Study Hints Education Can Cut Smoking, Not Drinking

Education programs that teach teen-agers to resist social pressure can prevent or reduce the use of cigarettes and marijuana but seem to have little effect on alcohol consumption among young adolescents, according to a major study reported today in the journal Science.

Conducted by researchers at the RAND Corp. in Santa Monica, the study, which followed 4,000 youths in 30 junior high schools in California and Oregon for 15 months, is thought by many researchers in the field to be the largest and most comprehensive of its kind ever published in the United States.

In the past, there has been “a lot of skepticism” and “a lot of unanswered questions” about drug education programs, according to Phyllis L. Ellickson, who along with Robert M. Bell conducted the RAND study.

“Our findings,” Ellickson said, “undercut the most common criticisms of prevention programs,” including those expressed recently by federal drug czar William J. Bennett, who said that while prevention programs are certainly a good idea, they do not necessarily help the students who need it most.

Donald Hamilton, a spokesman for Bennett, said the optimistic conclusions of the RAND drug education study should be tempered with “a certain caution” because they do not take into account the role played by hard-nosed school policy in dissuading drug use.

“We think policy is at least as important in changing behavior as curriculum is,” Hamilton said.

In the RAND study, students in 20 schools received eight 45- to 55-minute lessons and three follow-up “booster” classes in a program called Project ALERT. A control group involving students in 10 additional schools either did not receive any drug education or were enrolled in existing drug prevention programs.

The lessons in Project ALERT were designed to show students ages 12 to 14 the unpleasant aspects of drug use. Cigarette smoking, the students were told, yellows teeth and causes “ashtray breath,” while marijuana smoking can cause a person to become disoriented and can make it hard to communicate even with friends.

By teaching youngsters the reasons behind drug use and ways to resist peer pressure, the study concluded, it is possible to curb drugs in inner cities as well as in rural and suburban communities. If properly designed, drug education programs can be equally effective among poor minority teen-agers as well as white affluent youngsters, the study said.

One far-reaching implication of this study, the researchers said, is the deleterious impact that legalizing marijuana and other illicit drugs could have on drug prevention efforts.

If drugs were to be sanctioned in any way, it could make drug prevention among teen-agers as difficult a task as alcohol prevention now seems to be, the researchers said.

While most experts in the field had not seen the results of the RAND investigation, many expressed enthusiasm about what the findings seemed to suggest.

“Most (drug prevention) programs are essentially experimental programs,” said Tom Schelling, who directs the Institute on Smoking Policy at the Kennedy School at Harvard University. “We know little about what they do or their long-term effects.”

“Fifteen months is a short time to determine whether these kids have been permanently inoculated,” Schelling said. “I wouldn’t yet say it would be wise for a city to put a lot of money into this program.”

Nonetheless, he added, “I would say this looks good. . . . It looks very hopeful.”

Ellickson said, many drug prevention programs have brought about changes in behavior and attitudes that are “so trivial” as to be hardly worth the time and money spent on them. Too often, she added, programs have focused on middle-class suburban students who are least at risk for drug problems while ignoring poor inner-city students who are most at risk.

What makes the RAND study different is that the program focused on a large sample of students from diverse socioeconomic and ethnic backgrounds in a variety of school settings.

Despite its success in reducing some forms of drug use among young teen-agers, the RAND project found that it is difficult, even in a well-designed drug education program, to curb cigarette smoking among youngsters who are already smoking by the time they enter junior high and to have any impact whatsoever on teen-age drinking habits.

“Our study demonstrates that drug programs, if properly designed, can work. But they aren’t a panacea,” Ellickson said.

“Some youngsters, especially those who are regular smokers by the time they enter seventh grade, have a variety of problems--they tend to be poor students and already involved in delinquent activities--which need to be much more aggressively addressed at a very early age,” Ellickson said.

“There is also probably very little that can be done to curb drinking among teen-agers, as long as parents, the media and society as a whole so readily sanction alcohol consumption,” she said.

Bennett, who caused controversy when he described drug education as an “auxiliary” to other anti-drug efforts, said in a major speech this month that there had been “encouraging and hopeful” signs of success in some education programs.

But Bennett cautioned that “we shouldn’t then jump to the conclusion that we have now discovered a drug education equivalent of the polio vaccine.”

Project ALERT was designed to help students understand the internal pressures that can lead to drug use--boredom and fear of rejection, for example. Through classroom activities like play acting, the program tried to help youngsters develop the social and psychological skills to resist such pressures in the real world.

Project ALERT’s approach, Ellickson said, relies on the latest behavioral modification research and is far more sophisticated and effective than the “Just Say No” advertising campaign made famous by Nancy Reagan during the 1980s.

The program was aimed at cigarettes, marijuana and alcohol because they are the substances most widely used by young teen-agers and because they are the “gateways” through which hard drug users almost invariably pass, Ellickson said.

After the lessons, which were taught by trained teachers and student leaders, the vast majority of students showed a significant reduction in cigarette and marijuana use compared to youngsters at the control schools.

The program cut by one-third the number of students who tried marijuana for the first time in comparison to students in the control groups. Also, among those who had already experimented with cigarettes before they began the program, 50% to 60% cut out cigarette smoking entirely a year later.

Although the program seemed effective in keeping youngsters from getting hooked on cigarettes, it did not discourage non-smokers from trying cigarettes. Nor did the program seem to have any positive impact on regular smokers, who actually increased their use of cigarettes by 20% to 30%.

Although the program produced modest decreases in alcohol consumption among seventh graders, by eighth grade the improvements had disappeared.

Contrary to the researchers’ expectations, using older teen-agers in the classroom instruction did not produce better results than adult teachers working on their own.

The researchers also found that “booster” sessions--three lessons in the eighth grade after the more intensive eight weekly lessons in the seventh grade--were critical in maintaining and further reducing smoking of cigarettes and marijuana.

The RAND researchers are now following the students to see whether the results persist through the high school years.

In the meantime, the Conrad N. Hilton Foundation, which financed the $8.8-million study, plans to make the Project ALERT curriculum available to school districts throughout the country.

Times staff writer Douglas Jehl in Washington contributed to this story.