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Jiang Q, Risica PM, Tovar A, Cooksey Stowers K, Schwartz MB, Lombardi C, Gans KM. Mediation of the association between social environmental characteristics of family childcare home and weight status in children by diet quality. BMC Public Health 2023; 23:2301. [PMID: 37990180 PMCID: PMC10664465 DOI: 10.1186/s12889-023-17179-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status. METHODS Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N = 370) in FCCHs (N = 120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status. RESULTS Children's total HEI scores significantly mediated the relationship between the EPAO subscale Food Provided and children's BMI z-scores (B=-0.01, p < .05, 95% CI = [-0.03, - 0.002]). Further, the EPAO subscale Food Provided was positively associated with the total HEI score (B = 0.75, p < .01, 95% CI = [0.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-0.01, p < .05, 95% CI = [-0.02, - 0.001]). CONCLUSION Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity.
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Affiliation(s)
- Qianxia Jiang
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA.
| | - Patricia Markham Risica
- Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI, USA
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA
| | - Alison Tovar
- Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI, USA
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA
| | | | - Marlene B Schwartz
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, USA
| | - Caitlin Lombardi
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Kim M Gans
- Department of Behavioral and Social Health Sciences, School of Public Health, Brown University, Providence, RI, USA
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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Jiang Q, Risica PM, Tovar A, Stowers KC, Schwartz MB, Lombardi C, Gans KM. Mediation of the Association between Social Environmental Characteristics of Family Childcare Home and Weight Status in Children by Diet Quality. RESEARCH SQUARE 2023:rs.3.rs-3147729. [PMID: 37645722 PMCID: PMC10462247 DOI: 10.21203/rs.3.rs-3147729/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background The food and beverages served in family childcare homes (FCCHs) may play an important role in the development of childhood overweight and obesity. This analysis examines whether children's diet quality mediates the relationship between foods and beverages served in FCCHs and preschool-aged children's weight status. Methods Trained and certified staff conducted observations for two days in each FCCH, using the Environment and Policy Assessment and Observation (EPAO) measure to determine the foods and beverages served to children (N=370) in FCCHs (N=120). They also used the Dietary Observation in Child Care (DOCC) protocol to assess children's food and beverage intake during childcare, from which we calculated the Healthy Eating Index-2015 (HEI), a measure of diet quality. Height and weight were measured for each child with parent consent from which the child's body mass index (BMI) z-scores were calculated from. A multilevel mediation analysis was conducted to indicate whether children's diet quality mediates the relations between food and beverage served in FCCHs and preschool-aged children's weight status. Results Children's total HEI scores significantly mediated the relationship between the EPAO subscale "Food provided" and children's BMI z-scores (B=-.01, p<.05, 95% CI = [-.03, -.002]). Further, the EPAO subscale "Food provided" was positively associated with the total HEI score (B=.75, p<.01, 95% CI = [.32, 1.18]). Total HEI scores were negatively associated with BMI z-score (B=-.01, p<.05, 95% CI = [-.02, -.001]). Conclusion Children's diet quality did significantly mediate the relationship between the food served in FCCHs and children's weight status. More longitudinal studies with longer follow-up periods need to be conducted to confirm these relationships. Further, future studies need to examine the relationships between a broader spectrum of FCCH environmental characteristics and home environment with children's weight status, as well as other mediators including physical activity.
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Ba-Break M, Bewick B, Huss R, Ensor T, Abahussin A, Alhakimi H, Elsey H. Systematic review of intervention functions, theoretical constructs and cultural adaptations of school-based smoking prevention interventions in low-income and middle-income countries. BMJ Open 2023; 13:e066613. [PMID: 36787979 PMCID: PMC9930567 DOI: 10.1136/bmjopen-2022-066613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To identify the approaches and strategies used for ensuring cultural appropriateness, intervention functions and theoretical constructs of the effective and ineffective school-based smoking prevention interventions that were implemented in low-income and middle-income countries (LMICs). DATA SOURCES Included MEDLINE, EMBASE, Global Health, PsycINFO, Web of Science and grey literature which were searched through August 2022 with no date limitations. ELIGIBILITY CRITERIA We included randomised controlled trials (RCTs) with ≥6 months follow-up assessing the effect of school-based interventions on keeping pupils never-smokers in LMICs; published in English or Arabic. DATA EXTRACTION AND SYNTHESIS Intervention data were coded according to the Theoretical Domains Framework, intervention functions of Behaviour Change Wheel and cultural appropriateness features. Using narrative synthesis we identified which cultural-adaptation features, theoretical constructs and intervention functions were associated with effectiveness. Findings were mapped against the capability-motivation and opportunity model to formulate the conclusion. Risk of bias was assessed using the Cochrane risk of bias tool. RESULTS We identified 11 RCTs (n=7712 never-smokers aged 11-15); of which five arms were effective and eight (four of the effective) arms had a low risk of bias in all criteria. Methodological heterogeneity in defining, measuring, assessing and presenting outcomes prohibited quantitative data synthesis. We identified nine components that characterised interventions that were effective in preventing pupils from smoking uptake. These include deep cultural adaptation; raising awareness of various smoking consequences; improving refusal skills of smoking offers and using never-smokers as role models and peer educators. CONCLUSION Interventions that had used deep cultural adaptation which incorporated cultural, environmental, psychological and social factors, were more likely to be effective. Effective interventions considered improving pupils' psychological capability to remain never-smokers and reducing their social and physical opportunities and reflective and automatic motivations to smoke. Future trials should use standardised measurements of smoking to allow meta-analysis in future reviews.
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Affiliation(s)
- Maryam Ba-Break
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bridgette Bewick
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tim Ensor
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Asma Abahussin
- Department of Biomedical Technology, King Saud University, Riyadh, Saudi Arabia
| | - Hamdi Alhakimi
- Head of MedGebra Centre for Research Consultations, Epidemiologist and Community Medicine Specialist, MedGebra Centre for Research Consultations, Utrecht, The Netherlands
| | - Helen Elsey
- Health Sciences, University of York, York, UK
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Maceinaitė R, Šurkienė G, Žandaras Ž, Stukas R. The association between studying in health promoting schools and adolescent smoking and alcohol consumption in Lithuania. Health Promot Int 2021; 36:1644-1655. [PMID: 33608698 DOI: 10.1093/heapro/daab014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The concept of the Health Promoting School (HPS) encourages a holistic approach to promoting health in schools, instead of a more traditional education on health. The aim of this paper was to determine the association between studying in a HPS and smoking and alcohol consumption among adolescents. A cross-sectional study of 3574 adolescents from 44 HPS and 66 non-HPSs was conducted. The association between studying in a HPS and smoking and alcohol consumption among adolescents was analysed using logistic regression models. Pearson's χ2 test was used to determine the differences between HPS and non-HPS students' sociodemographic characteristics, and the difference in distribution of students who smoked and consumed alcohol at various rates across different groups. Studying in a HPS setting was not significantly associated with adolescent smoking or attempts to smoke. Compared to HPS students, non-HPS students had a significantly higher chance of attempting to consume alcohol and consumed alcohol once a month or more frequently. In comparing the distribution of HPS and non-HPS students according to the frequency of smoking and alcohol consumption across various groups of respondents, it was determined that some factors were associated with frequency of smoking and alcohol consumption among adolescents. The results of the study showed that studying in a HPS was associated with a reduction in both smoking and alcohol consumption, and therefore it is advisable to further develop the HPS network. However, both the individual and educational characteristics of adolescents must be taken into account when planning prevention measures.
