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Dodd S, Widnall E, Russell AE, Curtin EL, Simmonds R, Limmer M, Kidger J. School-based peer education interventions to improve health: a global systematic review of effectiveness. BMC Public Health 2022; 22:2247. [PMID: 36461024 PMCID: PMC9719233 DOI: 10.1186/s12889-022-14688-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Peer education, whereby peers ('peer educators') teach their other peers ('peer learners') about aspects of health is an approach growing in popularity across school contexts, possibly due to adolescents preferring to seek help for health-related concerns from their peers rather than adults or professionals. Peer education interventions cover a wide range of health areas but their overall effectiveness remains unclear. This review aims to summarise the effectiveness of existing peer-led health interventions implemented in schools worldwide. METHODS Five electronic databases were searched for eligible studies in October 2020. To be included, studies must have evaluated a school-based peer education intervention designed to address the health of students aged 11-18-years-old and include quantitative outcome data to examine effectiveness. The number of interventions were summarised and the impact on improved health knowledge and reductions in health problems or risk-taking behaviours were investigated for each health area separately, the Mixed Methods Appraisal Tool was used to assess quality. RESULTS A total of 2125 studies were identified after the initial search and 73 articles were included in the review. The majority of papers evaluated interventions focused on sex education/HIV prevention (n = 23), promoting healthy lifestyles (n = 17) and alcohol, smoking and substance use (n = 16). Papers mainly reported peer learner outcomes (67/73, 91.8%), with only six papers (8.2%) focussing solely on peer educator outcomes and five papers (6.8%) examining both peer learner and peer educator outcomes. Of the 67 papers reporting peer learner outcomes, 35/67 (52.2%) showed evidence of effectiveness, 8/67 (11.9%) showed mixed findings and 24/67 (35.8%) found limited or no evidence of effectiveness. Of the 11 papers reporting peer educator outcomes, 4/11 (36.4%) showed evidence of effectiveness, 2/11 (18.2%) showed mixed findings and 5/11 (45.5%) showed limited or no evidence of effectiveness. Study quality varied greatly with many studies rated as poor quality, mainly due to unrepresentative samples and incomplete data. DISCUSSION School-based peer education interventions are implemented worldwide and span a wide range of health areas. A number of interventions appear to demonstrate evidence for effectiveness, suggesting peer education may be a promising strategy for health improvement in schools. Improvement in health-related knowledge was most common with less evidence for positive health behaviour change. In order to quantitatively synthesise the evidence and make more confident conclusions, there is a need for more robust, high-quality evaluations of peer-led interventions using standardised health knowledge and behaviour measures.
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Affiliation(s)
- Steven Dodd
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Emily Widnall
- Population Health Sciences, University of Bristol, Bristol, UK.
| | | | - Esther Louise Curtin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Mark Limmer
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, UK
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Nyman J, Tornivuori A, Salanterä S, Barroso T, Parisod H. Systematic review of digital interventions to support refusal self-efficacy in child and adolescent health promotion. Health Promot Int 2022; 37:6722695. [PMID: 36166268 DOI: 10.1093/heapro/daac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Refusal self-efficacy protects against risky health behavior. Digital interventions have the potential to support self-efficacy due to the enactive experience provided by digital technologies. The aim of this systematic literature review was to evaluate the evidence of digital interventions to support refusal self-efficacy in child and adolescent health promotion. Following the Cochrane Collaboration guidelines, five electronic databases were searched from 2009 to 2020. The studies were assessed by two independent reviewers according to the eligibility criteria. Eligible studies were included in the review, assessed for risk of bias, synthesized narratively and assessed for evidence quality with the GRADE approach. Twenty-three studies, that examined 18 different interventions, were included in the review. The interventions included various digital elements as means to support the child and adolescent refusal self-efficacy (e.g. games, videos, feedback and activities for regulating feelings). The interventions improving refusal self-efficacy were more often used at home setting and addressed the four sources of self-efficacy with different digital elements regardless of intervention duration and intensity. Although the results on intervention effects varied and the evidence quality remained low, the overall evidence concerning these interventions was encouraging. Based on the subgroup analysis, the results were mainly encouraging among girls. When these interventions are implemented in health promotion, their benefits and weaknesses need to be considered comprehensively. The results provide information for designing and developing digital interventions to support child and adolescent refusal self-efficacy. Further research with larger sample sizes and more rigorous study designs is needed to strengthen the evidence of these interventions.
