[Tobacco use characteristics among apprentices in Vocational Centers]

Effect of a peer-led prevention program (P2P) on smoking in vocational high school students: Results from a two-school-year cluster-randomized trial

AIMS

The aim of this work was to measure the impact of P2P (i.e. peer-to-peer), a peer-led smoking prevention intervention, on daily smoking prevalence of adolescents over 2 school years.

DESIGN

A cluster-randomized controlled trial was performed over a 16-month follow-up (trial status: closed to follow-up). P2P was implemented 1-3 and 13-15 months after baseline. Assessments took place at baseline and 4, 10 and 16 months after baseline. The research team, assessors and adolescents were blinded to the study-arm assignment only at baseline.

SETTING

Fifteen vocational high schools in France were randomized into two clusters, using a 1:1 allocation ratio per French department (n intervention = 7, n control = 8).

PARTICIPANTS

Participants comprised a sample of 2010 students in year 11 (i.e. 15-16 years) in vocational high schools. A total of 437 students could not be assessed at baseline (absent or left school), yielding a total sample of 1573 students (n intervention = 749, n control = 824).

INTERVENTION AND COMPARATOR

The P2P programme trained voluntary students to become peer educators and design smoking prevention actions for their schoolmates in the intervention group (n = 945 students), compared with a passive control group (n = 1065 students).

MEASUREMENTS

The primary outcome was change from baseline in the prevalence of self-reported daily smoking (i.e. at least one cigarette per day) at 16 months.

FINDINGS

The 'time × group' interaction indicated that, compared with the control group, the intervention group had statistically significantly fewer daily smokers after 16 months [odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.20, 0.53]. Similarly, compared with the control group, the intervention group had statistically significantly fewer daily smokers after 4 months (OR = 0.50, 95% CI = 0.30, 0.82) and 10 months (OR = 0.60, 95% CI = 0.37, 0.98). No adverse events of P2P2 were reported.

CONCLUSIONS

A cluster-randomized trial found evidence that the peer-led P2P (peer-to-peer) smoking prevention intervention reduced the uptake of daily smoking among high school students in France over 16 months.

TABADO 2 : une stratégie d'accompagnement au sevrage tabagique des adolescents en milieu scolaire

La consommation de tabac est une des premières causes de mortalité évitable au niveau mondial. La dépendance au tabac s'observe dès l'adolescence. En complément des actions visant à prévenir l'entrée des jeunes dans le tabagisme, il est donc nécessaire de développer des stratégies spécifiques pour les adolescents déjà fumeurs. Un programme d'accompagnement au sevrage tabagique pour adolescents, TABADO, a montré son efficacité lors d'un essai contrôlé mené dans des centres de formation des apprentis en 2007/2009. En 2018, l'Institut national du cancer a souhaité généraliser TABADO au niveau national et l'étendre aux lycées professionnels. Pour accompagner ce processus de mise à l'échelle, il était essentiel d'élaborer la théorie d'intervention et d'analyser la transférabilité de TABADO en conditions de vie réelle et dans de nouveaux contextes, et de proposer les adaptations correspondantes. Une recherche spécifique a été conduite et détaillée par ailleurs. L'objectif de cette publication pragmatique est de présenter la nouvelle stratégie TABADO 2 aux acteurs et décideurs de santé publique, et le guide afférent développé pour les accompagner dans la mise en œuvre.Une étude de cas multiples (n = 10) a été menée à partir de la mise en œuvre de TABADO dans trois régions françaises, qui reposait sur des observations, entretiens et séminaires de retour d'expérience. Elle a mis en évidence l'adaptation de l'intervention aux contextes locaux, ainsi que de nouveaux leviers interventionnels mis en œuvre. De plus, les investigations ont montré que pour instaurer un climat favorable à la démarche d'arrêt de la consommation de tabac et soutenir son maintien sur la durée, il était nécessaire d'inscrire TABADO dans une stratégie globale de l'établissement scolaire et de son environnement. Cette démarche a permis de proposer une transformation de l'intervention TABADO en une nouvelle stratégie - TABADO 2 - et de proposer un guide pour accompagner son déploiement national.

[Use of electronic cigarette in France among adolescents aged 17: Results from the ESCAPAD 2017 survey]

INTRODUCTION

The use of electronic cigarettes has become relatively popular in France since 2010, including among adolescents. However, its use in relation to smoking and other factors is not well understood today.

METHODS

The data come from the ESCAPAD 2017 survey, a nationally representative cross-sectional survey taking place at a 1-day session of civic and military information compulsory for all French nationals around 17 (39,115 respondents). Descriptive analyses and multivariate regressions were undertaken to describe the recent use of e-cigarette at 17 and its associated factors.

