School-based programmes for preventing smoking

 

Abstract

Background

Smoking rates in adolescents are rising in some countries. Helping young people to avoid starting smoking is a widely endorsed goal of public health, but there is uncertainty about how to do this. Schools provide a route for communicating with a large proportion of young people, and school-based programmes for smoking prevention have been widely developed and evaluated.

Objectives

To review all randomized controlled trials of behavioural interventions in schools to prevent children (aged 5 to12) and adolescents (aged 13 to18) starting smoking.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Tobacco Addiction Group's Specialized Register, MEDLINE, EMBASE, PsyclNFO, ERIC, CINAHL, Health Star, Dissertation Abstracts and studies identified in the bibliographies of articles. Individual MEDLINE searches were made for 133 authors who had undertaken randomized controlled trials in this area.

Selection criteria

Types of studies: those in which individual students, classes, schools, or school districts were randomized to the intervention or control groups and followed for at least six months.
Types of participants: Children (aged 5 to12) or adolescents (aged 13 to18) in school settings.
Types of interventions: Classroom programmes or curricula, including those with associated family and community interventions, intended to deter use of tobacco. We included programmes or curricula that provided information, those that used social influences approaches, those that taught generic social competence, and those that included interventions beyond the school into the community. We included programmes with a drug or alcohol focus if outcomes for tobacco use were reported.
Types of outcome measures: Prevalence of non-smoking at follow up among those not smoking at baseline. We did not require biochemical validation of self-reported tobacco use for study inclusion.

Data collection and analysis

We assessed whether identified citations were randomized controlled trials. We assessed the quality of design and execution, and abstracted outcome data. Because of the marked heterogeneity of design and outcomes, we computed pooled estimates only for those trials that could be analyzed together and for which statistical data were available. We predominantly synthesized the data using narrative systematic review. We grouped studies by intervention method (information; social competence; social influences; combined social influences/social competence; multi-modal programmes). Within each group, we placed them into three categories (low, medium and high risk of bias) according to validity using quality criteria for reported study design.

Main results

Of the 94 randomized controlled trials identified, we classified 23 as category one (most valid). There was one category one study of information-giving and two of teaching social comeptence. There were thirteen category one studies of social influences interventions. Of these, nine found some positive effect of intervention on smoking prevalence, and four failed to detect an effect on smoking prevalence. The largest and most rigorous study, the Hutchinson Smoking Prevention Project, found no long-term effect of an intensive eight-year programme on smoking behaviour. There were three category one RCTs of combined social influences and social competence interventions: one provided significant results and one only for instruction by health educators compared to self-instruction.There was a lack of high quality evidence about the effectiveness of combinations of social influences and social competence approaches. There was one category one study providing data on social influences compared with information giving. There were four category one studies of multi-modal approaches but they provided limited evidence about the effectiveness of multi-modal approaches including community initiatives.

Authors' conclusions

There is one rigorous test of the effects of information-giving about smoking. There are well-conducted randomized controlled trials to test the effects of social influences interventions: in half of the group of best quality studies those in the intervention group smoke less than those in the control, but many studies failed to detect an effect of the intervention. There are only three high quality RCTs which test the effectiveness of combinations of social influences and social competence interventions, and four which test multi-modal interventions; half showed significant positive results.

 

Plain language summary

Are school-based programmes effective in the long term in preventing uptake of smoking

We identified 23 high quality randomized controlled trials of school-based programmes to prevent children who had never smoked becoming smokers. The interventions included information-giving, social influence approaches, social skills training, and community interventions. There is little evidence that information alone is effective. The majority of studies drew on a social influences intervention. Although half of the best quality studies in this group found short-term effects on children's smoking behaviour, the highest quality and longest trial (the Hutchinson Smoking Prevention Project) found no long-term effects from 65 lessons over eight years. There was limited evidence for the effects of interventions that included developing generic social competence, and for those with a multi-modal approach that included community initiatives.

