Образование и охрана здоровья. Сборник научно-методических материалов

1999). Differences in effectiveness for girls and boys could be explained by gender differences in resistance to the prevention activities. Aveyard and Markham et al. (2003) research revealed that effectiveness of prevention depends on students’ involvement in the prevention activities. It is possible that boys were less involved in prevention, thus the impact of prevention was lower on them. Other researchers suggest that positive changes for girls come quicker then for boys (Thrush, Fife-Shaw et al., 1999). More positive attitudes towards male smoking in Lithuanian society also could influence lower effect of smoking prevention for boys.

Despite initial expectations that our prevention program should increase students’ self-efficacy to refuse smoking, results did not support that idea. Some other authors also did not succeed in strengthening selfefficacy to refuse smoking (Cuijpers, Jonkers et al., 2002). One possible explanation could be that prevention programs do not teach how to resist social pressure to smoke, but enhance students’ skills which they already have (Langlois, Petosa et al., 1999). Others suggest that strong self-effi- cacy to refuse smoking not always relates to changes in smoking behavior, because adolescents often do not have adequate possibilities to change their behavior (Singleton, Pope, 2000).

Our survey revealed that the prevention program did not increase or maintain negative attitudes towards smoking as it was expected initially, even though expected changes in smoking behavior occurred. These unexpected results could be interpreted in three ways. First of all, almost all participants in the program already had negative attitudes towards smoking, so it was not possible to reach changes in more negative way. Another possible explanation is related to the evaluation procedure: it is possible that changes in attitudes have happened immediately after the prevention activities but disappeared after longer time, (that is also confirmed by other researchers; see Koumi, Tsiantis, 2001). The third interpretation is based on attitude towards smoking and smoking behavior relations: some authors find that negative attitudes towards smoking do not predict non smoking behavior and it means that individuals know that smoking is bad and harmful, but do not connect this knowledge to their own behavior (Huijding, de Jong et al, 2005; Kelly, Masterman et al., 2006; Mazanov, Byrne, 2007).

Our results suggest that effectiveness of the smoking prevention is associated with impacts intensiveness: more positive outcomes were reached in the advanced intervention group compared to the basic intervention group. Other researchers also confirm the need of sufficient intensi-

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veness of prevention (Flay, 2002) or additional booster sessions (Dijkstra, Mesters et al., 1999) in order to reduce smoking and increase non smoking cognitions. One possible explanation of the insufficient impact of the program could be due to strong social pressure to smoke in particular in later adolescence which could not be dissipated only by psychological impact. Resistance to prevention activities also can be one of the reasons for low or even negative effect of the prevention program (Dijkstra, Mesters et al., 1999), at is was also found in the basic intervention group of our study.

Conclusions

1.The smoking prevention program, based on the social influence approach, is partly effective reducing smoking prevalence in 6th grade: number of current smoking girls decreased in the advanced intervention group; no expected changes in smoking attitudes, intentions or self-effica- cy; less boys maintain stable self-efficacy to refuse smoking and more boys start thinking that smoking does not harm, more girls start seeing more positive social consequences of smoking in the basic intervention group.

2.Effectiveness of the smoking prevention is related to sufficient intensiveness of the program implementation:

o bigger smoking reduction and bigger increase or maintenance of non smoking cognitions are achieved in the advanced intervention group compared to the basic intervention group.

3.Effectiveness of the smoking prevention is related to gender of participants: girls are more susceptible to the intervention activities than boys.

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