescents. Schools in Australia (n=25) and the United States (n=21) were matched by size, demographic, and socioeconomic makeup. One school per pair was randomly assigned to implement Consider This with students in grades 6 through 9. The control schools continued their existing health education programs. Students completed pre- and post-tests to provide information on past 30-day smoking prevalence, expectancies, and attitudes. In both the Australian and American schools close to 90% of students completed the first module, while only 25% of students completed the entire Consider This program. More Australian students reported smoking a cigarette during the past month (Australia=5% vs. United States=3%) and ever smoking a cigarette (Australia=41% vs. United States=20%). For Australian students, the prevalence of smoking decreased more for students getting Consider This than students getting usual health education. Students in Australia receiving Consider This also had altered smoking expectancies, and were less likely to think that smoking was the norm. Altered subjective norms also mediated the relationship between Consider This and reduced smoking. In addition, a dose-response relationship was present for Australian students. Completing more modules of Consider This was associated with reduced smoking and greater changes in expectancies. In American students, Consider This was not associated with a significant reduction in the prevalence of smoking. American students receiving Consider This had lower future expectations for smoking.
Take Away: Results provide support for preliminary efficacy of Consider This to prevent smoking in early adolescents. Future research should investigate why Consider This was more effective in Australia than the United States, and the role of educators in the implementation and outcome success of the program.