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Affiliation(s)
- Rūta Maceinaitė
- Departament of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, Vilnius 03101, Lithuania
| | - Genė Šurkienė
- Departament of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, Vilnius 03101, Lithuania
| | - Žymantas Žandaras
- Departament of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, Vilnius 03101, Lithuania
| | - Rimantas Stukas
- Departament of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, Vilnius 03101, Lithuania
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School-based interventions to promote adolescent health: A systematic review in low- and middle-income countries of WHO Western Pacific Region. PLoS One 2020; 15:e0230046. [PMID: 32134985 PMCID: PMC7058297 DOI: 10.1371/journal.pone.0230046] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 02/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background In the World Health Organization Western Pacific Region (WHO WPRO), most adolescents enroll in secondary school. Safe, healthy and nurturing school environments are critical for adolescent health and development. Yet, there were no systematic reviews found on the efficacy of school-based interventions among adolescents living in low and middle income countries (LMIC) in the Region. There is an urgent need to identify effective school-based interventions and facilitating factors for successful implementation in adolescent health in WPRO. Methods For this systematic review, we used five electronic databases to search for school-based interventions to promote adolescent health published from January 1995 to March 2019. We searched RCT and non-RCT studies among adolescents between 10 to 19 years old, done in LMIC of WHO WPRO, and targeted health and behaviour, school environment and academic outcomes. Quality of studies, risk of bias and treatment effects were analyzed. Effective interventions and implementation approaches were summarized for consideration in scale-up. Results Despite a broad key term search strategy, we identified only eight publications (with 18,774 participants). Most of the studies used knowledge, attitudes and behaviours as outcome measures. A few also included changes in the school policy and physical environment as outcome measures while only one used BMI, waist circumference and quality of life as their outcome measures. The topics in these studies included: AIDS, sexual and reproductive health, de-worming, nutrition, obesity, tobacco use, and suicide. Some interventions were reported to be successful in improving knowledge, attitudes and behaviours, but their impact and scale were limited. The interventions used by the different studies varied from those that addressed a single action area (e.g. developing personal skills) or a combination of action areas in health promotion, e.g. developing a health policy, creating a supportive environment and developing personal skills. No intervention study was found on other important issues such as screening, counseling and developing safe and nurturing school environments. Conclusions Only eight school-based health interventions were conducted in the Region. This study found that school-based interventions were effective in changing knowledge, attitudes, behaviors, healthy policies and environment. Moreover, it was clarified that policy support, involving multiple stakeholders, incorporating existing curriculum, student participation as crucial factors for successful implementation.
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Al-Sheyab NA, Khader YS, Shah S, Roydhouse JK, Gallagher R. The Effect of a "Class Smoke Free Pledge" on Breath Carbon Monoxide in Arabic Male Adolescents. Nicotine Tob Res 2019; 20:568-574. [PMID: 28340136 DOI: 10.1093/ntr/ntx050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/01/2017] [Indexed: 11/14/2022]
Abstract
Introduction Arabic male adolescents have a high smoking prevalence. Introduction of "Class smoke-free" pledges have been successful amongst European adolescents but have not been evaluated using objective valid measures. We tested the impact of adding a smoke free pledge strategy to a proven peer-led asthma and smoking prevention program on breath carbon monoxide level (BCO) in male high-school students in Jordan. Methods We enrolled male students from four high-schools in Irbid, Jordan. Schools were randomly assigned to receive either TAJ (Triple A in Jordan, n = 218) or TAJ-Plus (with added class smoke-free pledge, n = 215). We hypothesized that students receiving TAJ-Plus would have greater reduction in BCO levels than those only receiving the TAJ intervention. Asthma and smoking status were assessed by self-administered questionnaires. Smoking outcomes were collected using a BCO Monitor. Results Both groups had significant reductions in BCO levels post-intervention (p < .0001), however, decreases were greater in TAJ-Plus group (3.9 ± 0.2 vs. 4.8 ± 0.2, p < .0001). Intervention effects on BCO over time did not vary by smoking status (p = .085), asthma status (p = .602), or a combination of the two (p = .702). Conclusions An added smoke-free pledge strategy to a proven peer-led asthma education program appears to be a promising approach to motivate adolescents to abstain from smoking in Jordan. Future research is required to determine if these results can be extended to Jordanian adolescent females. Implications A commitment by students via a "class smoke-free" pledge can be an added incentive to motivate adolescents in Arabic-speaking countries to abstain from smoking. Social influence approaches in schools can be useful in countering the aggressive tobacco marketing campaigns targeting Jordanian and other Arabic-speaking youth. The combination of "class smoke-free" pledges and an evidence-based peer-led asthma and smoking education can be implemented in schools to influence adolescents with asthma to abstain from smoking.
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Affiliation(s)
- Nihaya A Al-Sheyab
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan.,Charles Perkins Centre/Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Yousef S Khader
- Department of Community Medicine, Public Health, and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Smita Shah
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jessica K Roydhouse
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI
| | - Robyn Gallagher
- Charles Perkins Centre/Sydney Nursing School, University of Sydney, Sydney, Australia
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Nurumal MS, Zain SHM, Mohamed MHN, Shorey S. Effectiveness of School-Based Smoking Prevention Education Program (SPEP) Among Nonsmoking Adolescents: A Quasi-Experimental Study. J Sch Nurs 2019; 37:333-342. [DOI: 10.1177/1059840519871641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Preventing smoking among adolescents is critical. This study evaluated the effectiveness of the Smoking Prevention Education Program among nonsmoking adolescents. A quasi-experimental study design was used. Data were collected from Year 5 students ( n = 140) from four government primary schools in the Kuantan and Pahang districts of Malaysia. The participating schools were randomly assigned into the intervention and control groups. Questionnaires and exhaled carbon monoxide (CO) levels were used to collect data at the baseline and at 3 months postintervention. At 3 months postintervention, the percentage of nonsmokers remained 100% in the intervention group, while 2.9% of the participants in the control group reported to have smoked in past 7 days. Comparatively, the mean scores of attitudes, subjective norms, and nonsmoking intentions of the intervention group improved significantly. The intervention was effective in preventing smoking initiations among Malaysian adolescents; however, further evaluation of this intervention is needed among varied populations.
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Affiliation(s)
- Mohd Said Nurumal
- Kulliyyah of Nursing, International Islamic University Malaysia, Kuantan, Malaysia
| | - Siti Hajar Mohd Zain
- Kulliyyah of Nursing, International Islamic University Malaysia, Kuantan, Malaysia
| | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Zhao X, White KM, Young RM, Obst PL. Smoking Beliefs Among Chinese Secondary School Students: A Theory-Based Qualitative Study. Nicotine Tob Res 2019; 20:321-331. [PMID: 28187221 DOI: 10.1093/ntr/ntx012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/12/2017] [Indexed: 11/12/2022]
Abstract
Introduction China has the world's greatest number of smokers but theory-based smoking interventions are rare. To develop an effective intervention, understanding the determinants of Chinese adolescent smoking is crucial. The Theory of Planned Behavior (TPB) is empirically supported to predict and assist in informing intervention strategies to change health-related behaviors. Based on the TPB, the elicitation of shared smoking beliefs among adolescents can inform future intervention designs among this at-risk population. Methods We investigated the beliefs from six focus groups (N = 30) of one senior secondary school in Kunming, Yunnan Province, China. We used semi-structured questions based on the TPB framework, including prompts about behavioral (advantages and disadvantages), normative (important referents), and control (barriers and facilitators) beliefs. Following the Consensual Qualitative Research (CQR) methodology, data were discussed until consensus was reached. Auditing was undertaken by an external researcher. Results Seven domains (advantages, disadvantages, approvers, disapprovers, facilitators, barriers, and smoker images) were examined. Smoking as a gendered behavior, smoking as influenced by cultural and environmental contexts, smoking as a strategy to cope with stress, and awareness of the harm of smoking, are highlighted themes across domains. Data suggested an extended-TPB framework as an appropriate approach to adopt when addressing smoking beliefs among the target population. Conclusions These beliefs can be utilized to inform future school-based interventions and public health campaigns targeting smoking among Chinese adolescents. Implications A modified TPB approach has potential for future smoking interventions among Chinese adolescents. Beliefs elicited in this study form a strong basis for designing a location- and population-specific antismoking programme.
