EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE

Prevention of smoking in adolescents with lower education: a school based intervention study

M R Crone¹, S A Reijneveld¹, M C Willemsen², F J M van Leerdam¹, R D Spruijt², R A Hira Sing³

¹ TNO Prevention and Health, Leiden, Netherlands
² Stivoro for a Smoke-Free Future, The Hague, Netherlands
³ Department of Social Medicine, Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, Netherlands

Correspondence to:
Correspondence to:
Dr M R Crone, TNO Prevention and Health, PO Box 2215, Leiden, Netherlands;
mrcrone{at}pg.tno.nl

Objective: To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students.

Design: Group randomised controlled trial.

Setting: 26 Dutch schools that provided junior secondary education.

Subjects: 1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years.

Intervention: Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition.

Main outcome measures: Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis.

Results: In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant.

Conclusions: In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect.

Keywords: adolescent; prevention; smoking; socioeconomic status

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

A BUMPER ISSUE, TOUCHING ON SARS, HEALTH IMPACT ASSESSMENT, AND MUCH ELSE

John R Ashton, Carlos Alvarez-Dardet
J Epidemiol Community Health 2003 57: 641. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Reijneveld, S. A. (2009). The practising public health researcher. Eur J Public Health 19: 130-130 [Full Text]  
• Ariza, C., Nebot, M., Tomas, Z., Gimenez, E., Valmayor, S., Tarilonte, V., De Vries, H. (2008). Longitudinal effects of the European smoking prevention framework approach (ESFA) project in Spanish adolescents. Eur J Public Health 18: 491-497 [Abstract] [Full Text]  
• Muller-Riemenschneider, F, Bockelbrink, A, Reinhold, T, Rasch, A, Greiner, W, Willich, S N (2008). Long-term effectiveness of behavioural interventions to prevent smoking among children and youth. Tobacco Control 17: 301-302 [Abstract] [Full Text]  
• Hanewinkel, R., Wiborg, G., Abdennbi, K., Ariza, C., Bollars, C., Bowker, S., Clemente, M P., Fehri, V. E., Florek, E., Hruba, D., Jensson, V., Lepp, K., Lotrean, L., Nebot, M., Neuberger, M., Ojala, K., Pilali, M., Prost-Heinisch, M.-P., Ramala, K., Spruijt, R., Stastny, P., Tamang, E., Touraine, S., Veryga, A., Vartiainen, E. (2007). European smokefree class competition: a measure to decrease smoking in youth. J. Epidemiol. Community Health 61: 750-750 [Full Text]  
• Etter, J.-F., Bouvier, P. (2006). Some doubts about one of the largest smoking prevention programmes in Europe, the smokefree class competition.. J. Epidemiol. Community Health 60: 757-759 [Abstract] [Full Text]  
• Stronks, K., Mackenbach, J. P. (2006). Evaluating the effect of policies and interventions to address inequalities in health: lessons from a Dutch programme. Eur J Public Health 16: 346-353 [Abstract] [Full Text]  
• Darling, H., Reeder, A. I., Williams, S., McGee, R. (2006). Is there a relation between school smoking policies and youth cigarette smoking knowledge and behaviors?. Health Educ Res 21: 108-115 [Abstract] [Full Text]