Annals of Behavioral Medicine

, Volume 36, Issue 3, pp 231–243 | Cite as

Comparison of Two School-Based Smoking Prevention Programs among South African High School Students: Results of a Randomized Trial

  • Ken Resnicow
  • Sasiragha Priscilla Reddy
  • Shamagonam James
  • Riyadh Gabebodeen Omardien
  • Nilen Sunder Kambaran
  • Heinrich George Langner
  • Roger D. Vaughan
  • Donna Cross
  • Greg Hamilton
  • Tracy Nichols
Original Article



Smoking rates are projected to increase substantially in developing countries such as South Africa.


The aim of this study was to test the efficacy of two contrasting approaches to school-based smoking prevention in South African youth compared to the standard health education program. One experimental program was based on a skills training/peer resistance model and the other on a harm minimization model.


Thirty-six public schools from two South African provinces, KwaZulu-Natal and the Western Cape, were stratified by socioeconomic status and randomized to one of three groups. Group 1 (comparison) schools (n = 12) received usual tobacco use education. Group 2 schools (n = 12) received a harm minimization curriculum in grades 8 and 9. Group 3 schools (n = 12) received a life skills training curriculum in grades 8 and 9. The primary outcome was past month use of cigarettes based on a self-reported questionnaire.


Five thousand two hundred sixty-six students completed the baseline survey. Of these, 4,684 (89%) completed at least one follow-up assessment. The net change in 30-day smoking from baseline to 2-year follow-up in the control group was 6% compared to 3% in both harm minimization (HM) and life skills training (LST) schools. These differences were not statistically significant. Intervention response was significantly moderated by both gender and race. The HM intervention was more effective for males, whereas the life skills intervention was more effective for females. For black African students, the strongest effect was evident for the HM intervention, whereas the strongest intervention effect for “colored” students was evident for the LST group.


The two experimental curricula both produced similar overall reductions in smoking prevalence that were not significantly different from each other or the control group. However, the impact differed by gender and race, suggesting a need to tailor tobacco and drug use prevention programs. More intensive intervention, in the classroom and beyond, may be needed to further impact smoking behavior.


Smoking prevention South Africa Schools 



Sole funding for the project was provided by an NIH Fogarty International Center Grant TW005977 to the first author.


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Copyright information

© The Society of Behavioral Medicine 2008

Authors and Affiliations

  • Ken Resnicow
    • 1
  • Sasiragha Priscilla Reddy
    • 2
  • Shamagonam James
    • 2
  • Riyadh Gabebodeen Omardien
    • 3
  • Nilen Sunder Kambaran
    • 3
  • Heinrich George Langner
    • 3
  • Roger D. Vaughan
    • 4
  • Donna Cross
    • 5
  • Greg Hamilton
    • 6
  • Tracy Nichols
    • 7
  1. 1.School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.Medical Research Council of South AfricaCape TownSouth Africa
  3. 3.ARCH Actuarial ConsultingCape TownSouth Africa
  4. 4.Department of BiostatisticsColumbia UniversityNew YorkUSA
  5. 5.School of Exercise, Biomedical and Health SciencesEdith Cowan UniversityPerthAustralia
  6. 6.Community and Public HealthCanterbury District Health BoardChristchurchNew Zealand
  7. 7.Center for Women’s Health and Wellness, Health and Human PerformanceUniversity of North Carolina GreensboroGreensboroUSA

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