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Affiliation(s)
- Xiang Zhao
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Ross McD Young
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Patricia L Obst
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
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Future Smoking Intentions at Critical Ages among Students in Two Chinese High Schools. Int J Behav Med 2019; 26:91-97. [DOI: 10.1007/s12529-018-09759-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
OBJECTIVES China is the world's largest tobacco consumer and its adolescent smoking rate is increasing. Smoking interventions among high school students are limited. The aim of this study was to deliver and evaluate a brief theory-based smoking intervention in China, with a focus on anti-smoking cognitions. METHODS The intervention was based on the constructs of an extended theory of planned behavior and life skills training. Using class-level randomization sampling, 106 tenth graders from two high schools in Kunming, China received a four-session intervention; 101 students were assigned as control group members. Surveys were conducted at three time-points (1 week before the intervention, 1 week post-intervention, and 6 months post-intervention). MANOVA and latent class analysis were used to test the intervention's effectiveness and personal change trajectories over time. RESULTS The intervention failed to change smoking behavior, intention or willingness, but improved anti-smoking attitudes and perceived control over smoking. Skills showed a general enhancement, consistent with participants' qualitative feedback. Trajectories of smoking behavior, intention, and willingness all assumed two distinct but constant latent classes independent of the intervention. CONCLUSIONS This study suggests that addressing attitudinal and control beliefs among adolescents and building on assertiveness via additional strategies in life skills such as appropriate refusal skills may be beneficial. The absence of a successful change in subjective norm should be a focus for future anti-smoking programs in China.
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Affiliation(s)
- Xiang Zhao
- a School of Psychology and Counselling, Institute of Health and Biomedical Innovation , Queensland University of Technology , Brisbane , Australia
| | - Katherine M White
- a School of Psychology and Counselling, Institute of Health and Biomedical Innovation , Queensland University of Technology , Brisbane , Australia
| | - Ross McD Young
- b Faculty of Health, Institute of Health and Biomedical Innovation , Queensland University of Technology , Brisbane , Australia
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Challenges for school-based, anti-smoking education in China. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 3:6-7. [PMID: 30449677 DOI: 10.1016/s2352-4642(18)30338-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/24/2022]
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Andersen A, Bast LS, Due P, Thygesen LC. Evaluation of the smoking intervention X:IT after the second year: A randomized controlled trial. Scand J Public Health 2018; 47:885-889. [PMID: 30222087 DOI: 10.1177/1403494818799837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims:Review studies on the long-term effects of school-based smoking interventions show mixed results. X:IT was a three-year cluster randomized controlled trial to prevent uptake of smoking among Danish students from age 13 years until age 15 years which previously proved effective in preventing smoking after the first year of intervention. The aim of this paper was to conduct the pre-planned analyses of the effects of the X:IT intervention on smoking after the second year. Methods: We used self-reported questionnaire data from students at baseline, first, second, and third follow-up (n at second follow-up=3269, response rate=79.4%). Data from third follow-up were not suitable for analysis. Outcome measure: 'current smoking', dichotomised into smoke daily, weekly, monthly or more seldom versus do not smoke. We performed multilevel, logistic regression analyses of available cases and intention-to-treat (ITT) analyses, replacing missing outcome values by multiple imputation. Results: The prevalence of smoking increased from 5.8% at baseline to 17.0% at second follow-up among students at intervention schools, and from 7.6% to 18.7% among students at control schools. Analyses of available cases and ITT analyses did not support X:IT being effective in preventing smoking after the second year of intervention. Conclusions: Although X:IT was effective after the first year of intervention, we were not able to demonstrate any effects after the second year. Implementation of the intervention was lower in the second year compared to the first year which indicates that the missing effect of the intervention at second follow-up is due to lack of implementation.
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Affiliation(s)
- Anette Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lotus S Bast
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Zhao X, Young RMCD, White KM. 'I'm not a smoker…yet': a qualitative study on perceptions of tobacco control in Chinese high schools. BMJ Open 2018; 8:e019483. [PMID: 29678968 PMCID: PMC5914720 DOI: 10.1136/bmjopen-2017-019483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Chinese adolescents' perceptions about tobacco control at schools are rarely researched. We explored how current antismoking strategies work in middle school environments, as well as the attitudes towards these strategies held by students and teaching staff members. METHODS Four focus groups (24 eleventh graders; Mage=16 years) and five indepth interviews (teaching staff members with tobacco control experience in schools) were conducted in Kunming, Yunnan Province, China. We used thematic analysis combining inductive and deductive processes, along with field observations and research group discussions, for data analysis. RESULTS With educational approaches and practical strategies, antismoking education reported in the middle schools had limited effectiveness. Although smoking is banned in schools, students can circumvent schools' controls easily. Notably salient is the pessimistic attitude towards school-based antismoking strategies at school. Detrimental influences within (teachers' smoking) and beyond schools (high societal smoking prevalence) largely challenged the efforts to manage students' smoking. CONCLUSIONS Current antismoking approaches in schools fail to curb smoking among Chinese high school students. Their effectiveness is undermined by both within-campus and off-campus influences. Students' perceptions of smoking should be valued as their knowledge of smoking is actively constructed. Future antismoking education at school should incorporate interactive sessions rather than merely didactic approaches about the harms of smoking. Although stricter rules for teachers' smoking are needed, complementary strategies such as population-level interventions and policy measures in wider society will assist in efforts within schools.
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Affiliation(s)
- Xiang Zhao
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ross M cD Young
- Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katherine M White
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Chai W, Zou G, Shi J, Chen W, Gong X, Wei X, Ling L. Evaluation of the effectiveness of a WHO-5A model based comprehensive tobacco control program among migrant workers in Guangdong, China: a pilot study. BMC Public Health 2018; 18:296. [PMID: 29486753 PMCID: PMC6389256 DOI: 10.1186/s12889-018-5182-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a vulnerable population in China, migrant workers have a higher smoking rate than the general population. This study aims to assess the effectiveness of a WHO-5A based comprehensive tobacco control program in workplaces aggregated with migrants. METHODS Using a controlled before and after design, four purposely selected manufacturing factories were assigned to either intervention or control groups. Participants in the intervention arm received adapted 5A group counseling regularly supported by social-media and traditional health education approaches. The primary outcome was the change of smoking rate based on salivary cotinine concentration at three-month follow-up as compared to the control arm. Secondary outcomes were changes in smoking-related knowledge and attitudes assessed using questionnaires. Difference-in-differences approach (DID) and generalized estimating equations (GEE) models were used to conduct the effectiveness analysis. RESULTS 149 and 166 workers were enrolled in the intervention and control arm respectively. The multiple imputed and adjusted GEE models demonstrated that, compared to those in the control arm, participants in the intervention arm had nearly 2.4 times odds of improving smoking-related knowledge (OR = 2.40, 95% CI = 1.32-4.36, P = 0.02) and three times the odds of improving smoking-related attitude (OR = 3.07, 95% CI = 1.28-7.41, P = 0.03). However, no significant difference was found regarding the change of smoking rate between the two arms (P > 0.05). The regression analysis showed that attendance at the 5A group counseling sections was an important determinant of stopping smoking or improving smoking-related knowledge and attitudes in the intervention group. CONCLUSIONS This WHO-5A comprehensive intervention was effective in improving migrant workers' knowledge of smoking and anti-smoking attitudes. A large-scale, long-term trial is recommended to determine the effectiveness of this intervention. TRIAL REGISTRATION ChiCTR-OPC-17011637 at Chinese Clinical Trial Registry. Retrospectively registered on 12th June 2017.
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Affiliation(s)
- Wenxin Chai
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Guanyang Zou
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China.,Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Jingrong Shi
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiao Gong
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaolin Wei
- Division of Clinical Public Health and Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China. .,Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, People's Republic of China.