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Affiliation(s)
- Johanna Nyman
- Department of Nursing Science, FI-20014, University of Turku
| | - Anna Tornivuori
- Department of Nursing Science, FI-20014, University of Turku.,Turku University Hospital, Health Village, Turku, Finland
| | - Sanna Salanterä
- Department of Nursing Science, FI-20014, University of Turku.,Turku University Hospital, Turku, Finland
| | - Teresa Barroso
- Nursing School of Coimbra, Rua 5 de Outubro, Apartado 7001, 3046-851 Coimbra, Portugal
| | - Heidi Parisod
- Department of Nursing Science, FI-20014, University of Turku.,Nursing Research Foundation sr (NRF), Asemamiehenkatu 2, 00520 Helsinki, Finland
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Catalano RF, Skinner ML, Alvarado G, Kapungu C, Reavley N, Patton GC, Jessee C, Plaut D, Moss C, Bennett K, Sawyer SM, Sebany M, Sexton M, Olenik C, Petroni S. Positive Youth Development Programs in Low- and Middle-Income Countries: A Conceptual Framework and Systematic Review of Efficacy. J Adolesc Health 2019; 65:15-31. [PMID: 31010725 DOI: 10.1016/j.jadohealth.2019.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Positive youth development (PYD) has served as a framework for youth programs in high-income countries since the 1990s and has demonstrated broad behavioral health and developmental benefits. PYD programs build skills, assets, and competencies; foster youth agency; build healthy relationships; strengthen the environment; and transform systems to prepare youth for successful adulthood. The goal of this article was to systematically review the impact of PYD programs in low- and middle-income countries (LMICs). METHODS Targeted searches of knowledge repository Web sites and keyword searches of Scopus and PubMed identified over 21,500 articles and over 3,700 evaluation reports published between 1990 and mid-2016. Ninety-four PYD programs with evaluations in LMICs were identified, of which 35 had at least one experimental or rigorous quasi-experimental evaluation. RESULTS Sixty percent of the 35 programs with rigorous evaluations demonstrated positive effects on behaviors, including substance use and risky sexual activity, and/or more distal developmental outcomes, such as employment and health indicators. CONCLUSIONS There is promising evidence that PYD programs can be effective in LMICs; however, more rigorous examination with long-term follow-up is required to establish if these programs offer benefits similar to those seen in higher income countries.
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Affiliation(s)
- Richard F Catalano
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington
| | - Martie L Skinner
- The Social Development Research Group, School of Social Work, University of Washington, Seattle, Washington.
| | | | | | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - George C Patton
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Cassandra Jessee
- International Center for Research on Women, Washington, DC; Making Cents International, Washington, DC
| | | | | | - Kristina Bennett
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Meroji Sebany
- International Center for Research on Women, Washington, DC
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Mohammadi M, Ghaleiha A, Rahnama R. Effectiveness of a Peer-Led Behavioral Intervention Program on Tobacco Use-Related Knowledge, Attitude, Normative Beliefs, and Intention to Smoke among Adolescents at Iranian Public High Schools. Int J Prev Med 2019; 10:111. [PMID: 31360358 PMCID: PMC6592138 DOI: 10.4103/ijpvm.ijpvm_493_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/25/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Theory-based tobacco use prevention programs in schools were implemented to evaluate the effectiveness of this peer-led intervention on tobacco use-related knowledge, attitude, normative beliefs, and intention to tobacco use of school children aged 14-17 years old. METHODS A school-based cluster randomized controlled intervention study was conducted among 1st, 2nd, and 3rd grade high school children in Sanandaj City, Iran. 4-h integrated tobacco use prevention program comprising of four structured modules was developed and delivered to the intervention group by trained peer educator. Outcome measures comprised changes in students' smoking-related knowledge, attitude, normative beliefs, and intention to tobacco use from baseline to 6-month follow-up through validated anonymous questionnaire. RESULTS The present study showed an intervention effect on tobacco use-related knowledge, normative beliefs, and intention to tobacco use but not attitude. The results indicated that there was significant decrease in intention to tobacco use (P ≤ 0.013) observed after 6-month postintervention. The intervention module was also effective in improving smoking knowledge (P ≤ 0.001), normative beliefs with regard to perceived prevalence of cigarette smoking and water-pipe use among adults and adolescents (P ≤ 0.001) in intervention group 6-month postintervention. CONCLUSIONS Participation in the peer-led education program to tobacco use prevention may have improvement in knowledge, normative beliefs, and intention to tobacco use. An implementation of the peer-led behavioral intervention components in the school setting may have a beneficial effect on public health by decreasing intention to tobacco use among nonsmoker adolescents.
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Affiliation(s)
- Mahtab Mohammadi
- Rasht Health Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Ghaleiha
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rozina Rahnama
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia
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Lotrean L, Trofor A, Mihaltan F, Eremia M, De Vries H, Loghin C. National and international cooperation for improving smoking prevention and cessation among Romanian youth. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rose-Clarke K, Bentley A, Marston C, Prost A. Peer-facilitated community-based interventions for adolescent health in low- and middle-income countries: A systematic review. PLoS One 2019; 14:e0210468. [PMID: 30673732 PMCID: PMC6343892 DOI: 10.1371/journal.pone.0210468] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 12/25/2018] [Indexed: 01/23/2023] Open
Abstract
Background Adolescents aged 10–19 represent one sixth of the world’s population and have a high burden of morbidity, particularly in low-resource settings. We know little about the potential of community-based peer facilitators to improve adolescent health in such contexts. Methods We did a systematic review of peer-facilitated community-based interventions for adolescent health in low- and middle-income countries (LMICs). We searched databases for randomised controlled trials of interventions featuring peer education, counselling, activism, and/or outreach facilitated by young people aged 10–24. We included trials with outcomes across key areas of adolescent health: infectious and vaccine preventable diseases, undernutrition, HIV/AIDS, sexual and reproductive health, unintentional injuries, violence, physical disorders, mental disorders and substance use. We summarised evidence from these trials narratively. PROSPERO registration: CRD42016039190. Results We found 20 studies (61,014 adolescents). Fourteen studies tested interventions linked to schools or colleges, and 12 had non-peer-facilitated components, e.g. health worker training. Four studies had HIV-related outcomes, but none reported reductions in HIV prevalence or incidence. Nine studies had clinical sexual and reproductive health outcomes, but only one reported a positive effect: a reduction in Herpes Simplex Virus-2 incidence. Three studies had violence-related outcomes, two of which reported reductions in physical violence by school staff and perpetration of physical violence by adolescents. Seven studies had mental health outcomes, four of which reported reductions in depressive symptoms. Finally, we found eight studies on substance use, four of which reported reductions in alcohol consumption and smoking or tobacco use. There were no studies on infectious and vaccine preventable diseases, undernutrition, or injuries. Conclusions There are few trials on the effects of peer-facilitated community-based interventions for adolescent health in LMICs. Existing trials have mixed results, with the most promising evidence supporting work with peer facilitators to improve adolescent mental health and reduce substance use and violence.
