Smoking rates among teenagers can be cut by training influential peers to spread anti-smoking messages in everyday conversations with their friends and peer group, according to research published in The Lancet medical journal.

“These results show clearly that young people can help each other avoid taking up the health damaging and addictive habit of smoking,” Dr. Rona Campbell of University of Bristol, UK, told Reuters Health.

“If implemented widely, this approach could cut the recruitment of new smokers considerably. This is especially important because if people don’t start smoking when they are teenagers it’s unlikely that they ever will,” Campbell said.

Numerous studies have shown that whether or not a young person takes up smoking is strongly associated with their friends smoking behavior. Peer pressure, or peer influence, can also be used to encourage healthy behaviors, as shown by Campbell and colleagues with a smoking prevention program called ASSIST - an acronym for A Stop Smoking In Schools Trial.

The study involved 10,730 students aged 12 to 13 years at 59 schools from across the west of England and Wales that were assigned to either continue their normal education about smoking (the control schools) or add the ASSIST program to their regular smoking education curriculum (the intervention schools).

With the ASSIST program, willing, influential students attended a two-day training event, where they learned about the risks of smoking and the benefits of not smoking, and developed communication skills through role-playing.

“A key aspect of the peer supporter role” was having them identify and promote anti-smoking messages that they thought their peers would be receptive to, Campbell explained.

Over a 10-week period following the training, the peer supporters were asked to have informal conversations with other students outside the classroom to encourage their peers not to smoke. Follow up data were collected immediately after the intervention and after one and two years.

Overall, students in the schools that had participated in the ASSIST peer supporter program were 22 percent less likely to take up smoking than those in the control schools. “The ASSIST program was effective in reducing the number of young people taking up smoking for up to 2 years after its delivery,” Campbell said.

“We estimate that if implemented on a UK-wide basis, the ASSIST peer supporter program could potentially reduce the number of 14- to 15-year-olds taking up smoking by around 43,000 per year,” she added.

In a commentary published with the study, Robin Mermelstein calls the findings of the ASSIST study “encouraging,” adding that “too many adolescents still smoke.” [

The University of Illinois, Chicago researcher also notes that the absence of any effect on young people who were already smoking “calls for greater attention to programmes for smoking cessation.”

SOURCE: The Lancet, May 10, 2008.