Hutchinson Smoking Prevention Project

Trial Information

Hutchinson Smoking Prevention Project

Cigarette smoking remains the number one cause of preventable premature death in the U.S.,
annually killing more than 400,000 Americans. Without reversal of adolescent smoking trends,
five million of today's youth will die prematurely of smoking-related illnesses. The
16-year Hutchinson Smoking Prevention Project (HSPP) was conducted in 1984-1999 to (1)
address challenges of trial design and execution in school-based smoking prevention by
developing the most rigorous school-based randomized trial possible, and (2) use the trial
to answer the scientific questions, "To what extent can a theory-based, social-influences
smoking prevention intervention spanning elementary, middle and high school grades reduce
smoking among youth at 12th grade and two years post-high-school?"

The HSPP trial used a group-randomized, matched pair design with the school district as the
experimental unit. Of 40 participating school districts, 20 were randomly assigned to the
experimental (intervention) condition and 20 were assigned to the control (no HSPP
intervention) condition. No restrictions were placed on the health promotion or tobacco use
prevention activities of the control districts, thus enabling schools to continue whatever
health curricula were normally offered. Main endpoints were daily smoking at 12th grade and
2 years after high school (Plus-2). Study participants (N=8,388) were two consecutive third
grade enrollments in each of the 40 school districts. All third graders were followed to
endpoint, including those who dropped out of school or otherwise left their school
districts. The study achieved a 94% follow-up rate at the Plus-2 endpoint.

The HSPP intervention was a teacher-led, grades 3-10 tobacco use prevention curriculum plus
unit-specific teacher training. There were 65 classroom lessons in the HSPP curriculum: 9
lessons in each of grades 3-5, 10 lessons in each of grades 6-7, 8 lessons in grade 8, and 5
lessons in each of grades 9-10, for a total number of 46.75 hours of classroom instruction
time in grades 3-10. The HSPP uses an enhanced social influences approach that includes the
15 NCI-endorsed "essential elements" for school-based tobacco prevention and meets the CDC's
"best practices" guidelines. The intervention's behavioral components featured skills for
identifying and resisting social influences to smoke, correcting erroneous normative
perceptions regarding smoking, promoting tobacco-free norms, and building self-efficacy for
tobacco-free lifestyle choices. The intervention was developed to be practical for the
school setting, emphasizing ease of use by teachers, good fit into school routines and with
schools' existing educational objectives, and incorporation of topics/activities that are
interesting, engaging and developmentally-appropriate for students.