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Affiliation(s)
- Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King’s College London, London, United Kingdom
- * E-mail:
| | - Abigail Bentley
- Institute for Global Health, University College London, London, United Kingdom
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Audrey Prost
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bergagna E, Tartaglia S. The relation of modelling and the perception of parental care with adolescent smoking: a cross-sectional study. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2018. [DOI: 10.1080/17405629.2018.1455581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Elisa Bergagna
- Department of Psychology, University of Turin, Torino, Italy
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8
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Cheetham A, Lubman DI. The Role of Peers on School-Based Prevention Programs Targeting Adolescent Substance Use. CURRENT ADDICTION REPORTS 2017. [DOI: 10.1007/s40429-017-0165-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis. Prev Med 2017; 100:248-268. [PMID: 28390835 DOI: 10.1016/j.ypmed.2017.04.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/02/2017] [Accepted: 04/02/2017] [Indexed: 01/03/2023]
Abstract
Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both individual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10; OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau2=0.0, I2=0%), but not tobacco or alcohol use. A similar result was found when studies assessed as high risk of bias were excluded. Overall intervention effects were evident for illicit substance use within multiple intervention characteristic subgroups, but not tobacco and alcohol. Such results support the implementation of universal school-based interventions that address 'resilience' protective factors to reduce adolescent illicit substance use, however suggest alternate approaches are required for tobacco and alcohol use. PROSPERO registration: CRD42014004906.
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Mohd Zin F, Hillaluddin AH, Mustaffa J. Adolescents’ Perceptions Regarding Effective Tobacco Use Prevention Strategies for their Younger Counterparts: A Qualitative Study in Malaysia. Asian Pac J Cancer Prev 2016; 17:5113-5119. [PMID: 28122443 PMCID: PMC5454645 DOI: 10.22034/apjcp.2016.17.12.5113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose:The present qualitative study explored adolescents’ perceptions regarding effective strategies to prevent adolescents from using tobacco products (TP). Apart from the commercial TPs, there has been emerging use of alternatives such as vapes, e-cigarettes and shisha. This unfortunate phenomenon continues despite the currently available preventive strategies. Thus, understanding of the perceptions of the current generation would be valuable to provide new insights. Methods: Purposive sampling was utilized to recruit 40 adolescents between the age of 15 and 16 years old attending public daily secondary schools. Eight focus group discussions were conducted among the TP users, ex-users and non-users. Data were analyzed using a thematic content analysis procedure with NVivo. Results: Among barriers with the currently available strategies were having teachers who smoke tobacco, addiction to nicotine and self-perceptions of being healthy. The content of any program should include knowledge on negative outcomes of using tobacco products and awareness of the legislation together with ways to overcome peer and family influence including improving self-efficacy and refusal skills. Strategies were suggested to be delivered using information technology which provides interactive learning and visual effects. Conclusions: Adolescents agreed that the content and delivery of tobacco use prevention strategies need to be revised to suit the current generation to ensure sustainability.
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Affiliation(s)
- Faridah Mohd Zin
- Medical Lecturer, Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia.
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Mohammed M, Eggers SM, Alotaiby FF, de Vries N, de Vries H. Effects of a randomized controlled trial to assess the six-months effects of a school based smoking prevention program in Saudi Arabia. Prev Med 2016; 90:100-6. [PMID: 27386742 DOI: 10.1016/j.ypmed.2016.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/19/2016] [Accepted: 06/27/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the efficacy of a smoking prevention program which aimed to address smoking related cognitions and smoking behavior among Saudi adolescents age 13 to 15. METHOD A randomized controlled trial was used. Respondents in the experimental group (N=698) received five in-school sessions, while those in the control group (N=683) received no smoking prevention information (usual curriculum). Post-intervention data was collected six months after baseline. Logistic regression analysis was applied to assess effects on smoking initiation, and linear regression analysis was applied to assess changes in beliefs and analysis of covariance (ANCOVA) was used to assess intervention effects. All analyses were adjusted for the nested structure of students within schools. RESULTS At post-intervention respondents from the experimental group reported in comparison with those from the control group a significantly more negative attitude towards smoking, stronger social norms against smoking, higher self-efficacy towards non-smoking, more action planning to remain a non-smoker, and lower intentions to smoke in the future. Smoking initiation was 3.2% in the experimental group and 8.8% in the control group (p<0.01). CONCLUSION The prevention program reinforced non-smoking cognitions and non-smoking behavior. Therefore it is recommended to implement the program at a national level in Saudi-Arabia. Future studies are recommended to assess long term program effects and the conditions favoring national implementation of the program.
