Family Programs Can Help Keep Kids From Smoking

A review of research on smoking prevention programs has turned up several family-based initiatives that helped keep children from becoming smokers.

Successful approaches included an Iowa program that educated parents on substance abuse risks and encouraged adults to establish clear family rules about cigarette smoking and a program in Norway that emphasized each child’s freedom to choose.

“I’d say that well-tested programs with enthusiastic counselors work,” said lead review author Roger Thomas, M.D. But “these programs are not surefire,” he added.

The reviewers identified 19 trials that tested the effectiveness of prevention strategies centered on family and parent involvement, then drew their conclusions from 14 studies they determined were sufficiently reliable.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

“You are going to put more trust in the studies that try to figure out the trajectory and underlying causes of why children smoke, versus just taking a snapshot,” Thomas said. “The Cochrane approach is very cautious; if we are going to spend millions of dollars we need to make sure it really works. So the essence of the review is deciding what quality of data we have.”

Nine better-quality studies identified by the review authors tested family-based programs against no intervention. In four of these studies, the family intervention significantly reduced the risk that a child would become a smoker.

Some of the successful programs were short interventions, while others were multilayered approaches that extended for seven or eight sessions. “The programs that worked were quite different,” said Thomas, a professor of family medicine at the University of Calgary in Canada.

Asked if parents and policy-makers should have confidence in family-based smoking prevention programs, Thomas said: “It really depends on whether you are a glass-half-full or glass-half-empty person. An optimist would say ‘Oh, four worked, great, we’ll go ahead.’ A pessimist who controls the budget might say, ‘There were five programs that didn’t work. So I’m not going to bother.’”

Of the studies that compared a family and a school program, only one found the family program reduced smoking more than the school program. Six studies compared a combined family-plus-school program to a school program and none found a difference.

Two family programs were unusual: One aimed to reduce alcohol use, the other targeted a variety of risk behaviors including HIV. Although neither study intervened against smoking, in both programs smoking decreased compared to the control group.