Changes in cigarette smoking and dietary behavior of children after six years of school-based intervention.

Lung cancer will be a worldwide threat for at least another 100 years. In countries like ours with easy access to tobacco products, most smokers acquire the habit during childhood or adolescence. The same is likely to be true of third world countries because social and economic development makes them targets for cigarette marketing. Successful prevention at the school level could be one practical public health solution to the projected 21st century global epidemic of lung cancer. If the people in the United States can learn how to bring about permanent reductions in prevalence rates of adult smoking through intervention in public schools, virtually every country in the world stands to benefit from our knowledge. Although the worldwide philosophical goal of teaching good nutrition principles to school-age children would be to promote health and avoid disease in the future, the specific dietary changes promoted are likely to differ from country to country. Unless we have new evidence of added benefit by changing two or more health behaviors at a time, an integrated cigarette smoking and dietary intervention program is likely to have much less potential for worldwide sharing than smoking prevention alone.