Culturally Relevant Smoking Prevention for Minority Youth
Cella, David F., Tulsky, David S., Sarafian, Bernard, Thomas, Charles R., Jr., Thomas, Charles R., Sr., Journal of School Health
School-based interventions to prevent smoking have become well-established. Prior to 1978, smoking prevention programs emphasized "scare tactics," depicting health consequences of smoking. More contemporary curricula focused on skills to resist peer pressure,[3,4] promoting awareness of risks associated with smoking, and influencing the social environment. The social environment constitutes a major determinant of smoking initiation, so a program designed to shape that environment can be expected to affect smoking initiation. It is unknown whether shaping that environment on a small scale, such as single classroom, or on a larger scale, such as a school assembly, will have a greater impact.
The environment and values of economically disadvantaged-minority children is unique, requiring culture-specific attention. Few smoking prevention efforts have targeted minorities. This omission is particularly striking since smoking rates among minorities have risen or held constant in the face of drops in rates among White Americans.[3,8,9] Cooper and Simmons attributed the rise in smoking by African-Americans to the problem of creating a convincing message. Generic messages may be ineffective because they are not meaningful or convincing to disadvantaged African- American and Latino Americans in urban areas.
This study developed and tested the acceptability of a culture-specific approach to smoking prevention in disadvantaged children. The intervention employed a rap song contest. "Rap" music, very popular among children and adolescents, typically has a heavy emphasis on rhythm with spoken lyrics that often express commentary on themes perceived as relevant by disadvantaged youth. It was hypothesized that use of the culture-specific and relevant medium of rap music would increase the likelihood that students would attend to an anti-smoking message and find it personally relevant. A rap contest was used as a tool to help students rehearse an anti-smoking message and experience the necessary emotional affect to encode it, thereby preparing themselves for attitude change.
Four key curriculum features identified by Silvestri and Flay were introduced into the program: a socratic (dialectic) teaching method, small group activity, same-age peer delivery of the anti-smoking message, and classroom media (audiotape; videotape) presentation of skills to resist peer and media pressure. Efficacy of the intervention was assessed in students' evaluations of the assemblies and predictions of their impact, and in a pretest-posttest comparison of attitudes toward smoking. The independent variables were race of the student and size of the assembly. It was predicted that assembly ratings and attitudes against smoking would be better enhanced by smaller assemblies, and that this result would be further pronounced in students with minority backgrounds (African-American and Latino).
Study participants were 309 students from six sixth grade and six seventh grade classes located in four schools within a school district in a small city near Chicago. Participants were mostly African-American (57%) and Latino (19%). The mean age was 11.9 years (range - 10-14). Schools were randomly assigned to either a single-classroom or multiple-classroom (assembly) condition.
The pretest obtained demographic data, information about smokers in the home, and baseline date on smoking attitudes and behavior drawn from Botvin's life skills training program. Twelve five-point Likert type items were selected to comprise a smoking attitudes scale.[12,13] This scale taps attitudes relating to the smell of cigarettes, attractiveness of smoking cigarettes, and ability of smoking to win friends and look mature. It can easily be completed by children with a six grade reading level. Children with compromised reading level were assisted by the teacher or experimenter who read the question aloud. …