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Brinker TJ, Buslaff F, Suhre JL, Silchmüller MP, Divizieva E, Wilhelm J, Hillebrand G, Penka D, Gaim B, Swoboda S, Baumermann S, Walther JW, Brieske CM, Jakob L, Baumert HM, Anhuef O, Schmidt SM, Alfitian J, Batra A, Taha L, Mons U, Hofmann FJ, Haney AC, Haney CM, Schaible S, Tran TA, Beißwenger H, Stark T, Groneberg DA, Seeger W, Srivastava A, Gall H, Holzapfel J, Rigotti NA, Baudson TG, Enk AH, Fröhling S, von Kalle C, Bernardes-Souza B, Pereira RMDOS, Thomas R. Process Evaluation of a Medical Student-Delivered Smoking Prevention Program for Secondary Schools: Protocol for the Education Against Tobacco Cluster Randomized Trial. JMIR Res Protoc 2019; 8:e13508. [PMID: 30973348 PMCID: PMC6482400 DOI: 10.2196/13508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/22/2019] [Accepted: 03/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background Most smokers start smoking during their early adolescence under the impression that smoking entails positive attributes. Given the addictive nature of cigarettes, however, many of them might end up as long-term smokers and suffering from tobacco-related diseases. To prevent tobacco use among adolescents, the large international medical students’ network Education Against Tobacco (EAT) educates more than 40,000 secondary school students per year in the classroom setting, using evidence-based self-developed apps and strategies. Objective This study aimed to evaluate the long-term effectiveness of the school-based EAT intervention in reducing smoking prevalence among seventh-grade students in Germany. Additionally, we aimed to improve the intervention by drawing conclusions from our process evaluation. Methods We conduct a cluster-randomized controlled trial with measurements at baseline and 9, 16, and 24 months postintervention via paper-and-pencil questionnaires administered by teachers. The study groups consist of randomized schools receiving the 2016 EAT curriculum and control schools with comparable baseline data (no intervention). The primary outcome is the difference of change in smoking prevalence between the intervention and control groups at the 24-month follow-up. Secondary outcomes are between-group differences of changes in smoking-related attitudes and the number of new smokers, quitters, and never-smokers. Results A total of 11,268 students of both sexes, with an average age of 12.32 years, in seventh grade of 144 secondary schools in Germany were included at baseline. The prevalence of cigarette smoking in our sample was 2.6%. The process evaluation surveys were filled out by 324 medical student volunteers, 63 medical student supervisors, 4896 students, and 141 teachers. Conclusions The EAT cluster randomized trial is the largest school-based tobacco-prevention study in Germany conducted to date. Its results will provide important insights with regards to the effectiveness of medical student–delivered smoking prevention programs at school. International Registered Report Identifier (IRRID) DERR1-10.2196/13508
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Affiliation(s)
- Titus Josef Brinker
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany.,Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabian Buslaff
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | | | | | | | - Jilada Wilhelm
- Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Gabriel Hillebrand
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Dominik Penka
- Faculty of Medicine, Justus-Liebig-University of Gießen, Gießen, Germany
| | - Benedikt Gaim
- Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Susanne Swoboda
- Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | | | - Jörg Werner Walther
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | | | - Lena Jakob
- Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Ole Anhuef
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen, Germany
| | - Selina Marisa Schmidt
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen, Germany
| | - Jonas Alfitian
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen, Germany
| | - Lava Taha
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - Ute Mons
- Cancer Prevention Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Ailís Ceara Haney
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Caelán Max Haney
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Samuel Schaible
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Thien-An Tran
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Hanna Beißwenger
- Faculty of Medicine, University of Göttingen, Göttingen, Germany
| | - Tobias Stark
- Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Werner Seeger
- Faculty of Medicine, Justus-Liebig-University of Gießen, Gießen, Germany
| | - Aayushi Srivastava
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Henning Gall
- Faculty of Medicine, Justus-Liebig-University of Gießen, Gießen, Germany
| | - Julia Holzapfel
- Faculty of Medicine, Justus-Liebig-University of Gießen, Gießen, Germany
