What's the best way to get teens off cigarettes? A study published in the Archives of Pediatrics and Adolescent Medicine (Vol. 158, No. 3: 269-275) suggests activism may be the answer.

Researchers from Stanford University School of Medicine found that teen smokers who took part in an anti-tobacco advocacy program reduced their cigarette use more than those who participated in a traditional drug and alcohol prevention program. What's more, the teens in the advocacy class maintained their lower smoking rate after the program ended.

"The fact that regular smokers decreased their smoking and maintained [that decrease] is very encouraging," said lead author Marilyn Winkleby, PhD, an associate professor of medicine at the Stanford Prevention Research Center.

"What was most encouraging was that the decrease in smoking continued 6 months later, which is really a rarity," she added. In studies of other methods to reduce teen smoking, she explained, the teens reverted to their previous smoking habits much sooner.

That disappointing track record was part of the inspiration for the new approach taken by Winkleby and her colleagues. Rather than just teaching kids about the dangers of smoking, as traditional programs do, the Stanford group decided to show teens just how pervasive tobacco advertising and promotion are, and get them involved in action to counter those messages.

The study was conducted in 10 alternative high schools in the San Francisco Bay area. In half of the schools, juniors and seniors were invited to participate in a traditional drug and alcohol prevention program, while in the other half, the students participated in the advocacy program.

Winkleby said the alternative schools were chosen because smoking rates in these schools, which serve students at risk of failing or dropping out, are much higher than in regular high schools. Classes for each program were held once a week during the semester.

In the advocacy program, teens learned about the tobacco industry, its advertising methods, and the availability of tobacco. They also learned about successful activism -- how to research a topic, prepare for a press conference, and identify people in power who can help the cause.

Field trips were also part of the program. Teachers accompanied students to local convenience stores, for instance, to evaluate tobacco advertising and adherence to state tobacco laws. Did the store have more ads in the windows than allowed? Were the cigarettes locked behind the cash register as they're supposed to be? Were tobacco ads in other parts of the store -- on clocks, say, or on the bars used to separate groceries on the conveyor belt?

The kids were then given a choice of advocacy projects to work on, from forming a task force to enforce smoking bans on campus, to getting local stores to reduce cigarette sales to minors.

The results were better than expected, Winkleby said. At the beginning of the study, about 25% of the teens in the advocacy program identified themselves as regular smokers (a pack a week or more). At the end of the semester, about 21% called themselves regular smokers. Six months later, just 20% were regular smokers. By contrast, regular smoking actually increased by 1.5% among teens after a semester of the traditional program.

"Young people are learning to make decisions," said Winkleby. "They're not very knowledgeable about the availability and promotion of cigarettes and other aspects of our environments that may influence health choices, and when they're made aware, they respond with leadership and passion."

That enthusiasm can be tapped to work for other public health issues, Winkleby said, like making teens aware of the poor dietary choices promoted in schools and communities, or the lack of opportunities for physical activity.