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Affiliation(s)
- Mutaz Mohammed
- Maastricht University, School for Public Health and Primary Care (Caphri), P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Sander Matthijs Eggers
- Maastricht University, School for Public Health and Primary Care (Caphri), P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Fahad F Alotaiby
- School Health Program, Dawadmy School Health Unit Saudi Arabia, Saudi Arabia, Dawadmi, -11911, -P.O Box 760.
| | - Nanne de Vries
- Maastricht University, School for Public Health and Primary Care (Caphri), P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Hein de Vries
- Maastricht University, School for Public Health and Primary Care (Caphri), P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Carreras G, Bosi S, Angelini P, Gorini G. Mediating factors of a school-based multi-component smoking prevention intervention: the LdP cluster randomized controlled trial. HEALTH EDUCATION RESEARCH 2016; 31:439-449. [PMID: 27288347 DOI: 10.1093/her/cyw031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/20/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to investigate factors mediating the effects of Luoghi di Prevenzione (LdP) smoking prevention intervention based on social competence and social influence approaches, and characterized by peer-led school-based interventions, out-of-school workshops, school lessons, and by enforcing the school anti-smoking policy. Students aged 14-15 years in 13 secondary schools in Reggio Emilia, Italy (989 students) were randomly assigned to the LdP intervention or a control condition. The baseline and follow-up surveys were carried out before and 18 months after the intervention, respectively.The outcomes were cigarette daily and frequent smoking and smoking at school. Multilevel multiple mediation analyses were carried out in order to study effect mediation. The mediators were normative perception, positive and negative beliefs, refusal skills for smoking, social acceptability perception, risk perception, smoking knowledge and awareness about dangers of second-hand smoking.The intervention effects were explained by the social influence component through the mediator refusal skills for smoking. The programme also showed to significantly increase risk perception and smoking knowledge, even though these mediators had no effect on smoking. Moreover, LdP intervention directly reduced smoking in school areas. Future interventions should maintain and strengthen the LdP social influence component and the part regarding the school anti-smoking policy.
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Affiliation(s)
- G Carreras
- Cancer Prevention and Research Institute (ISPO), Florence, 50139, Italy
| | - S Bosi
- Lega Italiana per la Lotta contro i Tumori (LILT), Reggio Emilia, 42123, Italy
| | - P Angelini
- Public Health Service, Emilia-Romagna Region, Bologna, 40127, Italy
| | - G Gorini
- Cancer Prevention and Research Institute (ISPO), Florence, 50139, Italy
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Kaleta D, Usidame B, Dziankowska-Zaborszczyk E, Makowiec-Dąbrowska T. Socioeconomic Disparities in Age of Initiation and Ever Tobacco Smoking: Findings from Romania. Cent Eur J Public Health 2016; 23:299-305. [PMID: 26841142 DOI: 10.21101/cejph.a4067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 03/07/2015] [Indexed: 11/15/2022]
Abstract
AIM Smoking initiation is considered the fundamental behaviour that determines the future health burden of tobacco smoking in a society. The aim of the study was to evaluate the socio-demographic factors associated with initiation of regular smoking among adults. METHODS The data source was the 2011 Global Adult Tobacco Survey Romania (GATS), which is a cross-sectional, nationally representative study. Multivariate logistic regression model was applied for relevant analysis. RESULTS Among males, the regular smoking initiation rate was significantly higher compared to females (52.4% vs. 18.5%; p<0.001). Mean age of smoking initiation was lower in men compared to women (18.4±4.8 vs. 21.5±6.8; p<0.001). Age in men, awareness of environmental tobacco smoke consequences and place of living for women as well as educational attainment and employment status in both genders were associated with ever regular smoking. Moreover, cohabitation with a smoker was associated with greater odds for initiating smoking among both genders. CONCLUSIONS GATS revealed a significant but diverse role of socioeconomic factors in initiation of regular smoking among adult Romanians.
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Affiliation(s)
- Dorota Kaleta
- Tobacco Control Department, Department of Preventive Medicine, Medical University of Łódź, Łódź, Poland
| | - Bukola Usidame
- Department of Public Policy, University of Massachusetts, Boston, United States
| | | | - Teresa Makowiec-Dąbrowska
- Department of Work Physiology and Ergonomics, Nofer Institute of Occupational Medicine, Łódź, Poland
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Georgie J M, Sean H, Deborah M C, Matthew H, Rona C. Peer-led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11-21 years: a systematic review and meta-analysis. Addiction 2016; 111:391-407. [PMID: 26518976 PMCID: PMC4833174 DOI: 10.1111/add.13224] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/28/2015] [Accepted: 10/22/2015] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND AIMS Peer-led interventions may offer a beneficial approach in preventing substance use, but their impact has not yet been quantified. We conducted a systematic review to investigate and quantify the effect of peer-led interventions that sought to prevent tobacco, alcohol and/or drug use among young people aged 11-21 years. METHODS Medline, EMBASE, PsycINFO, CINAHL, ERIC and the Cochrane Library were searched from inception to July 2015 without language restriction. We included randomized controlled trials only. Screening and data extraction were conducted in duplicate and data from eligible studies were pooled in a random effects meta-analysis. RESULTS We identified 17 eligible studies, approximately half of which were school-based studies targeting tobacco use among adolescents. Ten studies targeting tobacco use could be pooled, representing 13,706 young people in 220 schools. Meta-analysis demonstrated that the odds of smoking were lower among those receiving the peer-led intervention compared with control [odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.99, P = 0.040]. There was evidence of heterogeneity (I(2) = 41%, χ(2) 15.17, P = 0.086). Pooling of six studies representing 1699 individuals in 66 schools demonstrated that peer-led interventions were also associated with benefit in relation to alcohol use (OR = 0.80, 95% CI = 0.65-0.99, P = 0.036), while three studies (n = 976 students in 38 schools) suggested an association with lower odds of cannabis use (OR = 0.70, 0.50-0.97, P = 0.034). No studies were found that targeted other illicit drug use. CONCLUSIONS Peer interventions may be effective in preventing tobacco, alcohol and possibly cannabis use among adolescents, although the evidence base is limited overall, and is characterized mainly by small studies of low quality.
