Adult-child contract for universal prevention of tobacco use: Protocol for a mixed-design evaluation of the Swedish school-based program “Tobacco-free Duo” (TOPAS study) (Preprint) (original) (raw)
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Design of a school-based randomized trial to reduce smoking among 13 to 15-year olds, the X:IT study
BMC Public Health, 2014
Background: Adolescent smoking is still highly prevalent in Denmark. One in four 13-year olds indicates that they have tried to smoke, and one in four 15-year olds answer that they smoke regularly. Smoking is more prevalent in socioeconomically disadvantaged populations in Denmark as well as in most Western countries. Previous school-based programs to prevent smoking have shown contrasting results internationally. In Denmark, previous programs have shown limited or no effect. This indicates a need for developing a well-designed, comprehensive, and multi-component intervention aimed at Danish schools with careful implementation and thorough evaluation. This paper describes X:IT, a study including 1) the development of a 3-year school-based multi-component intervention and 2) the randomized trial investigating the effect of the intervention. The study aims at reducing the prevalence of smoking among 13 to 15-year olds by 25%. Methods/Design: The X:IT study is based on the Theory of Triadic Influences. The theory organizes factors influencing adolescent smoking into three streams: cultural environment, social situation, and personal factors. We added a fourth stream, the community aspects. The X:IT program comprises three main components: 1) smoke-free school premises, 2) parental involvement including smoke-free dialogues and smoke-free contracts between students and parents, and 3) a curricular component. The study encompasses process-and effect-evaluations as well as health economic analyses. Ninety-four schools in 17 municipalities were randomly allocated to the intervention (51 schools) or control (43 schools) group. At baseline in September 2010, 4,468 year 7 students were eligible of which 4,167 answered the baseline questionnaire (response rate = 93.3%). Discussion: The X:IT study is a large, randomized controlled trial evaluating the effect of an intervention, based on components proven to be efficient in other Nordic settings. The X:IT study directs students, their parents, and smoking prevention policies at the schools. These elements have proven to be effective tools in preventing smoking among adolescents. Program implementation is thoroughly evaluated to be able to add to the current knowledge of the importance of implementation. X:IT creates the basis for thorough effect and process evaluation, focusing on various social groups. Trial registration: Current Controlled Trials ISRCTN77415416.
BMC Public Health, 2014
Background: The likelihood of an adolescent taking up smoking may be influenced by his or her society, school and family. Thus, changes in the immediate environment may alter a young person's perception of smoking. Methods/Design: The proposed multi-center, cluster-randomized controlled trial will be stratified by the baseline prevalence of smoking in schools. Municipalities with fewer than 100,000 inhabitants will be randomly assigned to a control or intervention group. One secondary school will be randomly selected from each municipality. These schools will be randomized to two groups: the students of one will receive any existing educational course regarding smoking, while those of the other school will receive a four-year, class-based curriculum intervention (22 classroom lessons) aimed at reinforcing a smoke-free school policy and encouraging smoking cessation in parents, pupils, and teachers. The intervention will also include annual meetings with parents and efforts to empower adolescents to change the smoking-related attitudes and behaviors in their homes, classrooms and communities. We will enroll children aged 12-13 years as they enter secondary school during two consecutive school years (to obtain sufficient enrolled subjects). We will follow them for five years, until two years after they leave secondary school. All external evaluators and analysts will be blinded to school allocation. The aim of this study is to analyze the effectiveness of a complex intervention in reducing the prevalence of smoking in the third year of compulsory secondary education (ESO) and two years after secondary school, when the participants are 14-15 and 17-18 years old, respectively. Discussion: Most interventions aimed at preventing smoking among adolescents yield little to no positive long-term effects. This clinical trial will analyze the effectiveness of a complex intervention aimed at reducing the incidence and prevalence of smoking in this vulnerable age group. Trial registration: Current Controlled Trials: NCT01602796.
Preventive Medicine, 2020
Assessment of the effectiveness of school tobacco policies (STPs) in reducing adolescent smoking remains inconclusive. Previous studies took insufficient account of different dimensions of STPs, the different views of students and staff, and policy changes over time. This study assessed how a multidimensional STP, as perceived by students and staff, was associated with adolescent smoking over time in six European cities. The SILNE and SILNE-R surveys were conducted among students (n = 18,502) and staff (n = 438) in 38 schools in 2013 and 2016. Three dimensions (comprehensiveness, enforcement, and communication) were assessed and we calculated total STP scores. Multilevel logistic regressions estimated associations of STPs with adolescent smoking on and just outside school premises and with weekly smoking. Further analyses estimated associations between 2013 and 2016 STP changes and smoking outcomes in 2016, controlling for STP and smoking prevalence in 2013. On average, there were few increases in STP scores over time. Greater STP enforcement, as perceived by students, was associated with lower odds of weekly smoking (OR:0.93, 95%CI:0.89-0.97) and of smoking on school premises (OR:0.80, 95%CI:0.72-0.90). Higher total STP scores were associated with lower odds of smoking on school premises (OR:0.76, 95%CI:0.67-0.86), but not of smoking just outside premises or smoking weekly. Greater increases in STP scores over time were associated with lower odds of smoking on school premises in 2016 (OR:0.65, 95%CI:0.47-0.89). Well-enforced STPs may help reduce adolescent smoking at school. Schools should be supported in adopting comprehensive policies that also extend to the surroundings of their premises.