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Tanja Gabriele Baudson
- Cognitive Science and Assessment Institute, University of Luxembourg, Luxembourg, Luxembourg
| | - Alexander H Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Fröhling
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Christof von Kalle
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | | | | | - Roger Thomas
- Health Sciences Centre, University of Calgary, Calgary, AB, Canada
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Brinker TJ, Buslaff F, Haney C, Gaim B, Haney AC, Schmidt SM, Silchmüller MP, Taha L, Jakob L, Baumert HM, Hallmann M, Heckl M, Alfitian J, Brieske CM, Divizieva EP, Wilhelm J, Hillebrand G, Penka D, Raveendranathan S, Suhre JL. [The global medical network Education Against Tobacco-voluntary tobacco prevention made in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1453-1461. [PMID: 30284623 DOI: 10.1007/s00103-018-2826-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Smoking is the leading preventable cause of premature death in Germany. The network "Education Against Tobacco" (EAT) is an initiative that was founded in Germany in 2012, in which more than 3500 medical students and physicians engage in volunteer work in about 80 medical faculties in 14 countries. In this article, the concept, activities, objectives and associated research studies oft he EAT initiative are introduced.On the school level, the initiative addresses 10- to 15-year-old secondary school students. In addition to a multimodal approach, school visits use modern media such as facemorphing apps, which are not only used by students (45,000 per year in 14 countries), but by a total of over 500,000 other people as well. The effectiveness of the school-based intervention is currently being investigated in randomised long-term studies with 20,000 adolescents in Germany. A first long-term study demonstrated evidence of a protective effect regarding the onset of smoking, especially among female students, students having a low level of education and students with a migratory background.The programme educates several hundred prospective physicians at 13 (of 28 participating) German medical faculties each year in science-based elective courses for the well-established smoking cessation counselling of patients and sensitises them to the tobacco epidemic. The approved members engage in dialogue with local members of the German house of representatives as "Ärzteverband Tabakprävention".EAT motivates the prospective generation of physicians, initially through prevention in school settings, to face the challenge of national tobacco control at the university and federal level.
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Affiliation(s)
- Titus Josef Brinker
- Abteilung für Translationale Onkologie, Nationales Centrum für Tumorerkrankungen (NCT), Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland.
- Klinik für Dermatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| | - Fabian Buslaff
- Universitätsklinikum Erlangen, Universität Erlangen, Erlangen, Deutschland
| | - Caelán Haney
- Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - Benedikt Gaim
- Universitätsklinikum Regensburg, Universität Regensburg, Regensburg, Deutschland
| | - Ailís Ceara Haney
- Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | | | | | - Lava Taha
- Universitätsklinikum Erlangen, Universität Erlangen, Erlangen, Deutschland
| | - Lena Jakob
- Universitätsklinikum Freiburg, Universität Freiburg, Freiburg, Deutschland
| | | | - Marvin Hallmann
- Medizinische Hochschule Hannover, Universität Hannover, Hannover, Deutschland
| | - Marlene Heckl
- Universitätsklinikum München, Universität München, München, Deutschland
| | - Jonas Alfitian
- Universitätsklinikum Köln, Universität Köln, Köln, Deutschland
| | | | | | - Jilada Wilhelm
- Universitätsklinikum Düsseldorf, Universität Düsseldorf, Düsseldorf, Deutschland
| | - Gabriel Hillebrand
- Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - Dominik Penka
- Universitätsklinikum Gießen, Universität Gießen, Gießen, Deutschland
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Faria BL, Brieske CM, Cosgarea I, Omlor AJ, Fries FN, de Faria COM, Lino HA, Oliveira ACC, Lisboa OC, Klode J, Schadendorf D, Bernardes-Souza B, Brinker TJ. A smoking prevention photoageing intervention for secondary schools in Brazil delivered by medical students: protocol for a randomised trial. BMJ Open 2017; 7:e018589. [PMID: 29229659 PMCID: PMC5778310 DOI: 10.1136/bmjopen-2017-018589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/31/2017] [Accepted: 09/22/2017] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous; the dramatic health consequences are too far in the future to fathom. We recently designed and tested an intervention that takes advantage of the broad availability of mobile phones as well as adolescents' interest in their appearance. A free photoageing mobile app (Smokerface) was implemented by medical students in secondary schools via a novel method called mirroring. The pupils' altered three-dimensional selfies