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15
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Adding Health Literacy to the Health Belief Model: Effectiveness of an Educational Intervention on Smoking Preventive Behaviors Among University Students. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018. [DOI: 10.5812/ircmj.13773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis. Prev Med 2017; 100:248-268. [PMID: 28390835 DOI: 10.1016/j.ypmed.2017.04.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/02/2017] [Accepted: 04/02/2017] [Indexed: 01/03/2023]
Abstract
Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both individual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10; OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau2=0.0, I2=0%), but not tobacco or alcohol use. A similar result was found when studies assessed as high risk of bias were excluded. Overall intervention effects were evident for illicit substance use within multiple intervention characteristic subgroups, but not tobacco and alcohol. Such results support the implementation of universal school-based interventions that address 'resilience' protective factors to reduce adolescent illicit substance use, however suggest alternate approaches are required for tobacco and alcohol use. PROSPERO registration: CRD42014004906.
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Chen ML, Chou LN, Zheng YC. Providing a Clean Environment for Adolescents: Evaluation of the Tobacco Hazards Prevention Act in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E634. [PMID: 28608829 PMCID: PMC5486320 DOI: 10.3390/ijerph14060634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 05/31/2017] [Accepted: 06/10/2017] [Indexed: 11/20/2022]
Abstract
Cigarette smoking not only damages the health of adolescents, but also contributes to air pollution. The Tobacco Hazards Prevention Act in Taiwan stipulates that cigarettes should not be sold to persons younger than 18 years. Therefore, schools should actively educate students and raise awareness of the Tobacco Hazards Prevention Act to reduce the level of damage to the health of adolescents and maintain good air quality. This study had two main goals: (1) to evaluate the stipulation that no person shall provide tobacco products to persons under the age of 18 and the effects of counseling strategies on store managers confirming customer ages before tobacco sale in southern Taiwan; and (2) to evaluate the situation of tobacco hazard prevention education conducted by school in southern Taiwan. A cross-sectional design was adopted for this study. Study I: The investigation involved an analysis of 234 retailers including convenience stores (n = 70), grocery stores (n = 83), and betel nut stalls (n = 81). The results indicated that among the 234 retailers, 171 (73.1%) of them routinely failed to confirm the buyers' ages before allowing them to purchase tobacco. The number of retailers who exhibited failure to confirm customer ages before selling tobacco products had decreased from 171 (73.1%) to 59 (25.2%) and that of those who confirmed customer ages before selling tobacco products had increased from 63 (26.9%) to 175 (74.8%) after counseling strategies had been provided, thereby revealing statistical significance (χ² = 11.26, p < 0.001). Study II: A total of 476 (89.1%) participants had received tobacco hazards prevention education and 58 (10.9%) had not. Among the various residential areas, the highest percentage of participants that did not received tobacco hazards prevention education located in the plane regions (8.4%). The government organizations should continue to adopt counseling strategies to reduce the rate of disobedience of the Tobacco Hazards Prevention Act by selling tobacco products to minors. Schools should pay close attention to tobacco hazard prevention education for junior high school students to ensure that such students are adequately educated about tobacco hazard prevention.
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Affiliation(s)
- Min-Li Chen
- Department of Respiratory Care and Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Puzi City 61363, Chiayi, Taiwan.
| | - Li-Na Chou
- Nursing Department, National Tainan Junior College of Nursing, Tainan 700, Taiwan.
| | - Ya-Cheng Zheng
- Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chiayi Campus and Chiayi Chang Gung Memorial Hospital, Puzi City 61363, Chiayi, Taiwan.
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18
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Mohd Zin F, Hillaluddin AH, Mustaffa J. Tobacco Use Prevention for the Young (TUPY-S): Development,
Validity and Reliability of an Interactive Multimedia Strategy
from the Adolescents’ Perspective in Malaysia. Asian Pac J Cancer Prev 2017; 18:1435-1443. [PMID: 28612599 PMCID: PMC5555559 DOI: 10.22034/apjcp.2017.18.5.1435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: This study aims to develop, validate and determine the reliability of an interactive multimedia strategy to prevent tobacco use among the young (TUPY-S) from an adolescents’ perspective. Methods: A descriptive study design was utilized. A modular instruction guideline by Russel (1974) was followed in the entire process, comprising a feasibility study, a review of existing modules, specification of the objectives, identification of the construct criterion items, learner analysis and entry behavior specification, establishment of the sequence instruction and media selection, a tryout with students and a field test. Result: Feasibility was agreed among the researchers and the school authorities. Culturally suitable rigorously developed tobacco use preventive strategies delivered using information technology (IT) are lacking in the literature. The objective of TUPY-S is to prevent tobacco use among adolescents living in Malaysia. Identified construct criterion items include knowledge, attitude, intention to use, self-efficacy, and refusal skill. The target population was early adolescents belonging to generation-Z. Content was developed from the adolescents’ perspective and delivered using IT in Malay language. Content validity, assessed by six experts in the field and module development, was good at 86%. The students’ tryout showed satisfactory face validity subjectively and objectively (85.5%) and high alpha Cronbach reliability (0.91). Conclusion: TUPY-S was confirmed to suit early adolescents of the current generation living in Malaysia. It demonstrated good content validity among the experts, satisfactory face validity and reliability among the target population. TUPY-S is ready to be evaluated for its effectiveness among early adolescents.
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Affiliation(s)
- Faridah Mohd Zin
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
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Karatay G, Gürarslan Baş N. Effects of Role-Playing Scenarios on the Self-efficacy of Students in Resisting Against Substance Addiction: A Pilot Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2017; 54:46958017720624. [PMID: 28741398 PMCID: PMC5798739 DOI: 10.1177/0046958017720624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
During the first phases of adolescent development, young people have little self-efficacy and resistance against substance use. The aim of this study was to demonstrate the effectiveness of role-playing scenarios on the self-efficacy of students in resisting substance use. A pre test and post test study design was used with a single group. The study was carried out with 245 secondary school students. The scenario-based training, developed by the researchers, was presented by the school counselors once a week for 4 weeks. For this purpose, a booklet of scenarios was prepared for the teachers. The role-playing scenarios were intended to improve adolescents’ abilities to say “no” to substance offers, to prevent them from becoming addicted to certain substances, and to call for help if needed. The data of the study were collected using the Personal Information Form and the Self-Efficacy for Adolescences Protecting Substance Abuse Scale . The obtained data were assessed using percentages, chi-square, t test, and F test in the SPSS software. Results showed that, after the training, the mean score in the Self-Efficacy for Adolescences Protecting Substance Abuse Scale increased significantly (103.20 ± 20.00) compared with before the training (92.11 ± 17.08) (P < .05). Short-term outcomes of the class-based scenario training were observed to be effective in the development of students’ self-efficacy to resist the temptations of substance use.
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Mohd Zin F, Hillaluddin AH, Mustaffa J. Adolescents’ Perceptions Regarding Effective Tobacco Use Prevention Strategies for their Younger Counterparts: A Qualitative Study in Malaysia. Asian Pac J Cancer Prev 2016; 17:5113-5119. [PMID: 28122443 PMCID: PMC5454645 DOI: 10.22034/apjcp.2016.17.12.5113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose:The present qualitative study explored adolescents’ perceptions regarding effective strategies to prevent adolescents from using tobacco products (TP). Apart from the commercial TPs, there has been emerging use of alternatives such as vapes, e-cigarettes and shisha. This unfortunate phenomenon continues despite the currently available preventive strategies. Thus, understanding of the perceptions of the current generation would be valuable to provide new insights. Methods: Purposive sampling was utilized to recruit 40 adolescents between the age of 15 and 16 years old attending public daily secondary schools. Eight focus group discussions were conducted among the TP users, ex-users and non-users. Data were analyzed using a thematic content analysis procedure with NVivo. Results: Among barriers with the currently available strategies were having teachers who smoke tobacco, addiction to nicotine and self-perceptions of being healthy. The content of any program should include knowledge on negative outcomes of using tobacco products and awareness of the legislation together with ways to overcome peer and family influence including improving self-efficacy and refusal skills. Strategies were suggested to be delivered using information technology which provides interactive learning and visual effects. Conclusions: Adolescents agreed that the content and delivery of tobacco use prevention strategies need to be revised to suit the current generation to ensure sustainability.
