Social Influences in Etiology and Prevention
of Smoking and Other Health Threatening
Behaviors in Children and Adolescents
Richard I. Evans
University of Houston
In his widely cited review of psychosocial approaches to smoking prevention, Flay (1985) commented on the brevity of the time line of prevention research:
Four generations of research on psychosocial approaches to smoking prevention have been conducted within less than one half of a human generation (indeed, less than one decade). Given this, remarkable progress has been made in an important area of health psychology and public health. …Research on smoking prevention …has evolved more systematically and progressed further than most other areas of health promotion. (p. 482)
For more than four decades, it has been my privilege to be an active participant-observer in the research processes just described (Evans, 1998), and the present chapter presents and historical perspective from that frame of reference. There is growing evidence that the components of smoking prevention programs may also be applicable to addressing the prevention of use of alcohol and other drugs as described, for example, by Glynn, Leukefeld, and Ludford (1985), and may be, at least, a basis for AIDS prevention interventions as well.
In examining the history of smoking prevention efforts, one first encounters the approach of conventional wisdom that high fear arousal is perceived as the major device for discouraging children and youth from beginning to smoke. As Janis and Feshbach (1953) suggested in their now classic study, high fear arousal to encourage a health protective behavior (oral hygiene) does have some impact on short-term changes in such behavior but may not impact on truly longterm changes. For example, Marston (1970) reported that immediately after a heart attack (certainly high fear arousal), individuals may change their lifestyles to minimize high risk behaviors (e.g., diet, smoking) to avoid a recurrence, but, over time, may return to many of their original risk-taking behaviors. So, even under conditions of intense fear, as pointed out in earlier research by Evans (1979), permanent changes in health habits may not occur. In fact, in the most recent report on smoking rates among adolescents, Johnston, Bachman, and O'Malley (1995) reported that most students in 8th, IOth, and 12th grades perceive a “great risk” in smoking, even in the face of increasing prevalence of smoking among these students. Further discussion of this report is addressed later in this chapter.
Because of the persistence of conventional wisdom concerning the effectiveness of “scare tactics” to prevent health threatening behaviors, a more detailed examination of fear arousal as a mechanism for instituting modification of behaviors may be instructive at this point. In his extensive review of the fear arousal literature, Higbee (1969) pointed out that no blanket statement could be made concerning the value of fear arousal as a persuasive device. However, this review suggested a basis for several interesting hypotheses that relate to the effects of various levels of fear arousal from minimal to