A school-based smoking prevention program centered on media literacy performed better than traditional anti-smoking educational programming, according to a new University of Pittsburgh School of Medicine study. While traditional anti-smoking education focuses on health effects of smoking and resisting peer and other social influences, media literacy empowers participants to analyze and evaluate portrayals of tobacco use in media.

In the study, published in the Journal of School Health, the researchers randomly assigned 796 9th-grade students in three Pittsburgh high schools to receive either an anti-smoking media literacy program or a rigorous traditional anti-smoking program.

Among high-risk students who originally said they planned to smoke in the future, more students in the media literacy program changed their minds at the conclusion of the program compared with those in the traditional program. Students who received media literacy programming also perceived smoking as less popular, which has been closely linked with behavioral smoking outcomes in the past.

The students in the media literacy group also gave higher evaluation scores for their enjoyment of and attention to the program, and they were more likely to indicate that they would look at smoking and advertising differently in the future, compared with the traditional group.

In many other areas, such as attitudes toward smoking, the two programs performed similarly, but no outcomes were superior for the traditional program.

"Because traditional programs have not been as successful as we would like in preventing smoking among youth, it is very important that we innovate in this area," said lead author Brian A. Primack, M.D., Ph.D., associate professor of medicine and pediatrics, and director of the Program for Research on Media and Health at Pitt. "The results of this study suggest that media literacy has potential, which we should continue to investigate."

Dr. Primack and his colleagues suggest that one reason media literacy may be effective is that youth aged 8 to 18 continue to be exposed to more than 10 hours of media content each day, including multiple positive images of smoking, which previous research has clearly linked to initiation of smoking. Additionally, media literacy inherently may be more effective for sensation-seeking, rebellious individuals who are more at risk for using tobacco.

"We were particularly interested in the group of 236 students who reported at the start of the program that they intended to smoke in the future. Among these individuals, 24 percent of those assigned to the media literacy group reverted to not intending to smoke after the intervention, compared with only 16 percent of those assigned to the traditional program," said Dr. Primack. "Although our study was relatively small, if changes of this magnitude are borne out in other studies, this would translate into clinically meaningful differences. Another challenge for the future will be to examine longer-term smoking outcomes."