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Affiliation(s)
- Faridah Mohd Zin
- Medical Lecturer, Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia.
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21
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Langford R, Bonell C, Komro K, Murphy S, Magnus D, Waters E, Gibbs L, Campbell R. The Health Promoting Schools Framework: Known Unknowns and an Agenda for Future Research. HEALTH EDUCATION & BEHAVIOR 2016; 44:463-475. [DOI: 10.1177/1090198116673800] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The World Health Organization’s Health Promoting Schools (HPS) framework is a whole-school approach to promoting health that recognizes the intrinsic relationship between health and education. Our recent Cochrane systematic review found HPS interventions produced improvements in a number of student health outcomes. Here we reflect on what this review was not able to tell us: in other words, what evidence is missing with regard to the HPS approach. Few HPS interventions engage with schools’ “core business” by examining impacts on educational outcomes. Current evidence is dominated by obesity interventions, with most studies conducted with children rather than adolescents. Evidence is lacking for outcomes such as mental or sexual health, substance use, and violence. Activities to engage families and communities are currently weak and unlikely to prompt behavioral change. The HPS approach is largely absent in low-income settings, despite its potential in meeting children’s basic health needs. Intervention theories are insufficiently complex, often ignoring upstream determinants of health. Few studies provide evidence on intervention sustainability or cost-effectiveness, nor in-depth contextual or process data. We set out an agenda for future school health promotion research, considering implications for key stakeholders, namely, national governments, research funders, academics, and schools.
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Affiliation(s)
| | | | | | | | | | - Elizabeth Waters
- University of Melbourne, Carlton, Melbourne, Victoria, Australia
| | - Lisa Gibbs
- University of Melbourne, Carlton, Melbourne, Victoria, Australia
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22
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Xu Y, Chen X. Protection motivation theory and cigarette smoking among vocational high school students in China: a cusp catastrophe modeling analysis. Glob Health Res Policy 2016; 1:3. [PMID: 29202053 PMCID: PMC5675066 DOI: 10.1186/s41256-016-0004-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/21/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tobacco use is one of the greatest public health problems worldwide and the hazards of cigarette smoking to public health call for better recognition of cigarette smoking behaviors to guide evidence-based policy. Protection motivation theory (PMT) provides a conceptual framework to investigate tobacco use. Evidence from diverse sources implies that the dynamics of smoking behavior may be quantum in nature, consisting of an intuition and an analytical process, challenging the traditional linear continuous analytical approach. In this study, we used cusp catastrophe, a nonlinear analytical approach to test the dual-process hypothesis of cigarette smoking. METHODS Data were collected from a random sample of vocational high school students in China (n = 528). The multivariate stochastic cusp modeling was used and executed with the Cusp Package in R. The PMT-based Threat Appraisal and Coping Appraisal were used as the two control variables and the frequency of cigarette smoking (daily, weekly, occasional, and never) in the past month was used as the outcome variable. RESULTS Consistent with PMT, the Threat Appraisal (asymmetry, α1 = 0.1987, p < 0.001) and Coping Appraisal (bifurcation, β2 = 0.1760, p < 0.05) significantly predicted the smoking behavior after controlling for covariates. Furthermore, the cusp model performed better than the alternative linear and logistic regression models with regard to higher R2 (0.82 for cusp, but 0.21 for linear and 0.25 for logistic) and smaller AIC and BIC. CONCLUSION Study findings support the conclusion that cigarette smoking in adolescents is a quantum process and PMT is relevant to guide studies to understand smoking behavior for smoking prevention and cessation.
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Affiliation(s)
- Yunan Xu
- University of Florida, Gainesville, Florida USA
| | - Xinguang Chen
- University of Florida, Gainesville, Florida USA
- Wuhan University Global Health Institute, Wuhan, China
- Wuhan Center for Disease Prevention and Control, Wuhan, China
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23
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McGee CE, Trigwell J, Fairclough SJ, Murphy RC, Porcellato L, Ussher M, Foweather L. Effect of a sport-for-health intervention (SmokeFree Sports) on smoking-related intentions and cognitions among 9-10 year old primary school children: a controlled trial. BMC Public Health 2016; 16:445. [PMID: 27229464 PMCID: PMC4882812 DOI: 10.1186/s12889-016-3048-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventing children from smoking is a public health priority. This study evaluated the effects of a sport-for-health smoking prevention programme (SmokeFree Sports) on smoking-related intentions and cognitions among primary school children from deprived communities. METHODS A non-randomised-controlled trial targeted 9-10 year old children from Merseyside, North-West England. 32 primary schools received a programme of sport-for-health activities over 7 months; 11 comparison schools followed usual routines. Data were collected pre-intervention (T0), and at 8 months (T1) and one year post-intervention (T2). Smoking-related intentions and cognitions were assessed using an online questionnaire. Intervention effects were analysed using multi-level modelling (school, student), adjusted for baseline values and potential confounders. Mixed-sex focus groups (n = 18) were conducted at T1. RESULTS 961 children completed all assessments and were included in the final analyses. There were no significant differences between the two study groups for non-smoking intentions (T1: β = 0.02, 95 % CI = -0.08-0.12; T2: β = 0.08, 95 % CI = -0.02-0.17) or for cigarette refusal self-efficacy (T1: β = 0.28, 95 % CI = -0.11-0.67; T2: β = 0.23, 95 % CI = -0.07-0.52). At T1 there was a positive intervention effect for cigarette refusal self-efficacy in girls (β = 0.72, 95 % CI = 0.21-1.23). Intervention participants were more likely to 'definitely' believe that: 'it is not safe to smoke for a year or two as long as you quit after that' (RR = 1.19, 95 % CI = 1.07-1.33), 'it is difficult to quit smoking once started' (RR = 1.56, 95 % CI = 1.38-1.76), 'smoke from other peoples' cigarettes is harmful' (RR = 1.19, 95 % CI = 1.20-2.08), 'smoking affects sports performance' (RR = 1.73, 95 % CI = 1.59-1.88) and 'smoking makes 'no difference' to weight' (RR = 2.13, 95 % CI = 1.86-2.44). At T2, significant between-group differences remained just for 'smoking affects sports performance' (RR = 1.57, 95 % CI = 1.43-1.72). Focus groups showed that SFS made children determined to remain smoke free and that the interactive activities aided children's understanding of smoking harms. CONCLUSION SFS demonstrated short-term positive effects on smoking attitudes among children, and cigarette refusal self-efficacy among girls. Although no effects were observed for non-smoking intentions, children said that SFS made them more determined not to smoke. Most children had strong intentions not to smoke; therefore, smoking prevention programmes should perhaps target early adolescents, who are closer to the age of smoking onset.
