School based programmes for smoking prevention

The Cochrane Collaboration have published a review into school based smoking prevention programmes, which updates a review of the evidence base from 2002.

The headline finding is that programmes that combine life skills and a focus on social influence seem to be the most successful, with those trials that were examined showing significant effect at one year and at the longest follow-up point.

Interestingly the review finds that a trials looking at using a social influence model on its own haven’t shown a significant effect, nor have programmes that seek to combine with interventions outside the classroom, or ones that rely on information provision alone.

The authors were able to find 49 randomised controlled trials (RCT) (reporting on over 140,000 school children) of interventions aiming to prevent children who had never smoked from becoming smokers.  They excluded over two hundred studies – mostly because they were not RCTs (114), didn’t take place in school (14), reported results only less than six months from the intervention (27) or didn’t find a smoking outcome (34).

They describe finding 5 different ways that programme developers have used to try to sustain non-smoking behaviours:

  1. Information only – this includes normative education aimed at reducing the misconceptions that may be prevalent about the number of peers that smoke.  They find that these materials are often used in social resistance programmes.
  2. Social competence –  these are more broadly recognised as life skills programmes, building generic competencies in areas such as problem solving and decision-making and working on skills such as resisting peer or media influences.
  3. Social influence – again an approach focused on raising awareness of social influences (eg peer and media) that support substance misuse and building skills to reduce those influences and the situations where they may occur.
  4. Combination of social competence and social influence.
  5. Multi-modal programmes – a combination of curricula and wider interventions (within and beyond the school)

The studies that make up the review were also grouped in the following ways:

  • Pure Prevention – Cohorts in which never-smokers at baseline were followed and the number remaining never-smokers at the various follow-up intervals was ascertained.
  • Change in Smoking Behaviour over time: Studies where the smoking behaviour was measured as change over time.
  • Point Prevalence of Smoking: Studies reporting smoking prevalence at baseline and follow-ups. Individuals were not followed individually to the follow-up points, and thus the prevalence rates at baseline and follow-up are cross-sectional data.

As mentioned above the analysis shows that some interventions have been more effective in preventing smoking than others and as a result the reviewers make recommendations for practice which include:

  • Combined social competence and social influences interventions at all time points, and social competence interventions at longest follow-up prevented smoking uptake compared with controls.
  • Social influence interventions did not appear to reduce uptake compared with controls.
  • Interventions delivered by adult presenters are more effective in the longer term than peer-led programmes.
  • Adding booster sessions in subsequent years do not change outcomes.
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