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Why Smoking Prevention Programs Sometimes Fail. Does Effectiveness Depend on Sociocultural Context and Individual Characteristics?

Institute for Health Promotion and Disease Prevention Research, University of Southern California Keck School of Medicine, Alhambra, California

Requests for reprints: Jennifer B. Unger, Institute for Health Promotion and Disease Prevention Research, University of Southern California Keck School of Medicine, 1000 S. Fremont, Box 8, Alhambra, CA 91803. Phone: 626-457-4052. E-mail: unger{at}usc.edu

Background: School-based smoking prevention programs sometimes fail in unexpected ways. This study tests the hypotheses that both social/cultural contexts and individual dispositional characteristics may interact with program content to produce effects that are variable in potentially predictable ways.

Methods: Students in 24 culturally heterogeneous or primarily Hispanic/Latino middle schools (N = 3,157 6th graders) received a multicultural collectivist-framed social influences (SI) program, an individualist-framed SI program, or a control condition. Three-way linear and nonlinear interactions, program frame x social context x dispositional phenotype, were tested.

Results: Three-way interactions were found for the dispositional phenotypes of depression and hostility with social context and program content/frame. In predominantly Hispanic/Latino schools, larger program effects were observed for high depressed and high hostile youth in both the collectivist and individualist framed programs. In culturally mixed schools, prevention effects were greatest for low depressed and low hostile youth, especially in the individualist framed program. In culturally mixed schools, there may have been a negative treatment effect for both programs among adolescents scoring high on depression and hostility.

Discussion: Prevention program effects can vary by combination of program content, social setting, and individual dispositional characteristics. The results suggest that prevention program design and implementation should be sensitive to population characteristics at both the individual and sociocultural levels. (Cancer Epidemiol Biomarkers Prev 2007;16(6):1043–9)