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Affiliation(s)
| | - Harrison Sean
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Caldwell Deborah M
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hickman Matthew
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Campbell Rona
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Tahlil T, Woodman RJ, Coveney J, Ward PR. Six-months follow-up of a cluster randomized trial of school-based smoking prevention education programs in Aceh, Indonesia. BMC Public Health 2015; 15:1088. [PMID: 26499860 PMCID: PMC4619432 DOI: 10.1186/s12889-015-2428-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 10/16/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Smoking prevention programs have been taught in schools to reduce the high smoking prevalence and its related problems among adolescent populations. Although short-term benefits have been observed, the long-term effectiveness of such programs appear to be inconsistent. This study aims at investigating the long-term impact of both health and Islamic focused interventions amongst students in Indonesia. METHODS At 6 months after completion of the interventions, 427 of the original 447 participants (control group = 128, intervention groups = 299) from a school-based cluster randomized control trial were re-assessed for their smoking knowledge, attitudes, intentions and behaviours using a self-report questionnaire. Data was analyzed according to the study's 2 × 2 factorial design with adjustment for baseline scores, school and classroom clustering effects and multiple comparisons. RESULTS Compared to the control group, significant long term effects were found for the health-based intervention program in improved health (β = 4.3 ± 0.4, p < 0.001), Islamic (β = 1.1 ± 0.4, p = 0.01) knowledge and a reduction of smoking attitudes (β = -11.5 ± 1.8, p < 0.001). For the Islamic-based intervention programs there was an improvement of health (β = 3.7 ± 0.4, p < 0.001) and Islamic (β = 2.2 ± 0.5, p < 0.001) knowledge and a reduction towards smoking attitude (β = -6.0 ± 1.9, p < 0.01) and smoking behaviors in the past month (OR = 0.1, 95 % CI = 0.0-0.8, p = 0.03). The effects were greater but less than additive in the combined group for health (β = -3.2 ± 0.9, p < 0.001 for interaction) and Islamic knowledge (β = -2.3 ± 0.9, p = 0.01 for interaction) but were additive for smoking attitudes (β = 6.1 ± 3.2, p = 0.07 for interaction). No significant effects on smoking intentions were observed at 6 months follow-up in the health or Islamic-based intervention programs. CONCLUSION School-based programs can provide long term benefits on Indonesian adolescents' smoking knowledge and attitudes. Tailoring program intervention components with participants' religious background might maximise program effectiveness. A larger and more encompassing study is now required to confirm the effectiveness of this new Indonesia culturally-based program. Adolescents in similar areas might also benefit from this type of school-based smoking cessation program. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry, ACTRN12612001070820.
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Affiliation(s)
- Teuku Tahlil
- Nursing Faculty, Syiah Kuala University, Banda Aceh, 23111, Indonesia.
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, SA, 5001, Australia.
| | - John Coveney
- Discipline of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, 5001, Australia.
| | - Paul R Ward
- Discipline of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, 5001, Australia.
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Khayyati F, Allahverdipour H, Shaghaghi A, Fathifar Z. Tobacco Use Prevention by Integrating Inside and Outside of School Based Programs: A Systematic Review Article. Health Promot Perspect 2015; 5:81-91. [PMID: 26290823 DOI: 10.15171/hpp.2015.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/01/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Experience of tobacco use in early ages will increase probability of addiction to nicotine therefore, efficient tobacco control programs for teenagers are crucial. This study was conducted to recognize elements of successful integrated inside and outside of school based smoking prevention programs. METHODS MeSH terms and related keywords were used to search PubMed, Cochrane, Medline, EMBASE, ERIC, SID databases from inception to 29th October 2013. Trials with random and non-random designs, systematic reviews and cohort studies that assessed or reported application of integrated tobacco control programs were included. Quality of the retrieved publications was checked independently by the authors and any disagreement was resolved by consensus. RESULT Among the 745 identified publications, only 15 studies had the inclusion criteria with a considerable methodological heterogeneity. While, precise out-come of integrated out of school/school-based interventions were not percepti-ble but this study's findings implied that outside of school intervention could strengthen school-based tobacco prevention programs. No study was found to examine school-based interventions integrated with primary health care such as anti-tobacco consultations, high-risk students screening and their referral to special centers. CONCLUSION Integration of outside and inside of school-based programs may boost probability of obtaining favorable outcomes and success rate in practice.
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Affiliation(s)
- Fariba Khayyati
- Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Allahverdipour
- Clinical Psychiatry Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ; Department of Health Education & Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Shaghaghi
- Department of Health Education & Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Fathifar
- Central Library of the Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Mohammed M, Eggers SM, Alotaiby FF, de Vries N, de Vries H. Smoking uptake among Saudi adolescents: tobacco epidemic indicators and preventive actions needed. Glob Health Promot 2014; 25:6-15. [PMID: 25425029 DOI: 10.1177/1757975914548193] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this cross-sectional school-based study was to assess smoking prevalence, indicators for the smoking epidemic and determinants of smoking among Saudi adolescents. The study included 695 male adolescents from 11 to 16 years of age who filled out self-report questionnaires based on the European Smoking Framework Approach questionnaire, which uses the I-Change model to assess attitude, social influence and the self-efficacy of the participants. Smokers were 275 (39.6%) adolescents. Smokers tended to receive more daily pocket money, live in more affluent families and show lower academic performance. Non-smokers were inclined to believe that smoking may help people to feel relaxed and confident, encountered less social influences to smoke than smokers, but reported low self-efficacy not to smoke when with smoker friends and when offered a cigarette. Smokers reported the lowest self-efficacy not to smoke in all situations assessed. The results suggest the smoking epidemic among male Saudi adolescents may still be in the early stages, providing ample opportunity for preventive actions aimed at halting the further progress of this epidemic. Secondly, smoking prevention programs in Saudi Arabia need to reinforce non-smoking attitudes, address how to resist pressure to smoke, and how to develop high self-efficacy towards non-smoking in various situations.