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Affiliation(s)
- Ciara E McGee
- Centre for Public Health, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2AT, UK.
| | - Joanne Trigwell
- Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, City Campus, Leeds, LS1 3HE, UK
| | - Stuart J Fairclough
- Department of Sport and Physical Activity, Edge Hill University, St. Helens Road, Ormskirk, Lancashire, L39 4QP, UK
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Rebecca C Murphy
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 62 Great Crosshall Street, Liverpool, L3 2AT, UK
| | - Lorna Porcellato
- Centre for Public Health, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2AT, UK
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Lawrence Foweather
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 62 Great Crosshall Street, Liverpool, L3 2AT, UK
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Tahlil T, Woodman RJ, Coveney J, Ward PR. Six-months follow-up of a cluster randomized trial of school-based smoking prevention education programs in Aceh, Indonesia. BMC Public Health 2015; 15:1088. [PMID: 26499860 PMCID: PMC4619432 DOI: 10.1186/s12889-015-2428-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 10/16/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Smoking prevention programs have been taught in schools to reduce the high smoking prevalence and its related problems among adolescent populations. Although short-term benefits have been observed, the long-term effectiveness of such programs appear to be inconsistent. This study aims at investigating the long-term impact of both health and Islamic focused interventions amongst students in Indonesia. METHODS At 6 months after completion of the interventions, 427 of the original 447 participants (control group = 128, intervention groups = 299) from a school-based cluster randomized control trial were re-assessed for their smoking knowledge, attitudes, intentions and behaviours using a self-report questionnaire. Data was analyzed according to the study's 2 × 2 factorial design with adjustment for baseline scores, school and classroom clustering effects and multiple comparisons. RESULTS Compared to the control group, significant long term effects were found for the health-based intervention program in improved health (β = 4.3 ± 0.4, p < 0.001), Islamic (β = 1.1 ± 0.4, p = 0.01) knowledge and a reduction of smoking attitudes (β = -11.5 ± 1.8, p < 0.001). For the Islamic-based intervention programs there was an improvement of health (β = 3.7 ± 0.4, p < 0.001) and Islamic (β = 2.2 ± 0.5, p < 0.001) knowledge and a reduction towards smoking attitude (β = -6.0 ± 1.9, p < 0.01) and smoking behaviors in the past month (OR = 0.1, 95 % CI = 0.0-0.8, p = 0.03). The effects were greater but less than additive in the combined group for health (β = -3.2 ± 0.9, p < 0.001 for interaction) and Islamic knowledge (β = -2.3 ± 0.9, p = 0.01 for interaction) but were additive for smoking attitudes (β = 6.1 ± 3.2, p = 0.07 for interaction). No significant effects on smoking intentions were observed at 6 months follow-up in the health or Islamic-based intervention programs. CONCLUSION School-based programs can provide long term benefits on Indonesian adolescents' smoking knowledge and attitudes. Tailoring program intervention components with participants' religious background might maximise program effectiveness. A larger and more encompassing study is now required to confirm the effectiveness of this new Indonesia culturally-based program. Adolescents in similar areas might also benefit from this type of school-based smoking cessation program. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry, ACTRN12612001070820.
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Affiliation(s)
- Teuku Tahlil
- Nursing Faculty, Syiah Kuala University, Banda Aceh, 23111, Indonesia.
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, SA, 5001, Australia.
| | - John Coveney
- Discipline of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, 5001, Australia.
| | - Paul R Ward
- Discipline of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, 5001, Australia.
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Su X, Li L, Griffiths SM, Gao Y, Lau JTF, Mo PKH. Smoking behaviors and intentions among adolescents in rural China: the application of the Theory of Planned Behavior and the role of social influence. Addict Behav 2015; 48:44-51. [PMID: 25973776 DOI: 10.1016/j.addbeh.2015.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 04/01/2015] [Accepted: 04/10/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study investigated the associations between the variables of the theory of planned behavior (TPB), influence of significant others, and smoking intentions and behaviors among adolescents living in rural southern China. METHODS A cross-sectional study was conducted among 2609 students in two junior high schools in rural Shantou, Guangdong province, using a self-administered questionnaire. Logistic regression models were fitted to estimate univariate and adjusted odds ratios and corresponding 95% confidence intervals. RESULTS Multivariate analyses showed that having favorable attitudes towards smoking on psychological and social aspects, perceived behavioral control, and having most friends who were current smokers were significantly associated with smoking intentions in the next six months and in the next five years. Having most family members who were current smokers was also significantly related to smoking intention in the next five years. Having favorable attitudes towards smoking on psychological aspect and negative attitudes on physical aspect, perceived support from friends on smoking, and having most friends and senior relatives being current smokers were significantly associated with increased likelihood of ever smoking. Perceived behavioral control and having most friends being current smokers were also significantly associated with regular smoking and smoking in the past 30days. CONCLUSIONS Our results suggest that the key constructs of the TPB model and friends' smoking behaviors play important roles in accounting for smoking intentions and behaviors among a sample of rural Chinese adolescents.
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Affiliation(s)
- Xuefen Su
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; The Chinese University of Hong Kong Shenzhen Research Institute, China
| | - Liping Li
- Injury Prevention Research Center, Medical College of Shantou University, Shantou, China
| | - Sian M Griffiths
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Yang Gao
- Department of Physical Education, Hong Kong Baptist University, Hong Kong Special Administrative Region
| | - Joseph T F Lau
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; The Chinese University of Hong Kong Shenzhen Research Institute, China; Centre for Medical Anthropology and Behavioral Health, School of Sociology and Anthropology, Sun Yat-sen University, China
| | - Phoenix K H Mo
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; The Chinese University of Hong Kong Shenzhen Research Institute, China.
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Kabir MI, Rahman MB, Smith W, Lusha MAF, Milton AH. Child Centred Approach to Climate Change and Health Adaptation through Schools in Bangladesh: A Cluster Randomised Intervention Trial. PLoS One 2015; 10:e0134993. [PMID: 26252381 PMCID: PMC4529232 DOI: 10.1371/journal.pone.0134993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/15/2015] [Indexed: 11/21/2022] Open
Abstract
Background Bangladesh is one of the most vulnerable countries to climate change. People are getting educated at different levels on how to deal with potential impacts. One such educational mode was the preparation of a school manual, for high school students on climate change and health protection endorsed by the National Curriculum and Textbook Board, which is based on a 2008 World Health Organization manual. The objective of this study was to test the effectiveness of the manual in increasing the knowledge level of the school children about climate change and health adaptation. Methods This cluster randomized intervention trial involved 60 schools throughout Bangladesh, with 3293 secondary school students participating. School upazilas (sub-districts) were randomised into intervention and control groups, and two schools from each upazila were randomly selected. All year seven students from both groups of schools sat for a pre-test of 30 short questions of binary response. A total of 1515 students from 30 intervention schools received the intervention through classroom training based on the school manual and 1778 students of the 30 control schools did not get the manual but a leaflet on climate change and health issues. Six months later, a post-intervention test of the same questionnaire used in the pre-test was performed at both intervention and control schools. The pre and post test scores were analysed along with the demographic data by using random effects model. Results None of the various school level and student level variables were significantly different between the control and intervention group. However, the intervention group had a 17.42% (95% CI: 14.45 to 20.38, P = <0.001) higher score in the post-test after adjusting for pre-test score and other covariates in a multi-level linear regression model. Conclusions These results suggest that school-based intervention for climate change and health adaptation is effective for increasing the knowledge level of school children on this topic.
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Affiliation(s)
- Md Iqbal Kabir
- Department of Community Medicine and Clinical Epidemiology, Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
- Department of Epidemiology, National Institute of Preventive and Social Medicine, Mohakhali, Dhaka, Bangladesh
- Climate Change and Health Promotion Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh
- * E-mail:
| | - Md Bayzidur Rahman
- Department of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Wayne Smith
- Department of Community Medicine and Clinical Epidemiology, Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
| | | | - Abul Hasnat Milton
- Department of Community Medicine and Clinical Epidemiology, Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
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Yu S, Koplan J, Eriksen MP, Yao S, Redmon P, Song J, Uretsky E, Huang C. The Effects of Antismoking Messages From Family, School, and Mass Media on Smoking Behavior and Smoking Intention Among Chinese Adolescents. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1255-1263. [PMID: 25876081 DOI: 10.1080/10810730.2015.1018561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The prevalence of adolescent smoking has been increasing rapidly in China. Expanding adolescent exposure to antismoking messages may be an effective approach to prevent tobacco use among this population. Using a cross-sectional sample of 8,444 high school students in four Chinese cities, this study assessed the relation between self-reported exposure to antismoking messages from families, schools, and mass media and the rate of past 30-day smoking and smoking intention among junior and senior high school students. Results from logistic regression suggested that antismoking messages delivered via school and media inhibited both tobacco use and the intention to smoke. The effects of familial warnings about harmful effects of smoking, in contrast, were at best insignificant.