on tablets were 'mirrored' via a projector in front of their whole grade. This is the first randomised trial to measure the effectiveness of the mirroring approach on smoking behaviour in secondary schools. METHODS AND ANALYSIS The mirroring intervention, which lasts 45 min, is implemented by Brazilian medical students in at least 35 secondary school classes with 21 participants each (at least 35 classes with 21 participants for control) in February 2018 in the city of Itauna, Brazil. External block randomisation via computer is performed on the class level with a 1:1 allocation. In addition to sociodemographic data, smoking behaviour is measured via a paper-pencil questionnaire before, 3 and 6 months postintervention plus a random carbon monoxide breathing test at baseline and end line. The primary outcome is cigarette smoking in the past week at 6 months follow-up. Smoking behaviour (smoking onset, quitting) and effects on the different genders are studied as secondary outcomes. Analysis is by intention to treat. ETHICS AND DISSEMINATION Ethical approval is obtained from the ethics committee of the University of Itauna in Brazil. Results will be disseminated at conferences, in peer-reviewed journals, throughout the Education Against Tobacco network social media channels and on our websites. TRIAL REGISTRATION NUMBER NCT03178227.
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Affiliation(s)
| | - Christian M Brieske
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Ioana Cosgarea
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Albert J Omlor
- Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Germany
| | - Fabian N Fries
- Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Germany
| | | | | | | | | | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | | | - Titus J Brinker
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
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Brinker TJ, Owczarek AD, Seeger W, Groneberg DA, Brieske CM, Jansen P, Klode J, Stoffels I, Schadendorf D, Izar B, Fries FN, Hofmann FJ. A Medical Student-Delivered Smoking Prevention Program, Education Against Tobacco, for Secondary Schools in Germany: Randomized Controlled Trial. J Med Internet Res 2017; 19:e199. [PMID: 28588007 PMCID: PMC5478798 DOI: 10.2196/jmir.7906] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 05/15/2017] [Accepted: 05/23/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More than 8.5 million Germans suffer from chronic diseases attributable to smoking. Education Against Tobacco (EAT) is a multinational network of medical students who volunteer for school-based prevention in the classroom setting, amongst other activities. EAT has been implemented in 28 medical schools in Germany and is present in 13 additional countries around the globe. A recent quasi-experimental study showed significant short-term smoking cessation effects on 11-to-15-year-old adolescents. OBJECTIVE The aim of this study was to provide the first randomized long-term evaluation of the optimized 2014 EAT curriculum involving a photoaging software for its effectiveness in reducing the smoking prevalence among 11-to-15-year-old pupils in German secondary schools. METHODS A randomized controlled trial was undertaken with 1504 adolescents from 9 German secondary schools, aged 11-15 years in grades 6-8, of which 718 (47.74%) were identifiable for the prospective sample at the 12-month follow-up. The experimental study design included measurements at baseline (t1), 6 months (t2), and 12 months postintervention (t3), via questionnaire. The study groups consisted of 40 randomized classes that received the standardized EAT intervention (two medical student-led interactive modules taking 120 minutes total) and 34 control classes within the same schools (no intervention). The primary endpoint was the difference in smoking prevalence from t1 to t3 in the control group versus the difference from t1 to t3 in the intervention group. The differences in smoking behavior (smoking onset, quitting) between the two groups, as well as gender-specific effects, were studied as secondary outcomes. RESULTS None of the effects were significant due to a high loss-to-follow-up effect (52.26%, 786/1504). From baseline to the two follow-up time points, the prevalence of smoking increased from 3.1% to 5.2% to 7.2% in the control group and from 3.0% to 5.4% to 5.8% in the intervention group (number needed to treat [NNT]=68). Notable differences were observed between the groups for the female gender (4.2% to 9.5% for control vs 4.0% to 5.2% for intervention; NNT=24 for females vs NNT=207 for males), low educational background (7.3% to 12% for control vs 6.1% to 8.7% for intervention; NNT=30), and migrational background (students who claimed that at least one parent was not born in Germany) at the 12-month follow-up. The intervention appears to prevent smoking onset (NNT=63) but does not appear to initiate quitting. CONCLUSIONS The intervention appears to prevent smoking, especially in females and students with a low educational background.