 

摘要

背景

學校為基礎的預防吸菸計畫

在一些國家青少年吸菸的比率在升高中。幫助青少年不抽菸是公共衛生領域公認的目標，但是不確定該如何做。學校提供了一個與眾多青少年溝通的途徑，校園菸害防治計劃也廣泛地發展與被評估

目標

回顧對兒童(5 – 12歲)和青少年(13 – 18歲)執行行為介入的校園預防開始吸菸計劃的隨機控制試驗

搜尋策略

我們搜尋了考科藍臨床試驗中心的登記資料，以及考科藍香菸成癮團體特別登錄(Cochrane Tobacco Addiction Group's Specialized Register)，MEDLINE, CINAHL, Healthe Star, 碩博士論文摘要，與研究文獻的書目。由133位在此領域中進行臨床試驗研究的作者個別進行MEDLINE搜尋

選擇標準

研究類型:將個別學生、班級、學校或學校地區隨機分派到實驗組或控制組，且追蹤至少6個月。 參與者類型:學校中的兒童(5至12歲)或青少年(13至18歲)。 介入的類型:班級計畫或學校課程納入了家屬及社區處遇，以便中的使用香菸。計畫或課程內容包含提供資訊，像是社會影響取向，教導一般的社會能力，以及在校園的基礎下進入到社區。如果發現有吸菸的情形，介入計劃會增加焦點在藥物或酒精的部份。 測量結果的類型:測量在基礎值上不吸菸者，在追蹤期保持不吸菸的比例。在研究條款中，我們不使用生化評估確認自陳吸菸量

資料收集與分析

我們確認是否為可引用的臨床隨機控制試驗。評估其設計與實行的品質，抽出其結果資料。由於研究設計與結果的異質性太明顯，我們只比較這些試驗的聯合估計值，才能將這些資料一起分析，其統計結果才有用。我們優先以敘述性的系統回顧來整合這些資料。我們將介入的方法做分組(提供資訊；社會能力；合併社會影響和社會影響/社會能力；多模式計畫)。根據研究設計的頻值標準的有效性，每一組又分成三個類型(偏誤風險值低、中、高)

主要結論

有94個試驗納入本研究，我們區分出23個為第一組(最有效的)。第一組中有1個研究是提供資訊，有2個是教導社會能力，有13個是社會影響的介入方案。在這些研究裡面，有9個在菸害防治上有正向的效果，有4個效果是不顯著的。規模最大也最精確的研究，Hutchinson預防吸菸計劃(Hutchinson Smoking Prevention Project)，發現密集的8年計劃，對吸菸行為沒有長期的影響。第一組中有3個臨床試驗合併社會影響與社會能力:1個有顯著的效果，另一個是比較自我學習與健康教育者。有一個結合社會影響與社會能力取向的研究則缺乏高品質的證據。第一組還有1個研究比較社會影響與訊息提供，有4研究採用多模式取向，多模式的取向包含社區自主權，但在相關的成效方面證據有限

作者結論

對於吸菸者給予戒菸訊息的有效性是一個嚴格的考驗。良好的隨機控制試驗能檢驗社會影響介入方案的效果:有一半的高品質研究，其介入組的吸菸率低於控制組，但很多研究沒有發現顯著的效果。只有三個高品質的隨機控制試驗的研究檢驗結合社會影響與社會能力的方案，以及四個多模式的方案的有效性，有一半有顯著的效果

翻譯人

本摘要由彰化基督教醫院陳美貴翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

沒有什麼強有力的證據顯示，在校園預防吸菸計劃上有長遠的效果。我們找了23個高品質的隨機控制試驗研究了解校園菸害防治計劃，防止未吸菸者成為吸菸者的介入措施。介入措施包含了提供訊息、社會影響取向、社交技巧訓練與社區介入。單純的提供訊息，其效果有限。有比較多的研究著重在社區影響介入方面。雖然在這些品質良好的研究當中有一半在預防孩童的吸菸行為上有短期的效果，但在高品質與長期的研究上(Hutchinson Smoking Prevention Project)發現，在八年之中，65個課程的介入之下，沒有長期的效果。在包含一般的社會能力發展的方案，以及包含社區自主權的多模式取向介入方案上，其有效性是有限的