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Affiliation(s)
- Mutaz Mohammed
- 1. Maastricht University - School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands
| | - Sander Matthijs Eggers
- 1. Maastricht University - School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands
| | | | - Nanne de Vries
- 1. Maastricht University - School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands
| | - Hein de Vries
- 1. Maastricht University - School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands
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Menati W, Nazarzadeh M, Bidel Z, Würtz M, Menati R, Hemati R, Yaghoubi M, Zareimanesh E, Mohammadi MS, Akhlaghi Ardekani F, Tazval J, Delpisheh A. Social and Psychological Predictors of Initial Cigarette Smoking Experience: A Survey in Male College Students. Am J Mens Health 2014; 10:14-23. [PMID: 25326133 DOI: 10.1177/1557988314553262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Knowledge about social and psychological risk factors for initial cigarette smoking experience (ICSE) is sparse. The present study aimed to estimate the prevalence of ICSE and to examine the psychological and social factors related to ICSE. In a cross-sectional survey, 1,511 male college students were recruited using multistage sampling techniques from four universities located within the city of Ilam, Iran. Self-administered multiple-choice questionnaires were distributed to students from March to June 2013. Risk factors for ICSE were evaluated using logistic regression models. Participants were 22.3 ± 2.4 years of age. ICSE prevalence was 30.6%. In multivariable adjusted analysis, risk taking behavior (odds ratio [OR] = 1.61; 95% confidence interval [CI] = 1.11-2.33), perceived peer smoking prevalence (OR = 2.48; 95% CI = 1.03-5.97), positive thoughts about smoking (OR = 1.06; 95% CI = 1.02-1.10), high self-efficacy (OR = 0.95, 95% CI [0.93, 0.98]), presence in smokers' gathering (OR = 4.45; 95% CI = 2.88-6.81), comity of smokers (OR = 2.56; 95% CI = 1.66, 3.92), very hard access to cigarettes (OR = 2.20; 95% CI = 1.16-4.16), close friends' medium reaction toward smoking (OR = 1.38; 95% CI = 1.02-1.88), and sporting activity (OR = 0.74; 95% CI = 0.56-0.98) were significantly associated with ICSE. This study identified that a combination of psychological and social variables account for up to 78% of the probability of ICSE. The most important protective factor against ICSE was physical activity, whereas the most important risk factor for ICSE was frequent gathering in the presence of smokers.
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Affiliation(s)
| | - Milad Nazarzadeh
- Ilam University of Medical Sciences, Ilam, Iran Shahid Beheshti University of Medical Science, Tehran, Iran Tehran University of Medical Science, Tehran, Iran
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Psychosocial determinants of cigarette smoking among university students in Jordan. J Dev Orig Health Dis 2014; 2:152-61. [PMID: 25141040 DOI: 10.1017/s2040174411000122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objectives of this study were to describe the prevalence of cigarette use and water pipe smoking in Jordanian university students and to analyze differences in determinants between cigarette smokers and non-smokers. A cross-sectional questionnaire was administered to a random sample of 400 students (18-24 years, 51% males). Smokers were compared with non-smokers on several smoking-related determinants. Data were analyzed using descriptive statistics, t-test, χ 2 test and binary logistic regression analysis. The prevalence rates of cigarette use and water pipe smoking were 25.9% and 23.3%, respectively. Cigarette smokers differed significantly from non-smokers on almost all of the assessed determinants. The I-Change model explained 85% of the total variance of cigarette-smoking behavior. Cigarette smoking was determined by being male and older, having more depressive symptoms, having less Muslim identity, being more emancipated, perceiving more pros of smoking, having more modeling from peers and having lower self-efficacy. The popularity of cigarette use and water pipe smoking among Jordanian students necessitates health promotion interventions that motivate students not to engage in smoking behaviors by clearly outlining the outcomes of smoking and the healthier alternatives, how to cope with social influences and difficult situations in order to increase self-efficacy.
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Tahlil T, Coveney J, Woodman RJ, Ward PR. Exploring recommendations for an effective smoking prevention program for indonesian adolescents. Asian Pac J Cancer Prev 2014; 14:865-71. [PMID: 23621253 DOI: 10.7314/apjcp.2013.14.2.865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present qualitative study assessed the need, acceptability and appropriateness for implementing effective and culturally appropriate smoking prevention programs for adolescents in schools in Indonesia. METHODS Snowball sampling was used to recruit participants. The study sample comprised a mixture of staff in the education department, junior high school teachers and individuals who had taught junior high school students in Aceh Province, Indonesia. Data were collected through one hour in-depth face to face or telephone interviews and analyzed using a descriptive content analysis procedure. RESULTS School teachers and policy makers in education firmly supported the implementation of a school-based smoking prevention program in Aceh. An appropriate intervention for smoking prevention program in schools in Aceh should involve both health and Islamic based approaches, and be provided by teachers and external providers. Potential barriers to the program included smoker teachers and parents, time constraints of students and/or teachers, lack of teachers' ability, increase in students' load, the availability of tobacco advertising and sales, and lack of tobacco regulation and support from community and related departments. To increase program effectiveness, involvement of and coordination with other relevant parties are needed. CONCLUSIONS The important stakeholders in Indonesian childhood education agreed that school-based smoking prevention program would be appropriate for junior high school students. An appropriate intervention for smoking prevention program for adolescents in schools in Indonesia should be appropriate to participants' background and involve all relevant parties.