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Affiliation(s)
- Titus Josef Brinker
- Universities of Giessen and Marburg Lung Center; Member of the German Center for Lung Research (DZL), Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt am Main, Germany
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Andreas Dawid Owczarek
- Universities of Giessen and Marburg Lung Center; Member of the German Center for Lung Research (DZL), Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Werner Seeger
- Universities of Giessen and Marburg Lung Center; Member of the German Center for Lung Research (DZL), Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - David Alexander Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt am Main, Germany
| | - Christian Martin Brieske
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Philipp Jansen
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Joachim Klode
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Ingo Stoffels
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Dirk Schadendorf
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Benjamin Izar
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA, United States
| | - Fabian Norbert Fries
- Saarland University Medical Center and Saarland University Faculty of Medicine, Department of Ophthalmology, University of Homburg, Homburg, Germany
| | - Felix Johannes Hofmann
- Universities of Giessen and Marburg Lung Center; Member of the German Center for Lung Research (DZL), Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
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Brinker TJ, Holzapfel J, Baudson TG, Sies K, Jakob L, Baumert HM, Heckl M, Cirac A, Suhre JL, Mathes V, Fries FN, Spielmann H, Rigotti N, Seeger W, Herth F, Groneberg DA, Raupach T, Gall H, Bauer C, Marek P, Batra A, Harrison CH, Taha L, Owczarek A, Hofmann FJ, Thomas R, Mons U, Kreuter M. Photoaging smartphone app promoting poster campaign to reduce smoking prevalence in secondary schools: the Smokerface Randomized Trial: design and baseline characteristics. BMJ Open 2016; 6:e014288. [PMID: 27821601 PMCID: PMC5128772 DOI: 10.1136/bmjopen-2016-014288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Smoking is the largest cause of preventable death globally. Most smokers smoke their first cigarette in early adolescence. We took advantage of the widespread availability of mobile phones and adolescents' interest in appearance to develop a free photoaging app which is promoted via a poster campaign in secondary schools. This study aims to evaluate its effectiveness regarding smoking prevalence and students' attitudes towards smoking. METHODS AND ANALYSIS A randomised controlled trial is conducted with 9851 students of both genders with an average age of 12 years in grades 6 and 7 of 126 secondary schools in Germany. At present, cigarette smoking prevalence in our sample is 4.7%, with 4.6% of the students currently using e-cigarettes (1.6% use both). The prospective experimental study design includes measurements at baseline and at 6, 12 and 24 months postintervention via a questionnaire plus a random cotinine saliva sample at 24 months postintervention. The study groups consist of randomised schools receiving the Smokerface poster campaign and control schools with comparable baseline data (no intervention). The primary end point is the difference of change in smoking prevalence in the intervention group versus the difference in the control group at 24 months follow-up. Longitudinal changes in smoking-related attitudes, the number of new smokers and quitters and the change in the number of never-smokers will be compared between the two groups as secondary outcomes. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethics committee of the University of Gießen and the ministries of cultural affairs, both in Germany. Results will be disseminated at conferences, in peer-reviewed journals, on our websites and throughout the multinational Education Against Tobacco network. TRIAL REGISTRATION NUMBER NCT02544360, Pre-results.
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Affiliation(s)
- Titus J Brinker
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Julia Holzapfel
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | | | | | - Lena Jakob
- University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | - Ana Cirac
- Technical University of Munich, Munich, Germany
| | | | - Verena Mathes
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Fabian N Fries
- Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Hannah Spielmann
- Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Nancy Rigotti
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Werner Seeger
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Felix Herth
- Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
| | - Tobias Raupach
- Department of Cardiology and Pneumology, University Medical Centre, Göttingen, Germany
| | - Henning Gall
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Claudia Bauer
- Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Pat Marek
- Division of Public Health Sciences, Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - Chase H Harrison
- Department of Government, Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Lava Taha
- University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Owczarek
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Felix J Hofmann
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Roger Thomas
- University of Calgary, Health Sciences Centre, Calgary, Alberta, Canada
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Kreuter
- Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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