A study of the effectiveness of an intervention program designed to favorably modify behaviors hypthesized to be related to the future development of cancer was initiated among 1,105 eligible children in 15 schools in the vicinity of New York City. Schools were assigned to either an intervention or a nonintervention group. Subjects in schools in the intervention group received each year, from fourth through ninth grade, a teacher-delivered curriculum focusing on diet and prevention of cigarette smoking. After 6 years of intervention, the rate of initiation of cigarette smoking was significantly lower among subjects in intervention schools than among those in nonintervention schools. There was a significant net decrease in reported intake of saturated fat and a significant net increase in reported intake of total carbohydrate among subjects in intervention schools compared to those in nonintervention schools. These findings, if replicated, suggest that such programs are feasible and acceptable and may have a favorable effect on diet and prevention of cigarette smoking in children. [J Natl Cancer Inst 81:995-999, 1989]
Cancer is the second leading cause of mortality in the United States today, accounting for ≈20% of all adult deaths (1). The age-adjusted cancer mortality rates for sites other than the respiratory tract (cancers of which are primarily attributed to cigarette smoking) have remained generally stable over the past 30-40 years (2).
Considerable effort has been expended over this period to elucidate the environmental and genetic factors initiating and promoting the development of cancer. In the course of this research, evidence has accumulated implicating behavioral causative or promoting factors, particularly cigarette smoking and diet. Some researchers suggest that these two factors contribute to the development of up to 70% of all cancers (3). Specifically, tobacco smoking is associated with increased risk for cancers of the lung, larynx, mouth, esophagus, bladder, kidney, and pancreas (4), and excessive intake of dietary fat has been linked to the development of cancers of the breast, colon, and prostate (5). A low intake of certain components of dietary fiber may be related to increased risk for colorectal cancer (6).