Journal of Public Health, 2010
Aim A randomised field trial was conducted to evaluate a school-based programme to prevent tobacco use in children and adolescents. Subject and methods The trial included 534 children and 308 adolescents who were randomly selected to receive or not to receive the prevention programme. The prevention programme included: (a) health facts and the effect of smoking, (b) analysis of the mechanisms underlying intiation of smoking and (c) refusal skills training to deal with the social pressures to smoke. A questionnaire was administered before the intervention programme and 2 years later. Results The prevalence rates of smoking in both groups of children and adolescents were increased at the end of the study. Anyway, the difference of smoking prevalence between the intervention and control groups was statistically significant only for the children’s group (from 18.3 to 18.8% for the intervention group and from 17.8 to 26.9% in the control group) (p = 0.035). As regards reasons that induced the start of smoking, there was a significant increase of the issue “because smokers are fools” (p = 0.004 for children; p because smokers are irresponsible” (p ≤ 0.001 for both children and adolescents) in the experimental groups. Conclusion The results suggest that a school-based intervention programme addressing tobacco use among children and adolescents, based on the development of cognitive and behavioural aspects, can be effective. After 1 year of intervention, smoking prevalence was significantly lower in children belonging to the intervention group than in children not randomised to intervention. Targeting young children before they begin to smoke can be a successful way of prevention.
The effects of a three-year smoking prevention programme in secondary schools in Helsinki
The European Journal of Public Health, 2007
Background: This study evaluates the effects of a 3-year smoking prevention programme in secondary schools in Helsinki. The study is part of the European Smoking prevention Framework Approach (ESFA), in which Denmark, Finland, the Netherlands, Portugal, Spain and the UK participated. Methods: A total of 27 secondary schools in Finland participated in the programme (n ¼ 1821). Schools were randomised into experimental (13) and control groups . The programme included 14 information lessons about smoking and refusal skills training. The 3-year smoking prevention programme was also integrated into the standard curriculum. The community-element of the programme included parents, parish confirmation camps and dentists. The schools in the experimental group received the prevention programme and the schools in the control group received the standard health education curriculum. Results: Among baseline never smokers (60.8%), the programme had a significant effect on the onset of weekly smoking in the experimental group [OR ¼ 0.63 (0.45-0.90) P ¼ 0.009] when compared with the control group. Being female, doing poorly at school, having parents and best friends who smoke and more pocket money to spend compared with others were associated with an increased likelihood of daily and weekly smoking onset. These predictors did not have an interaction effect with the experimental condition. Conclusion: This study shows that a school-and community-based smoking prevention programme can prevent smoking onset among adolescents.
2012
Preventing smoking initiation among adolescents of lower socioeconomic groups is crucial for the reduction of socioeconomic inequalities in health. The aim of the present study was to examine whether effective smoking prevention interventions in Europe are equally effective among adolescents of low-and high-socioeconomic status (SES). As part of the European Union-funded TEENAGE project, three school-based smoking prevention intervention studies in Europe were selected for secondary analyses: (i) a Dutch class competition intervention, (ii) the European Smoking Prevention Framework (ESFA) study and (iii) the A Stop Smoking in Schools Trial (ASSIST) intervention. All three studies differed in effectiveness by SES. The Dutch class competition study only had a significant effect among higher SES adolescents. The results for the ESFA study and ASSIST study were mixed and depended on which SES indicator was used. The conclusion of the study is that stratified analyses provide important insights in differential intervention effects for higher and lower socioeconomic groups. Although findings from the different studies were mixed, interventions that use a social network approach in which youngsters are allowed to deliver the intervention themselves may be a successful strategy in targeting adolescents from lower socioeconomic groups.
Effects of a School Tobacco Policy on Student Smoking and Snus Use
Health Behavior and Policy Review, 2020
Objective: A school tobacco policy (STP) commonly is used to reduce smoking among adolescents, but the effectiveness of such programs is unclear. We evaluated the impact of an STP on tobacco use in 4 schools. Methods: The study included 4 intervention and 4 control schools, located in the inner city of Stockholm, Sweden. Schools self-selected for assignment to either an intervention program or a comparison group. In total, the study was comprised of 2671 students in grades 9 and 11, ages 15 to 18, and 1998 students (75%) responded to the questionnaire. We used a repeated cross-sectional design with assessment of tobacco use prevalence before implementation of the STP in 2016 and after 2 years under the program, in 2018. Results: Two years after the STP, the intervention school in grade 9 showed a lower prevalence (13.5% vs 1.6%) in the proportion of students who reported smoking (χ 2 = 4.54; p < .05) whereas the proportion reporting snus use was practically unchanged. We found no statistically significant impact of the STP for grade 11. Conclusions: The results are promising with regard to smoking, when the STP is implemented in early adolescence.