Tabakprävention der Bundeszentrale für gesundheitliche Aufklärung

[Tobacco prevention using the example of the "smoke-free" campaign : Nationwide measures by the Federal Center for Health Education (BZgA)]

Currently, 28.7% of 18- to 64-year-olds in Germany smoke (26.1% of women/31.2% of men). Among the 12- to 17-year-olds, the smoking rate at 7.4%, is at a historic low. The smoking rate among the 18- to 25-year-olds has also fallen in recent years.The most important goal of the nationwide measures of the Federal Center for Health Education (BZgA) on tobacco prevention is to reduce the smoking rate. For this purpose, the BZgA carries out the "smoke-free" campaign, which is targeted at both adolescents and adults. With a closely interlinked and continuously reviewed and further developed mix of measures, the target groups are reached on the internet, in settings and via media and mass communication. In addition to the information on the risks of smoking and passive smoking, the motivation to quit smoking and the quality-assured support in smoking cessation play an important role here.The measures of the BZgA are reviewed and further developed on the basis of representative surveys on the smoking behavior of the 12- to 25-year-olds, which the BZgA regularly carries out. On this basis, new products, such as e‑cigarettes, e‑shishas or tobacco heaters, and new consumer trends, such as the trend for waterpipe smoking, are integrated. Access routes to the target groups are continuously reviewed against the background of the digitization of society and the health-promoting design of settings is supported. All in all, the smoke-free campaign offers a quality-assured range of measures that is continuously being developed.

Mass media interventions for preventing smoking in young people

BACKGROUND

Mass media interventions can be used as a way of delivering preventive health messages. They have the potential to reach and modify the knowledge, attitudes and behaviour of a large proportion of the community.

OBJECTIVES

To assess the effects of mass media interventions on preventing smoking in young people, and whether it can reduce smoking uptake among youth (under 25 years), improve smoking attitudes, intentions and knowledge, improve self-efficacy/self-esteem, and improve perceptions about smoking, including the choice to follow positive role models.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE and Embase in June 2016. This is an update of a review first published in 1998.

SELECTION CRITERIA

Randomized trials, controlled trials without randomization and interrupted time-series studies that assessed the effect of mass media campaigns (defined as channels of communication such as television, radio, newspapers, social media, billboards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person-to-person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years. We define smoking behaviour as the presence or absence of tobacco smoking or other tobacco use, or both, and the frequency of tobacco use. Eligible comparators included education or no intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risks of bias. We combined studies using qualitative narrative synthesis. We assessed the risks of bias for each study using the Cochrane 'Risk of bias' tool, alongside additional domains to account for the nature of the intervention. We assessed the quality of evidence contributing to outcomes using GRADE.

MAIN RESULTS

We identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time-series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.Three studies (n = 17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school-based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n = 72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school-based intervention, and one interrupted time-series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school-based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school-based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.

AUTHORS' CONCLUSIONS

Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review. Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed.

Long-term effectiveness of a combined student-parent and a student-only smoking prevention intervention among 7th grade school children in Berlin, Germany

BACKGROUND AND AIMS

In Germany, the smoking prevalence among adolescents is among the highest in Europe. Our aim was to evaluate the long-term effectiveness of a combined student-parent and a student-only smoking prevention programme to reduce the smoking prevalence among 7th grade students in Berlin.

DESIGN

Three-armed cluster-randomized controlled trial (RCT). Schools as cluster units were randomized into (i) student intervention, (ii) combined student-parent intervention or (iii) control group, with follow-up after 12 and 24 months.

SETTING

High schools and integrated secondary schools in Berlin, Germany.

PARTICIPANTS

Seventh grade students aged 11-16 years. We included 47 schools, 161 classes and 2801 students [50.1% girls, mean age ± standard deviation (SD) = 13.0 ± 0.6 years].

MEASUREMENTS

The primary outcome was self-reported regular smoking (at least one cigarette per day) after 24 months (point prevalence). Further self-reported outcomes were other smoking behaviours as well as parental rules and attitudes towards smoking. Comparisons were calculated as odds ratios (OR) with 95% confidence intervals (CI).

FINDINGS

At baseline, 2.3% of the students reported that they smoked regularly. After 24 months, 7.8% and 7.0% were regular smokers in the student-only intervention and the student-parent intervention, respectively, compared with 10.1% in the control group. The OR for being a regular smoker was 0.81 (0.34-1.92) for the student-parent intervention versus control, 0.95 (CI = 0.41-2.22) for the student-only intervention versus control and 0.85 (0.38-1.89) for student-parent intervention versus student-only intervention.

CONCLUSION

A combined student-parent smoking prevention intervention delivered via secondary schools in Berlin, Germany did not result in a statistically significant reduction in regular smoking compared with a control group or a student-only intervention. The student-only intervention did not result in a significant reduction in regular smoking compared with the control group.

Mass media interventions for preventing smoking in young people

BACKGROUND

The mass media have been used as a way of delivering preventive health messages. They have the potential to reach and to modify the knowledge, attitudes and behaviour of a large proportion of the community.

OBJECTIVES

To evaluate the effectiveness of mass media interventions to prevent smoking in young people in terms of reduced smoking uptake, in addition to secondary outcomes including improved smoking outcomes, attitudes, behaviours, knowledge, self-efficacy and perception.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of MEDLINE and EMBASE in July 2010.

SELECTION CRITERIA

Randomized trials, controlled trials without randomization and time series studies that assessed the effectiveness of mass media campaigns (defined as channels of communication such as television, radio, newspapers, bill boards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person to person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years.

DATA COLLECTION AND ANALYSIS

Information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risk of bias was abstracted by two independent reviewers. Studies were combined using qualitative narrative synthesis.

MAIN RESULTS

Seven out of a total of 84 studies reporting information about mass media smoking campaigns met all of the inclusion criteria. All seven studies used a controlled trial design. Three studies concluded that mass media reduced the smoking behaviour of young people. All of the effective campaigns had a solid theoretical basis, used formative research in designing the campaign messages, and message broadcast was of reasonable intensity over extensive periods of time.

AUTHORS' CONCLUSIONS

There is some evidence that mass media can prevent the uptake of smoking in young people, however the evidence is not strong and contains a number of methodological flaws.