Effectiveness of a complex intervention on smoking in adolescents: A cluster-randomized controlled trial

Developing and Evaluating a School-Based Tobacco and E-Cigarette Prevention Program for Deaf and Hard-of-Hearing Youth

School-based programs are an important tobacco prevention tool. Yet, existing programs are not suitable for Deaf and Hard-of-Hearing (DHH) youth. Moreover, little research has examined the use of the full range of tobacco products and related knowledge in this group. To address this gap and inform development of a school-based tobacco prevention program for this population, we conducted a pilot study among DHH middle school (MS) and high school (HS) students attending Schools for the Deaf and mainstream schools in California (n = 114). American Sign Language (ASL) administered surveys, before and after receipt of a draft curriculum delivered by health or physical education teachers, assessed product use and tobacco knowledge. Thirty-five percent of students reported exposure to tobacco products at home, including cigarettes (19%) and e-cigarettes (15%). Tobacco knowledge at baseline was limited; 35% of students knew e-cigarettes contain nicotine, and 56% were aware vaping is prohibited on school grounds. Current product use was reported by 16% of students, most commonly e-cigarettes (12%) and cigarettes (10%); overall, 7% of students reported dual use. Use was greater among HS versus MS students. Changes in student knowledge following program delivery included increased understanding of harmful chemicals in tobacco products, including nicotine in e-cigarettes. Post-program debriefings with teachers yielded specific recommendations for modifications to better meet the educational needs of DHH students. Findings based on student and teacher feedback will guide curriculum development and inform next steps in our program of research aimed to prevent tobacco use in this vulnerable and heretofore understudied population group.

Prevention of tobacco use in an adolescent population through a multi-personal intervention model

INTRODUCTION

The study aimed to assess the impact of a new intervention proposal involving students, teachers, and parents on smoking prevalence in secondary school adolescents.

METHODS

A quasi-experimental study was conducted, in which the response to a preventive multi-personal intervention model (intervention) against tobacco consumption was compared with a standard anti-smoking activity carried out by the local government administration (control). The study was carried out during the 2017-2018 academic year. The study population included 306 students (intervention 151, control 155) with a mean age of 13.4 years. The model involved the parents, the students (aged 15-17 years), and the teachers. The primary outcome was the change in smoking status one year after the intervention.

RESULTS

The percentage of non-smokers increased from 84.1% to 88.7% in the intervention group and remained almost unchanged among controls (89.3% vs 89.9%). After one year, there was an increase in the prevalence of non-smokers of 4.6% and a decrease in the prevalence of smokers of 4.7% among students who received the multi-personal intervention, whereas changes among controls were almost negligible (there was in fact a slight increase in the prevalence of smokers of 0.9%). The students who received the intervention smoked less or quit smoking more than those in the control group (OR=0.135; 95% CI: 0.019-0.973, p=0.047).

CONCLUSIONS

The multi-personal model developed in the study with the participation of teachers and parents focused on students was feasible, and effectively reduced the prevalence of smoking among high school adolescents.

School tobacco policies and adolescent smoking in six European cities in 2013 and 2016: A school-level longitudinal study

Assessment of the effectiveness of school tobacco policies (STPs) in reducing adolescent smoking remains inconclusive. Previous studies took insufficient account of different dimensions of STPs, the different views of students and staff, and policy changes over time. This study assessed how a multidimensional STP, as perceived by students and staff, was associated with adolescent smoking over time in six European cities. The SILNE and SILNE-R surveys were conducted among students (n = 18,502) and staff (n = 438) in 38 schools in 2013 and 2016. Three dimensions (comprehensiveness, enforcement, and communication) were assessed and we calculated total STP scores. Multilevel logistic regressions estimated associations of STPs with adolescent smoking on and just outside school premises and with weekly smoking. Further analyses estimated associations between 2013 and 2016 STP changes and smoking outcomes in 2016, controlling for STP and smoking prevalence in 2013. On average, there were few increases in STP scores over time. Greater STP enforcement, as perceived by students, was associated with lower odds of weekly smoking (OR:0.93, 95%CI:0.89-0.97) and of smoking on school premises (OR:0.80, 95%CI:0.72-0.90). Higher total STP scores were associated with lower odds of smoking on school premises (OR:0.76, 95%CI:0.67-0.86), but not of smoking just outside premises or smoking weekly. Greater increases in STP scores over time were associated with lower odds of smoking on school premises in 2016 (OR:0.65, 95%CI:0.47-0.89). Well-enforced STPs may help reduce adolescent smoking at school. Schools should be supported in adopting comprehensive policies that also extend to the surroundings of their premises.

