After examining over a hundred "gold standard" studies, researchers found that school-based programs that teach children life skills and self esteem were linked to a significant reduction in the number who started using tobacco down the road. "There was a significant effect for more than one year," said Julie McLellan, one of the study's authors from the University of Oxford in the United Kingdom.
McLellan and her colleagues published their findings in The Cochrane Library, which is a publication of the Cochrane Collaboration, an international organization that evaluates medical research.
They write that the review was needed because many U.S. schools include tobacco education in their lessons although few have been tested.
Programs that taught life skills and those that also showed them how to overcome social influences were linked to a reduction in the number of smokers.
A survey from 2000 found between 50 and 70 percent of U.S. middle and high school students had been taught about the short-term consequences of tobacco use.
"It's important because there are no other reviews that have gone and looked into the world literature on school-based smoking prevention programs," McLellan said.
For the new review, the researchers searched several academic databases for studies that assigned students, classes, or schools randomly to either have a prevention program, or not have one. The children had to be between five and 18 years old, and had to be tracked by the researchers for at least six months.
While the researchers found 134 studies, they focused on 49 that tracked about 142,000 students who never smoked before the programs began. Some programs consisted of lessons that gave students information on smoking, and others taught students life skills, such as problem solving and decision making.
Overall, the programs that taught students life skills and those that also showed them how to overcome social influences were linked to a reduction in the number of smokers after at least a year.
McLellan gave the example that they would expect about 30 percent of any population to smoke. The program would be linked to a three percentage point decrease, which would bring the number of smokers to 27 percent of the group. But McLellan said more research is needed on those social support programs, which made up only a few of the 49 studies, and whether prevention programs lead to cost savings.
Andy Johnson, who has studied school-based prevention programs but was not involved with the new research, told Reuters Health that the new findings point to areas for future research. "It does say there is a productive science here of how to prevent cigarette smoking and probably other substances as well. We have to pursue that science," said Johnson, dean of the School of Community and Global Health at Claremont Graduate University in California.