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Affiliation(s)
- Shaohua Yu
- a Department of Criminal Justice and Criminology , Georgia State University , Atlanta , Georgia , USA
| | - Jeffrey Koplan
- b Global Health Institute , Emory University , Atlanta , Georgia , USA
| | - Michael P Eriksen
- c School of Public Health , Georgia State University , Atlanta , Georgia , USA
| | - Shuo Yao
- d School of Communication , Radford University , Radford , Virginia , USA
| | - Pamela Redmon
- c School of Public Health , Georgia State University , Atlanta , Georgia , USA
| | - Julia Song
- e Department of Global Health , The George Washington University , Washington , District of Columbia , USA
| | - Elanah Uretsky
- e Department of Global Health , The George Washington University , Washington , District of Columbia , USA
| | - Cheng Huang
- e Department of Global Health , The George Washington University , Washington , District of Columbia , USA
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Abstract
OBJECTIVE To assess effectiveness of school-based smoking prevention curricula keeping children never-smokers. DESIGN Systematic review, meta-analysis. DATA MEDLINE (1966+), EMBASE (1974+), Cinahl, PsycINFO (1967+), ERIC (1982+), Cochrane CENTRAL, Health Star, Dissertation Abstracts, conference proceedings. DATA SYNTHESIS pooled analyses, fixed-effects models, adjusted ORs. Risk of bias assessed with Cochrane Risk of Bias tool. SETTING 50 randomised controlled trials (RCTs) of school-based smoking curricula. PARTICIPANTS Never-smokers age 5-18 (n=143,495); follow-up ≥6 months; all countries; no date/language limitations. INTERVENTIONS Information, social influences, social competence, combined social influences/competence and multimodal curricula. OUTCOME MEASURE Remaining a never-smoker at follow-up. RESULTS Pooling all curricula, trials with follow-up ≤1 year showed no statistically significant differences compared with controls (OR 0.91 (0.82 to 1.01)), though trials of combined social competence/social influences curricula had a significant effect on smoking prevention (7 trials, OR 0.59 (95% CI 0.41 to 0.85)). Pooling all trials with longest follow-up showed an overall significant effect in favour of the interventions (OR 0.88 (0.82 to 0.95)), as did the social competence (OR 0.65 (0.43 to 0.96)) and combined social competence/social influences curricula (OR 0.60 (0.43 to 0.83)). No effect for information, social influences or multimodal curricula. Principal findings were not sensitive to inclusion of booster sessions in curricula or to whether they were peer-led or adult-led. Differentiation into tobacco-only or multifocal curricula had a similar effect on the primary findings. Few trials assessed outcomes by gender: there were significant effects for females at both follow-up periods, but not for males. CONCLUSIONS RCTs of baseline never-smokers at longest follow-up found an overall significant effect with average 12% reduction in starting smoking compared with controls, but no effect for all trials pooled at ≤1 year. However, combined social competence/social influences curricula showed a significant effect at both follow-up periods. SYSTEMATIC REVIEW REGISTRATION Cochrane Tobacco Review Group CD001293.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada
| | - Julie McLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Langford R, Bonell C, Jones H, Pouliou T, Murphy S, Waters E, Komro K, Gibbs L, Magnus D, Campbell R. The World Health Organization's Health Promoting Schools framework: a Cochrane systematic review and meta-analysis. BMC Public Health 2015; 15:130. [PMID: 25886385 PMCID: PMC4339015 DOI: 10.1186/s12889-015-1360-y] [Citation(s) in RCA: 242] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/06/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization's Health Promoting Schools (HPS) framework is a holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed. METHODS We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013. We included cluster randomised controlled trials. Participants were children and young people aged four to 18 years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school's ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses. RESULTS We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates. CONCLUSION This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.
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Affiliation(s)
- Rebecca Langford
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Christopher Bonell
- Social Science Research Unit, Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, UK.
| | - Hayley Jones
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Theodora Pouliou
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Simon Murphy
- Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
| | - Elizabeth Waters
- Jack Brockhoff Child Health & Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3053, Melbourne, Australia.
| | - Kelli Komro
- Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, 1329 SW 16th Street, Gainesville, FL, 32610-0177, USA.
| | - Lisa Gibbs
- Jack Brockhoff Child Health & Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3053, Melbourne, Australia.
| | - Daniel Magnus
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Rona Campbell
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
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Coppo A, Galanti MR, Giordano L, Buscemi D, Bremberg S, Faggiano F. School policies for preventing smoking among young people. Cochrane Database Syst Rev 2014; 2014:CD009990. [PMID: 25342250 PMCID: PMC6486025 DOI: 10.1002/14651858.cd009990.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND School tobacco policies (STPs) might prove to be a promising strategy to prevent smoking initiation among adolescents, as there is evidence that the school environment can influence young people to smoke. STPs are cheap, relatively easy to implement and have a wide reach, but it is not clear whether this approach is effective in preventing smoking uptake. OBJECTIVES To assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. SEARCH METHODS We searched seven electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO and ERIC. We also searched the grey literature and ongoing trials resources. The most recent search was performed in May 2014. SELECTION CRITERIA We included cluster-randomised controlled trials (c-RCTs) in which primary and secondary schools were randomised to receive different levels of smoking policy or no intervention. Non-randomised controlled trials, interrupted time series and controlled before-after studies would also have been eligible. Cross-sectional studies were not formally included but we describe their findings and use them to generate hypotheses to inform future research. DATA COLLECTION AND ANALYSIS We independently assessed studies for inclusion in the review, and present a narrative synthesis, as the studies are too limited in quality to undertake a formal meta-analysis. MAIN RESULTS We found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow-up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face-to-face interviews with school staff members, and the outcome evaluation was performed using self-administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal STPs when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. AUTHORS' CONCLUSIONS Despite a comprehensive literature search, and rigorous evaluation of studies, we found no evidence to support STPs. The absence of reliable evidence for the effectiveness of STPs is a concern in public health. We need well-designed randomised controlled trials or quasi-experimental studies to evaluate the effectiveness of school tobacco policies.
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Affiliation(s)
- Alessandro Coppo
- Università del Piemonte OrientaleDepartment of Translational MedicineNovaraItaly
| | | | - Livia Giordano
- CPO Piemonte, AOU San Giovanni Battista HospitalCenter for Oncological PreventionVia San Francesco da paola 31TurinPiedmontItaly10123
| | - Daria Buscemi
- Università del Piemonte OrientaleDepartment of Translational MedicineNovaraItaly
| | - Sven Bremberg
- Karolinska InstitutetDepartment of Public Health SciencesStockholmSweden
| | - Fabrizio Faggiano
- Università del Piemonte OrientaleDepartment of Translational MedicineNovaraItaly
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Tahlil T, Coveney J, Woodman RJ, Ward PR. Exploring recommendations for an effective smoking prevention program for indonesian adolescents. Asian Pac J Cancer Prev 2014; 14:865-71. [PMID: 23621253 DOI: 10.7314/apjcp.2013.14.2.865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present qualitative study assessed the need, acceptability and appropriateness for implementing effective and culturally appropriate smoking prevention programs for adolescents in schools in Indonesia. METHODS Snowball sampling was used to recruit participants. The study sample comprised a mixture of staff in the education department, junior high school teachers and individuals who had taught junior high school students in Aceh Province, Indonesia. Data were collected through one hour in-depth face to face or telephone interviews and analyzed using a descriptive content analysis procedure. RESULTS School teachers and policy makers in education firmly supported the implementation of a school-based smoking prevention program in Aceh. An appropriate intervention for smoking prevention program in schools in Aceh should involve both health and Islamic based approaches, and be provided by teachers and external providers. Potential barriers to the program included smoker teachers and parents, time constraints of students and/or teachers, lack of teachers' ability, increase in students' load, the availability of tobacco advertising and sales, and lack of tobacco regulation and support from community and related departments. To increase program effectiveness, involvement of and coordination with other relevant parties are needed. CONCLUSIONS The important stakeholders in Indonesian childhood education agreed that school-based smoking prevention program would be appropriate for junior high school students. An appropriate intervention for smoking prevention program for adolescents in schools in Indonesia should be appropriate to participants' background and involve all relevant parties.