Implications of personality and parental education on healthy lifestyles among adolescents

Several studies have shown an association between personality and health status. The aim of this study was to evaluate the association between personality traits, parental education and health-related lifestyles in a cohort of Spanish adolescents. This is a longitudinal study with a source population of 1,123 third-year students (aged 14-15) in secondary schools in Spain. At the baseline evaluation sociodemographic variables, parental education and personality (Big Five Questionnaire for Children) were collected. At 18 months of follow-up health related lifestyles, including adherence to a healthy diet (KidMed index), tobacco and alcohol consumption, physical exercise, sleep problems and recreative screen and social network time were collected. A total of 824 adolescents (73.4%) completed the 18 months assessment and 695 (84.3%) presented valid data. Higher conscientiousness was associated to a lower risk for non-adherence to Mediterranean diet (OR = 0.7, 95% CIs=0.5-0.9), tobacco (OR = 0.5, 95% CIs=0.3-0.7) and alcohol consumption (OR = 0.6, 95% CIs=0.5-0.8), excessive use of screens (OR = 0.7, 95% CIs=0.5-0.9) and social network sites (OR = 0.7, 95% CIs=0.5-0.8). Higher levels of extraversion was significantly related to a lower risk of physical inactivity (OR = 0.7, 95% CIs=0.6-0.9), but they are at a higher risk of low adherence to Mediterranean diet (OR = 1.3, 95% CIs=1.0-1.7), tobacco (OR = 2.7, 95% CIs=1.7-4.3) and alcohol consumption (OR = 1.9, 95% CIs=1.5-2.4) and excessive use of social network sites (OR = 1.6, 95% CIs=1.3-1.9). High levels of emotional instability were associated with tobacco consumption (OR = 1.5, 95% CIs=1.0-2.2) and sleep problems (OR = 2.0, 95% CIs=1.5-2.7). Finally, we found an association with lower parental education and adolescents' low adherence to Mediterranean diet (OR = 1.6, 95% CIs=1.0-2.4) and sleep problems (OR = 1.8, 95% CIs=1.0-3.0). Cluster analysis of health-related behaviours indicated the presence of two different clusters (unhealthy and healthy adolescents) that were associated with personality traits. Conscientiousness, extraversion, emotional instability and parental education are independent factors associated with the acquisition of adolescent healthy lifestyles.

Alcohol and Tobacco Consumption, Personality, and Cybervictimization among Adolescents

Cyberbullying has emerged as a public health problem. Personality may play an important role in substance use and cybervictimization. The aim of this study was to examine whether tobacco and alcohol consumption and personality traits are associated with cybervictimization in Spanish adolescents. A cross-sectional study was conducted with 765 secondary students (aged 14–16) from 16 secondary schools in Spain. Participants completed a questionnaire assessing sociodemographic characteristics; tobacco and alcohol consumption; cybervictimization (Garaigordobil Scale); and personality traits (Big Five Questionnaire). A logistic regression model controlling for sex, age, parental education and personality traits was used to determine the independent associations and interactions between tobacco and alcohol consumption and cybervictimization. The results indicate that a total of 305 adolescents (39.9%) reported that they were cyberbullied in the past year. Girls were more likely to be cyberbullied than boys. Cybervictims had a significantly greater monthly alcohol consumption (OR = 1.51; 95% CI = 1.05–2.15), higher scores for extraversion (OR = 1.31; 95% CI = 1.06–1.63) and emotional instability (OR = 1.53; 95% CI = 1.27–1.83); as well as lower scores for conscientiousness (OR = 0.78; 95% CI = 0.63–0.95). These results suggest that personality traits and alcohol consumption are independently associated with cybervictimization. Our study suggests the existence of underlying common personality factors for cybervictimization and alcohol and tobacco use.