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Affiliation(s)
- Teuku Tahlil
- Discipline of Public Health, School of Medicine, Flinders University, Australia.
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de Josselin de Jong S, Candel M, Segaar D, Cremers HP, de Vries H. Efficacy of a Web-based computer-tailored smoking prevention intervention for Dutch adolescents: randomized controlled trial. J Med Internet Res 2014; 16:e82. [PMID: 24657434 PMCID: PMC3978560 DOI: 10.2196/jmir.2469] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/29/2014] [Accepted: 02/19/2014] [Indexed: 11/17/2022] Open
Abstract
Background Preventing smoking initiation among adolescents is crucial to reducing tobacco-caused death and disease. This study focuses on the effectiveness of a Web-based computer-tailored smoking prevention intervention aimed at adolescents. Objective The intent of the study was to describe the intervention characteristics and to show the effectiveness and results of a randomized controlled trial. We hypothesized that the intervention would prevent smoking initiation among Dutch secondary school students aged 10-20 years and would have the largest smoking prevention effect among the age cohort of 14-16 years, as smoking uptake in that period is highest. Methods The intervention consisted of a questionnaire and fully automated computer-tailored feedback on intention to start smoking and motivational determinants. A total of 89 secondary schools were recruited via postal mail and randomized into either the computer-tailored intervention condition or the control condition. Participants had to complete a Web-based questionnaire at baseline and at 6-month follow-up. Data on smoking initiation were collected from 897 students from these schools. To identify intervention effects, multilevel logistic regression analyses were conducted using multiple imputation. Results Smoking initiation among students aged 10-20 years was borderline significantly lower in the experimental condition as compared to the control condition 6 months after baseline (OR 0.25, 95% CI 0.05-1.21, P=.09). Additional analyses of the data for the 14-16 year age group showed a significant effect, with 11.5% (24/209) of the students in the control condition reporting initiation compared to 5.7% (10/176) in the experimental condition (OR 0.22, 95% CI 0.05-1.02, P=.05). No moderation effects were found regarding gender and educational level. Conclusions The findings of this study suggest that computer-tailored smoking prevention programs are a promising way of preventing smoking initiation among adolescents for at least 6 months, in particular among the age cohort of 14-16 years. Further research is needed to focus on long-term effects. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 77864351; http://www.controlled-trials.com/ISRCTN77864351 (Archived by WebCite at http://www.webcitation.org/6BSLKSTm5).
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Lotrean LM, Loghin CR, Popa M, Vries HD. Smoking prevention for adolescents in Romanian schools. Asian Pac J Cancer Prev 2014; 14:7017-21. [PMID: 24377642 DOI: 10.7314/apjcp.2013.14.11.7017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study had two objectives. The first was to assess the frequency and content of school-based anti-smoking education received by Romanian adolescents aged 14-15. Secondly, the study aimed to evaluate to what extent the implementation of a specific 5 lessons smoking prevention program influences the quality of anti-smoking school education among Romanian adolescents. The investigation was performed in twenty schools from Cluj- Napoca, Romania, which were randomly assigned to the control and experimental conditions, resulting in 55 participating classes from the seventh grade (28 in the control group and 27 in the experimental group). The experimental group participated in a school-based smoking prevention program consisting of 5 lessons. The control group beneficiated only in the standard anti-smoking education offered by their schools. Six months after the program implementation, students from both experimental and control groups filled in a questionnaire, assessing several issues regarding their exposure to anti-smoking school education in the last year. The results showed a low exposure to anti-smoking school education among the Romanian adolescents. The implementation of the specific school-based smoking prevention program increased the exposure of Romanian adolescents to a higher number of lessons of smoking prevention and influenced positively the quality of these lessons. The study identified several gaps with respect to anti-smoking education in Romanian schools. It underlines the benefits of the implementation of a school based smoking prevention program with a clear structure, which contains appropriate educational messages and it is easy to implement.
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Affiliation(s)
- Lucia Maria Lotrean
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania E-mail :
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Lotrean LM, Mesters I, de Vries H. Why do Romanian junior high school students start to smoke? Child Care Health Dev 2013; 39:851-5. [PMID: 22928585 DOI: 10.1111/j.1365-2214.2012.01428.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescence is a crucial period in the development of smoking behaviour. To develop efficient prevention programmes for teenagers, it is essential to understand why adolescents start to smoke. The objective of this study was to assess the predictors of smoking onset among Romanian junior high school students aged 13-14. METHODS The data were obtained from a two-wave, 9-month longitudinal study carried out among 504 junior high school non-smokers from Cluj-Napoca, Romania. Questionnaires assessed smoking behaviour, attitudes, social influence, self-efficacy and intention regarding smoking (motivational variables), as well as different sociodemographic features. RESULTS The results from the logistic regression analysis revealed that baseline lower self-efficacy in refraining from smoking in several social situations, baseline pressures from peers to smoke and baseline intentions to smoke significantly increased the risk of non-smokers to become smokers at follow-up 9 months later. CONCLUSIONS These findings underline that reinforcing social self-efficacy to refuse smoking, resisting peer pressures and maintaining negative intentions regarding smoking are essential ingredients for smoking prevention programmes among Romanian junior high school students.
