Targeting high-risk neighborhoods for tobacco prevention education in schools.

Objectives: We examined whether individual and neighborhood characteristics associated with smoking were also predictive of exposure to smoking prevention education in schools, to determine whether education programs were targeted appropriately to reach neighborhoods with the greatest need.

Methods: We merged data from 2 sources-the 2005 Virginia Youth Tobacco Survey (n=2208) and the Census 2000 School District Demographics Project-and used binary multilevel models with random effects to determine whether the same demographic characteristics and neighborhood characteristics predicted both adolescent smoking and exposure to prevention programs.

Results: We found that although light, medium, and heavy smoking rates were higher in neighborhoods of lower socioeconomic status (relative risk ratio=1.49, 1.36, and 1.65, respectively), prevention programs were less available in those areas (odds ratio=0.82).

Conclusions: Our study indicates that school prevention programs are not being effectively targeted and that more effective ways to reach high-risk and disadvantaged neighborhoods are needed.