Socioeconomic Differences in Cigarette Smoking and Alternative Tobacco Product Use Among Adolescents in a School-Based Smoking Preventive Intervention: Findings From the Second Year of the X:IT II Study

The Effect of Health Belief Model-Based Creative Drama Education on Health Locus of Control and Smoking Perception in Adolescents: A Randomized Controlled Trial

INTRODUCTION

The aim of this study is to examine the effect of education given to eighth-grade adolescents in a primary school with health belief model (HBM)-based creative drama techniques on health locus of control (HLC) and smoking perception.

METHOD

This randomized controlled study was conducted between January and December 2019 in two primary schools in the Erzurum city center, Türkiye. The study included 80 eighth-grade students, who were randomly assigned to either the experimental group (n = 40) or the control group (n = 40) The experimental group received six sessions of creative drama training based on the HBM. Data collection instruments included the Multidimensional Health Locus of Control Scale (MHLC) and the Decisional Balance Scale for Children (DBSC). Pre- and post-test measurements were taken for both groups to assess changes in HLC and smoking perception. Statistical analyses were performed using repeated measures ANOVA to examine within-group changes over time and between-group differences, allowing us to understand the precise effect of the intervention across time points. Additionally, descriptive statistics were used to report means and standard deviations for all variables. No protocol registration number was available for this study at the time of its execution.

RESULTS

The students in the experimental group showed a significant increase in the internal control sub-dimension of the HLC (t = -5.090, p < 0.001) and a decrease in the external control sub-dimension (U = -3.369, p < 0.001). For the Decisional Balance Scale, there was a significant decrease in the pros sub-dimension (t = -5.535, p < 0.001) and an increase in the cons sub-dimension (U = -3.934, p < 0.001). In the control group, only the pre-test mean score for the chance/fate sub-dimension was higher (p < 0.05). The repeated measures ANOVA confirmed significant within-group changes in the experimental group: an increase in internal locus of control and a decrease in external locus of control. Smoking perception also showed significant changes, with a decrease in the pros sub-dimension and an increase in the cons sub-dimension, validating the intervention's effectiveness.

CONCLUSION

When creative drama practices are used together with the HBM, it caused a positive change in the HLC and the perception of cons toward smoking.

Effect of a multicomponent school-based intervention with parental involvement on socioeconomic inequalities in smoking initiation: equity impact analysis of the TOPAS study

BACKGROUND

As prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in smoking initiation among adolescents. We evaluated whether a multicomponent school-based prevention programme with parental involvement has differential effects on smoking initiation across socioeconomic groups and affects the magnitude of socioeconomic inequalities in smoking initiation.

METHODS

A secondary analysis of data from a 3-year cluster randomised controlled trial, the TOPAS study, conducted in Sweden from 2018 to 2021. Schools were randomised either to the full programme (Tobacco-Free Duo, T-DUO) or minimal intervention (EDU). The analysis was conducted according to intention to treat for the primary outcome, the probability of remaining a non-user of cigarettes at the end of compulsory school (ages 15-16). Parents' educational attainment was the socioeconomic variable. Differential effects were analysed by comparing adolescents exposed to T-DUO with those exposed to EDU within each socioeconomic group. The effect of the intervention on the magnitude of inequalities was analysed by comparing several measures of absolute and relative inequalities between T-DUO and EDU.

RESULTS

At the end of follow-up, the full programme had a similar, at most moderate effect on smoking initiation in all socioeconomic groups (relative risk 1.13 (95% CI 1.02 to 1.25) in the middle group). The programme did not significantly affect the magnitude of inequalities (Slope Index of Inequality difference 1.49 (95% CI -15.34 to 18.32)).

DISCUSSION

Socioeconomic inequalities in smoking initiation remain substantial. Our results indicate the absence of an effect of the programme T-DUO on these inequalities.

Predicting longitudinal changes in patterns of tobacco and nicotine product use among adolescents: A Latent Transition Analysis based on the X:IT study

INTRODUCTION

Understanding factors influencing the transition from non-use to tobacco and nicotine product initiation among adolescents is crucial for designing and implementing effective preventive strategies. This study explores transition patterns among 13-15-year-old adolescents in lower secondary school, focusing on the transition from non-use to tobacco and nicotine product initiation and the influence of individual, social, risk behavioral, and mental health factors on this transition.

