[School-based tobacco prevention: the "Be Smart - Don't Start" program]

The competition for smoke-free classes, the "Be Smart - Don't Start" program has been implemented in Germany since 1997. Using contract management techniques, school classes participating in the competition commit themselves to abstain from smoking for six months. Classes report on a regular basis whether they have stayed smoke-free or not. After the end of the competition period, successful classes participate in a prize draw. The competition aimes to influence social norms.Over the past 20 years, the competition has become a major school-based intervention to prevent smoking in Germany. Several studies addressed process and outcome evaluation, cost-benefit efficacy and iatrogenic effects. Following the evidence so far, the intervention is feasible for implementation in school routines, evokes positive feedback in teachers and students, and reveals a positive cost-benefit ratio. Findings from controlled studies imply that negative side-effects are unlikely to occur and that participation in the competition affects the progression of smoking positively at least in the short term.

Meta-Analyse zur Wirksamkeit deutscher suchtpräventiver Lebenskompetenzprogramme

Zusammenfassung. Schulbasierte Lebenskompetenzprogramme (LKP) sind ein wichtiger Ansatz der Suchtprävention in Deutschland. Ihre Wirksamkeit wurde bisher nicht meta-analytisch getestet. Resultate von 13 systematisch identifizierten randomisierten und nicht-randomisierten Studien mit deutschsprachigen Zielgruppen wurden quantitativ integriert. Risk Ratios (RR) wurden signifikant für den Einstieg in den Tabakkonsum (RR=.77) bzw. das allgemeine Rauchverhalten (RR=.64) bei GrundschülerInnen, bei SekundarstufenschülerInnen ein Initialeffekt von RR=.44 für den aktuellen Konsum. Effekte für die Lebenszeitprävalenz (RR=.78) und den aktuellen Konsum (RR=.71) von Alkohol wurden zum Posttest signifikant. Die Ergebnisse belegen eine Wirksamkeit der suchtpräventiven LKP mit deutsch(sprachig)en SchülerInnen insofern, als dass sie das Risiko für einen frühzeitigen Konsum, der einen Risikofaktor für späteren Substanzmissbrauch darstellt, verringern.

Langzeiteffekte des Präventionsprogramms Klasse2000 auf den Substanzkonsum

Zielsetzung: Untersuchung der langfristigen Auswirkungen des für die Grundschule konzipierten Präventionsprogramms Klasse2000 auf den Substanzkonsum. Methodik: Klasse2000 will mittels interaktiver Methoden die Lebenskompetenzen fördern und zu einem gesunden Lebensstil motivieren. Die Daten wurden in schriftlichen Nachbefragungen einer Kontrollgruppenstudie mit Messwiederholung 16 Monate (N = 501, mittl. Alter 11,4 Jahre, 43,7 % männlich) und 36 Monate (N = 408, mittl. Alter 12,9 Jahre, 43,1 % männlich) nach Ende der Intervention gewonnen. Die Zuteilung zu den Gruppen erfolgte in der Ursprungsstudie auf Ebene der Schulen unter Berücksichtigung der Präferenz der Schulen. Ergebnisse: In beiden Nachbefragungen waren Lebenszeitprävalenz und Inzidenz des Rauchens in der Interventionsgruppe statistisch bedeutsam geringer als in der Kontrollgruppe. Beim Alkoholkonsum konnte nur in der ersten Nachbefragung eine signifikant geringere Lebenszeitprävalenz in der Interventionsgruppe gefunden werden. In der zweiten Nachbefragung war in der Untergruppe derjenigen Jugendlichen, die bereits Alkohol konsumiert hatten, in der Interventionsgruppe die Intensität des Alkoholkonsums geringer als in der Kontrollgruppe. Schlussfolgerungen: 16 bzw. 36 Monate nach Abschluss der Intervention finden sich Hinweise auf präventive Effekte des Programms Klasse2000 auf das Rauchverhalten. Für den Alkoholkonsum ist die Befundlage weniger überzeugend.

Strong and healthy in Primary School Klasse2000 Program, Germany: a Program Impact Pathways (PIP) analysis

BACKGROUND

Developing a Program Impact Pathways (PIP) diagram helps identify and clarify the key objectives, processes, activities, and evaluation indicators of school-based nutrition programs. The Mondelēz International Foundation has recently supported the development of PIP analyses for programs in seven countries around the world. The results were shared with other project organizers at a Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, under the auspices of the Mondelēz International Foundation.

OBJECTIVE

The objectives were to develop the PIP assessment of the Strong and Healthy in Primary School Klasse2000 Program in order to refine the primary, secondary, and tertiary objectives of the program; identify Critical Quality Control Points (CCPs); and identify core indicators of the program's impact on healthy lifestyles.

METHODS

The PIP report was developed based on detailed instructions provided prior to the workshop, taking into account the Klasse2000 Program evaluation reports.

RESULTS

The following CCPs were identified: monitoring the qualifications and motivation of teaching staff (external health promoters and schoolteachers); assessing involvement of the students' environmental influences, including families, schools, and sponsors; and assessing the children's healthy lifestyle knowledge, attitudes, and behaviors before and after program exposure. The healthy lifestyle indicators identified were children's knowledge of healthy diets and health-enhancing physical activities; the availability of healthy breakfast and snacks; the frequency of consumption of fruits, vegetables, sweetened and unsweetened drinks,fast food, and sweets, as well as attitudes toward physical activity; and the frequency and extent of physical activity in school and during free time. Body mass index (BMI) was identified as the final outcome indicator.

CONCLUSIONS

Developing a PIP report helped to focus the objectives of the program. Identifying CCPs helped draw attention to the processes linking critical program activities. As a result, plans for the upcoming school year include conducting a PIP-informed survey of participating parents and children to gauge their satisfaction with the program.

Smoking prevention in school students: positive effects of a hospital-based intervention

BACKGROUND

Adolescents have smoked less in recent years, but 11.7% of 12-to-17-year-olds were still smokers in 2011. The prevalence of smoking has also remained high among 18-to-25-year-olds (36.8%). An intervention program called "Students in the Hospital" was developed in which the health aspects of smoking and its individual and societal consequences were presented in an interactive informational event. In this study, we determine the efficacy of the program.

METHODS

From September 2007 to July 2008, we performed an anonymous survey by questionnaire, with a quasi-experimental control-group design, two weeks before (t(1)) and six months after (t(2)) the intervention in a group of 760 participating school students in Berlin.

RESULTS

40.8% of the participants were smokers, among whom 79% stated that they smoked water pipe. Significantly fewer students in the intervention group than in the control group began smoking in the six months after the intervention (p<0.001). The chance of remaining a non-smoker was four times as high in the intervention group (OR, 4.14; CI, 1.66-10.36). Girls benefited from the intervention more than boys (OR 2.56, CI 1.06-6.19). 16.1% of smokers in the intervention group and 17.6% in the control group gave up smoking (p>0.05).

CONCLUSION

A clear primary preventive effect of the program was demonstrated, although it apparently did not induce persons who were already smokers to quit.