A Stop Smoking in Schools Trial (ASSIST)
*Note: The National Mentoring Resource Center makes these “Insights for Mentoring Practitioners” available for each program or practice reviewed by the National Mentoring Resource Center Research Board. Their purpose is to give mentoring professionals additional information and understanding that can help them apply reviews to their own programs. You can read the full review on the Crime Solutions website.
In considering the key takeaways from the research on this program that other mentoring programs can apply to their work, it’s useful to reflect on the features and practices that might have influenced its rating as “No effects” (that is, a program that has strong evidence that it did not achieve justice-related goals).
Manualized programs may bring consistency, but that doesn’t mean they will be easy to implement.
One of the striking features of this program is the scope of its ambition in terms of the delivery mechanisms for the core messages of the program. This program builds on a number of theories, including ecological development theory and innovation theory, which suggest that the use of peer mentors should be effective as deliverers of anti-smoking messages. However, this program is attempting to influence an entire student body and that requires, according to the developers of the program, a very large number of peer mentors. The developers recommend that 18% of the student body be recruited to serve as peer mentors, almost one in five of all students. In the British context where this program was developed, that adds up to about 80 peer mentors for a typical grade.
Not only does this program have to recruit that many peer mentors, but they then need to all participate in a two-day training on the curriculum and then keep a log throughout the year on each conversation about smoking they have with a fellow student. While that kind of training and fidelity tracking is likely needed to ensure that the program is being offered in an ideal way, it can be quite a burden on both staff and youth, especially at the scale of one-fifth of a whole grade. (And we are not even addressing the practice of doing biomedical testing of peer mentors to see if they have, in fact, been smoking throughout the year, something that would likely hinder the widespread adoption of this program in the United States.)
While there is little doubt that using peers in a deliverer-of-key-messages role can be effective (for example, see our recent review of the similar Sources of Strength program, which earned a “Promising” rating), programs attempting this approach should think carefully about how many peer leaders are needed to deliver messages at a wide enough scale. Sources of Strength supplemented the individual, organic conversations that peer mentors engaged in with some schoolwide assemblies, signs and posters, and other activities that helped keep the expected number of peer mentors needed at a reasonable level.
Think about how to make the impact of peer-led interventions last over time.
It’s worth noting that this program had statistically significant impacts at the end of the year in terms of reduced smoking at participating schools. But those effects diminished over time and were gone by the 2 year follow up cited in the review. The issue of diminishing impact the further out from the relationship one gets is an almost universal problem for the mentoring field. Many youth seem to thrive when actively engaged with a mentor, only to “slide back” once the relationship ends. But programs using peer mentors as the key intervention vehicles may be especially vulnerable to this. Peer relationships are notoriously fickle and the “cool kid” or respected peer delivering a message today could easily be someone in the “ignore” group a year later. Peer relationships are tremendously fluid and subject to big swings in value and closeness. It may simply be that messages delivered by a peer don’t hold as much long-term weight as those delivered by a respected adult (although research on this is not clear, by any means).
Aligning the message, the moment, and the recipient’s perspective. One thing that this program did get right is the targeted audience: Youth who were on the verge of becoming life-long smokers. By targeting 12-13 year olds, ASSIST was attempting to hit a sweet spot⎯youth who were toying with the idea of becoming a smoker, or who had just started down that path, as opposed to youth who were already regular smokers. Given how hard a nicotine addiction can be to beat, the program was targeting those for whom smoking was “on the table” but who hadn’t let the drug get a physiological grip on them yet. More mentoring programs should target these “on the cusp of…” groups, rather than waiting until a problem has already become serious to intervene.
But, there may be something inherently misaligned about the approach taken here. By engaging such a large and diverse number of students in a class as mentors, one wonders if they wound up diluting the acceptance of the messages of the program. First off, all students in a grade nominated their peers for this role, meaning they were highly aware of who was nominated to fill this role. They probably also observed that many of their peers were doing this “extra” thing in their spare time (the extensive training and follow-up with the program staff). Given that this program is premised largely on “respected” or well-liked peers being the deliverers of these anti-smoking messages, one wonders whether the public and obvious nomination process influenced future receptivity to those anti-smoking messages. If I know that I nominated a respected peer for something, and that person subsequently starts weaving overt anti-smoking messages into our normal conversations in and out of school, it’s highly likely that I might not take those messages at face value. I might assume that they are being told to tell me these things and that the opinions they are expressing about smoking are not their own. In fact, I may be inclined to reject that message because it now may lack, in my teenage opinion, the “authenticity” that made me nominate that peer as a “leader” in the first place.
Programs that seek to use “listened to” peers as deliverers of interventions also need to be careful about taking the fragility of the peer pecking order for granted. It may be your robust program that takes that “cool” peer from being someone to be followed to someone to be ignored. If peers are delivering your intervention, make sure that it seems authentic and honest. It’s hard to tell if that was an issue in the case of ASSIST (especially given that the program did have positive effects at the end of the year), but it may explain, in part, that drop-off of effects over time.
For more information on research-informed program practices and tools for implementation, be sure to consult the Elements of Effective Practice for Mentoring™ and the "Resources" section of the National Mentoring Resource Center site.