METHODS

Based on data from a Danish smoking prevention trial between 2017 and 2019, this study employed questionnaire surveys at three time points: baseline (start of seventh grade, n = 1,990, response rate = 86.3%), eight-month follow-up (end of seventh grade, n = 1,666, response rate = 74,8%), and 20-month follow-up (end of eighth grade, n = 1,149, response rate = 70,6%). Tobacco and nicotine use indicators included current and lifetime use of cigarettes and lifetime use of e-cigarettes, smokeless tobacco, and hookah. A latent transition analysis was applied to identify longitudinal transition patterns across waves and to explore predictors of these patterns.

RESULTS

Three user classes emerged across all waves: none-use, lifetime e-cigarette and cigarette use, and poly-tobacco use. While the most prevalent class was the non-user class (71%-86%), the proportion of the lifetime e-cigarette and cigarette class increased over time (from 12% to 17%). Similarly, the poly-tobacco user class increased from 2% to 12%. The probability of transitioning from non-use to lifetime e-cigarette and cigarette use increased from 0.5% at baseline to 12% by the second follow-up, while the probability of transitioning from lifetime e-cigarette and cigarette use remained stable over time (12%-15%). Across all waves, elevated risk behavior predicted this transition. For instance, binge-drinking (OR = 3.76, 95% CI: 1.51-9.34), susceptibility to smoking (OR = 7.63, 95% CI: 3.68-16.83), and truancy (OR = 7.00, 95% CI: 1.98-24.59) influenced the transition from non-use at baseline to lifetime e-cigarette and cigarette use at first follow-up. Additionally, boys, adolescents with low socioeconomic status, low life satisfaction, and those with smoking friends or parents were more likely to transition from non-use to lifetime e-cigarette and cigarette use.

CONCLUSION

This study demonstrates that sociodemographic, social risk, behavioral, and mental health factors impact the transition from non-use to lifetime e-cigarette and cigarette use. The findings provide valuable insights for developing targeted preventive strategies focusing on these influencing factors.

Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial

OBJECTIVES

Public health interventions are designed to improve specific health-related outcomes; however, they may also produce negative side effects, such as substitution use, psychological or social harms. Knowledge about the unintended effects of school-based smoking preventive interventions is sparse. Hence, this study examined these potential unintended effects of the smoking-reducing intervention, Focus, among students in the vocational education and training setting.

DESIGN

Cluster randomised controlled trial stratified by school type with 5 months follow-up.

SETTING AND PARTICIPANTS

Across Denmark, eight schools were randomised to the intervention group (n=844 students, response proportion 76%) and six schools to the control group (n=815 students, response proportion 75%). This study focused solely on students who smoked at baseline (N=491).

INTERVENTIONS

The intervention was developed systematically based on theory and a thoroughly mixed-methods needs assessment. Intervention components included a comprehensive school tobacco policy (smoke-free school hours) supported by a 3-day course for school staff and launched by an edutainment session for students; class-based lessons and a quit-and-win competition; and individual telephone smoking cessation support.

OUTCOMES

Alternative tobacco and nicotine products (regular use of smokeless tobacco, hookah and e-cigarettes), regular cannabis use, boredom and loneliness at school, stress and perceived stigmatisation among smokers.

RESULTS

We found no statistically significant unintended effects of the intervention. Nonetheless, insignificant findings indicated that students in the intervention group were less likely to be bored during school hours (OR 0.59, 95% CI 0.32 to 1.10) and experience stress (OR 0.62, 95% CI 0.35 to 1.10), but more likely to report feeling stigmatised compared with the control group (OR 1.55, 95% CI 0.71 to 3.40).

CONCLUSIONS

Overall, findings suggested no unintended effects of the Focus trial with respect to substitution use, psychological, nor group or social harms. Future research is encouraged to report potential harmful outcomes of smoking preventive interventions, and interventions should be aware of the possible stigmatisation of smokers.

TRIAL REGISTRATION NUMBER

ISRCTN16455577.