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Affiliation(s)
- L M Lotrean
- Department of Environmental Health, University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Thomas RE, McLellan J, Perera R. School-based programmes for preventing smoking. ACTA ACUST UNITED AC 2013. [DOI: 10.1002/ebch.1937] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
BACKGROUND Helping young people to avoid starting smoking is a widely endorsed public health goal, and schools provide a route to communicate with nearly all young people. School-based interventions have been delivered for close to 40 years. OBJECTIVES The primary aim of this review was to determine whether school smoking interventions prevent youth from starting smoking. Our secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Tobacco Addiction Group's Specialised Register, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, Health Star, and Dissertation Abstracts for terms relating to school-based smoking cessation programmes. In addition, we screened the bibliographies of articles and ran individual MEDLINE searches for 133 authors who had undertaken randomised controlled trials in this area. The most recent searches were conducted in October 2012. SELECTION CRITERIA We selected randomised controlled trials (RCTs) where students, classes, schools, or school districts were randomised to intervention arm(s) versus a control group, and followed for at least six months. Participants had to be youth (aged 5 to 18). Interventions could be any curricula used in a school setting to deter tobacco use, and outcome measures could be never smoking, frequency of smoking, number of cigarettes smoked, or smoking indices. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed studies for inclusion, extracted data and assessed risk of bias. Based on the type of outcome, we placed studies into three groups for analysis: Pure Prevention cohorts (Group 1), Change in Smoking Behaviour over time (Group 2) and Point Prevalence of Smoking (Group 3). MAIN RESULTS One hundred and thirty-four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.Pure Prevention cohorts (Group 1) included 49 studies (N = 142,447). Pooled results at follow-up at one year or less found no overall effect of intervention curricula versus control (odds ratio (OR) 0.94, 95% confidence interval (CI) 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow-up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes.Change in Smoking Behaviour over time (Group 2) included 15 studies (N = 45,555). At one year or less there was a small but statistically significant effect favouring controls (standardised mean difference (SMD) 0.04, 95% CI 0.02 to 0.06). For follow-up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI -0.00 to 0.02).Twenty-five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled.We were unable to analyse data for 49 studies (N = 152,544).Subgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow-up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco-only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow-up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow-up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. AUTHORS' CONCLUSIONS Pure Prevention cohorts showed a significant effect at longest follow-up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less. The combined social competence and social influences interventions showed a significant effect at one year and at longest follow-up. Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information-only approach were similarly ineffective.Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada.
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Mao A, Bristow K, Robinson J. Caught in a dilemma: why do non-smoking women in China support the smoking behaviors of men in their families? HEALTH EDUCATION RESEARCH 2013; 28:153-164. [PMID: 22843329 DOI: 10.1093/her/cys078] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Intimate relationships influence family members' health practices. Although cigarette smoking in China is predominantly a male behavior, (non-smoking) women's roles should be taken into account for the development of home-smoking interventions. Drawing on ethnographic interviews with 22 families in a rural area of China, this article explores non-smoking women's attitudes towards male smoking. The findings suggest that women's ability to influence male behavior is largely determined by culturally defined gender roles, underpinned by ideologies of familism and collectivism. Despite concerns about the adverse results of smoking to their family members and households, non-smoking women ultimately maintain the (male) smokers' argument that smoking plays an important role in construction and maintenance of intra- and extra-family relationships. By accepting male smoking and men's engagement in the social practice of smoking and cigarette exchanges, women maintain their identities as supportive wives, filial daughters/in-law and responsible family members who pursue family collective interests at the expense of their own personal beliefs. Future smoking control initiatives that target non-smoking women to influence male smoking should take into account the women's overarching need to maintain the status and harmony of their families.
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Affiliation(s)
- Aimei Mao
- School of Law and Social Justice, University of Liverpool, Liverpool L69 7WW, UK.
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Hiemstra M, Otten R, Engels RCME. Smoking onset and the time-varying effects of self-efficacy, environmental smoking, and smoking-specific parenting by using discrete-time survival analysis. J Behav Med 2012; 35:240-51. [PMID: 21643802 PMCID: PMC3305880 DOI: 10.1007/s10865-011-9355-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 05/18/2011] [Indexed: 10/31/2022]
Abstract
This study examined the timing of smoking onset during mid- or late adolescence and the time-varying effects of refusal self-efficacy, parental and sibling smoking behavior, smoking behavior of friends and best friend, and parental smoking-specific communication. We used data from five annual waves of the 'Family and Health' project. In total, 428 adolescents and their parents participated at baseline. Only never smokers were included at baseline (n = 272). A life table and Kaplan-Meier survival curve showed that 51% of all adolescents who did not smoke at baseline did not start smoking within 4 years. The risk for smoking onset during mid- or late adolescence is rather stable (hazard ratio between 16 and 19). Discrete-time survival analyses revealed that low refusal self-efficacy, high frequency of communication, and sibling smoking were associated with smoking onset one year later. No interaction effects were found. Conclusively, the findings revealed that refusal self-efficacy is an important predictor of smoking onset during mid- or late adolescence and is independent of smoking-specific communication and smoking behavior of parents, siblings, and (best) friend(s). Findings emphasize the importance of family prevention programs focusing on self-efficacy skills.
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Affiliation(s)
- Marieke Hiemstra
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
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Blumenthal-Barby JS, Burroughs H. Seeking better health care outcomes: the ethics of using the "nudge". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:1-10. [PMID: 22304506 DOI: 10.1080/15265161.2011.634481] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for the utilization of each principle.
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