RESULTS

e-cigarettes were experimented by 52.4 % of 17 year-olds, and used by 16.8 % in the preceding month, 1.9 % daily. Most recent users were also daily smokers (62.5 %), and only 7.6 % had never experimented cigarettes before. Among those who experimented with both products, only 13.3 % tried e-cigarettes before cigarettes. The associated uses of other products were the most striking factors: daily smoking (relative risk [RR]=2.73), ever use of hookah (RR=2.31), cannabis use in the last year (RR=1.60), regular alcohol drinking (RR=1.20) and ever use of another illicit drug (RR=1.11). Recent vapers that were also daily smokers had a more pronounced sociodemographic profile and a higher level of other drugs consumptions than recent vapers only.

DISCUSSION

Although a majority of French adolescents experiment with vaping, they are fewer to use it regularly and its current use is frequently associated with daily smoking. Future trends and the relationship between smoking and vaping among adolescents will have to be further investigated, including the motivations of its use.

[Socioeconomic profile and smoking among adolescents in vocational training]

BACKGROUND

Targeted interventions among vulnerable youth populations represent an important approach to the reduction of health inequalities. We must, however, ensure that impacts are not unequally distributed according to the range of resources available to them. We explore these concerns among youth in vocational training to be enrolled in a smoking cessation intervention by describing (1) their socio-economic profile and (2) the association between their socioeconomic characteristics, their smoking practices, and key factors that could be targeted in interventions.

METHODS

A total of 234 young people aged 15-20 years were recruited in three centers in the Lorraine region in France in 2016-2017 as part of the Social Network and Tobacco Cessation (Réseau social et sevrage tabagique [RESIST]) study. We measured participants' socio-economic characteristics using their parents' education and occupational grade. We examined the associations of these characteristics with participants' smoking habits, intention to quit, nicotine dependence, presence of smokers in their network, and representation of a young smoker. We examined the associations between variables with bivariate tests depending on the nature of the variables.

RESULTS

Participants were more likely to be from a socio-professional background more modest than the national average (56% versus 33%), but still exhibited considerable socioeconomic variability. Smoking status did not vary significantly according to the educational level of the participants' parents (from 52% to 57%, P=0.78) or occupational grade (from 52% to 58%, P=0.35). Compared to participants whose parents had completed a professional or pre-university degree, participants with parents in the lowest education category were less likely to report not intending to quit (P=0.01) and more likely to report seriously considering to quit in the next six months (P=0.03) and to have already tried to quit but failed (P=0.01).

CONCLUSION

It is tempting to define youth in vocational training as a homogeneous group, especially when they share the same school environment, employment status, and income. Our results, however, highlight substantial variability in their socioeconomic profiles and smoking characteristics. Researchers are encouraged to further consider these equity issues to contribute to the reduction of health inequalities.

Preventing tobacco in vocational high schools: study protocol for a randomized controlled trial of P2P, a peer to peer and theory planned behavior-based program

BACKGROUND

In France, the issue of youth smoking remains a major challenge for public health. School failure, socio-economic and socio-cultural backgrounds influence the initiation and maintenance of smoking behavior in adolescents. Vocational students are at particularly high risk of using psychoactive substances, including tobacco. One of the most important factors is the environment, whether family, friends or peers. Therefore, peer education has a positive potential to change smoking behavior of adolescents. It has also been demonstrated that the Theory of Planned Behavior (TPB) has yielded the best prediction of intentions and behavior, in several health domains, including on tobacco. However, it is usually confined to the measurement of processes by which interventions change behavior, rather than to the development of these interventions. The objective of this paper is to describe the protocol for a randomized controlled trial of a peer intervention based on the TPB on a highly exposed young population.

METHODS/DESIGNS

This is a cluster randomized controlled trial comparing an intervention group to a control group, randomized into clusters (professional schools and classes) and stratified in three departments (Hérault, Aude and Gard) in the Languedoc-Roussillon region. The primary issue is the prevalence of daily smoking at 24 months, defined by a daily tobacco use of at least 1 cigarette, validated by CO levels in exhaled air. The primary hypothesis is that intervention will lead to decrease the daily smoking prevalence of 10% between the intervention group and the control group during a 2-year follow-up.

DISCUSSION

The results from this trial will provide evidence on the effectiveness of an innovative peer-to-peer intervention based on the TPB.

TRIAL REGISTRATION

ISRCTN: 37336035 , Retrospectively registered 11/12/2015.