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Affiliation(s)
- Teuku Tahlil
- Discipline of Public Health, School of Medicine, Flinders University, Australia.
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Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, Komro KA, Gibbs LF, Magnus D, Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev 2014; 2014:CD008958. [PMID: 24737131 PMCID: PMC11214127 DOI: 10.1002/14651858.cd008958.pub2] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
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Affiliation(s)
- Rebecca Langford
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Christopher P Bonell
- Institute of Education, University of LondonSocial Science Research Unit18 Woburn SquareLondonLondonUKWC1H 0NR
| | - Hayley E Jones
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Theodora Pouliou
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Simon M Murphy
- Cardiff UniversityCardiff School of Social Sciences1‐3 Museum PlaceCardiffSouth GlamorganUKCF10 3BD
| | - Elizabeth Waters
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Kelli A Komro
- University of FloridaHealth Outcomes and Policy and Institute for Child Health PolicyPO Box 100177GainesvilleFloridaUSA32610‐0177
| | - Lisa F Gibbs
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Daniel Magnus
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Rona Campbell
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
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Application of the protection motivation theory in predicting cigarette smoking among adolescents in China. Addict Behav 2014; 39:181-8. [PMID: 24157424 DOI: 10.1016/j.addbeh.2013.09.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/22/2013] [Accepted: 09/09/2013] [Indexed: 11/21/2022]
Abstract
Reducing tobacco use among adolescents in China represents a significant challenge for global tobacco control. Existing behavioral theories developed in the West - such as the Protection Motivation Theory (PMT) - may be useful tools to help tackle this challenge. We examined the relationships between PMT factors and self-reported cigarette smoking behavior and intention among a random sample of vocational high school students (N=553) in Wuhan, China. Tobacco-related perceptions were assessed using the PMT Scale for Adolescent Smoking. Among the total sample, 45% had initiated cigarette smoking, and 25% smoked in the past month. Among those who never smoked, 15% indicated being likely or very likely to smoke in a year. Multiple regression modeling analysis indicated the significance of the seven PMT constructs, the four PMT perceptions and the two PMT pathways in predicting intention to smoke and actual smoking behavior. Overall, perceived rewards of smoking, especially intrinsic rewards, were consistently positively related to smoking intentions and behavior, and self-efficacy to avoid smoking was negatively related to smoking. The current study suggests the utility of PMT for further research examining adolescent smoking. PMT-based smoking prevention and clinical smoking cessation intervention programs should focus more on adolescents' perceived rewards from smoking and perceived efficacy of not smoking to reduce their intention to and actual use of tobacco.
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Thomas RE, McLellan J, Perera R. School-based programmes for preventing smoking. ACTA ACUST UNITED AC 2013. [DOI: 10.1002/ebch.1937] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
BACKGROUND Helping young people to avoid starting smoking is a widely endorsed public health goal, and schools provide a route to communicate with nearly all young people. School-based interventions have been delivered for close to 40 years. OBJECTIVES The primary aim of this review was to determine whether school smoking interventions prevent youth from starting smoking. Our secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Tobacco Addiction Group's Specialised Register, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, Health Star, and Dissertation Abstracts for terms relating to school-based smoking cessation programmes. In addition, we screened the bibliographies of articles and ran individual MEDLINE searches for 133 authors who had undertaken randomised controlled trials in this area. The most recent searches were conducted in October 2012. SELECTION CRITERIA We selected randomised controlled trials (RCTs) where students, classes, schools, or school districts were randomised to intervention arm(s) versus a control group, and followed for at least six months. Participants had to be youth (aged 5 to 18). Interventions could be any curricula used in a school setting to deter tobacco use, and outcome measures could be never smoking, frequency of smoking, number of cigarettes smoked, or smoking indices. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed studies for inclusion, extracted data and assessed risk of bias. Based on the type of outcome, we placed studies into three groups for analysis: Pure Prevention cohorts (Group 1), Change in Smoking Behaviour over time (Group 2) and Point Prevalence of Smoking (Group 3). MAIN RESULTS One hundred and thirty-four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.Pure Prevention cohorts (Group 1) included 49 studies (N = 142,447). Pooled results at follow-up at one year or less found no overall effect of intervention curricula versus control (odds ratio (OR) 0.94, 95% confidence interval (CI) 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow-up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes.Change in Smoking Behaviour over time (Group 2) included 15 studies (N = 45,555). At one year or less there was a small but statistically significant effect favouring controls (standardised mean difference (SMD) 0.04, 95% CI 0.02 to 0.06). For follow-up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI -0.00 to 0.02).Twenty-five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled.We were unable to analyse data for 49 studies (N = 152,544).Subgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow-up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco-only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow-up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow-up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. AUTHORS' CONCLUSIONS Pure Prevention cohorts showed a significant effect at longest follow-up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less. The combined social competence and social influences interventions showed a significant effect at one year and at longest follow-up. Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information-only approach were similarly ineffective.Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada.
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Macdonell K, Chen X, Yan Y, Li F, Gong J, Sun H, Li X, Stanton B. A Protection Motivation Theory-Based Scale for Tobacco Research among Chinese Youth. ACTA ACUST UNITED AC 2013; 4:154. [PMID: 24478933 PMCID: PMC3903136 DOI: 10.4172/2155-6105.1000154] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rates of tobacco use among adolescents in China and other lower and middle-income countries remain high despite notable prevention and intervention programs. One reason for this may be the lack of theory-based research in tobacco use prevention in these countries. In the current study, a culturally appropriate 21-item measurement scale for cigarette smoking was developed based on the core constructs of Protection Motivation Theory (PMT). The scale was assessed among a sample of 553 Chinese vocational high school students. Results from correlational and measurement modeling analysis indicated adequate measurement reliability for the proposed PMT scale structure. The two PMT Pathways and the seven PMT constructs were significantly correlated with adolescent intention to smoke and actual smoking behavior. This study is the first to evaluate a PMT scale for cigarette smoking among Chinese adolescents. The scale provides a potential tool for assessing social cognitive processes underlying tobacco use. This is essential for understanding smoking behavior among Chinese youth and to support more effective tobacco use prevention efforts. Additional studies are needed to assess its utility for use with Chinese youth in other settings.
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Affiliation(s)
- Karen Macdonell
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Xinguang Chen
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Yaqiong Yan
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Fang Li
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Jie Gong
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Huiling Sun
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Xiaoming Li
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Bonita Stanton
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
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37
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Promoting life skills and preventing tobacco use among low-income Mumbai youth: effects of Salaam Bombay Foundation intervention. PLoS One 2012; 7:e34982. [PMID: 22523567 PMCID: PMC3327682 DOI: 10.1371/journal.pone.0034982] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 03/08/2012] [Indexed: 11/19/2022] Open
Abstract
Background In response to India's growing tobacco epidemic, strategies are needed to decrease tobacco use among Indian youth, particularly among those who are economically disadvantaged. The objective of this study was to assess the effectiveness of a school-based life-skills tobacco control program for youth of low socio-economic status in Mumbai and the surrounding state of Maharashtra. We hypothesized that compared to youth in control schools, youth exposed to the program would have greater knowledge of effects of tobacco use; be more likely to take action to prevent others from using tobacco; demonstrate more positive life skills and attitudes; and be less likely to report tobacco use. Methods/Findings Using a quasi-experimental design, we assessed program effectiveness by comparing 8th and 9th grade students in intervention schools to 8th grade students in comparable schools that did not receive the program. Across all schools, 1851 students completed a survey that assessed core program components in early 2010. The program consisted of activities focused on building awareness about the hazards of tobacco, developing life skills, and advocacy development. The primary outcome measure was self-reported tobacco use in the last 30 days. Findings indicate that 4.1% of 8th grade intervention students (OR = 0.51) and 3.6% of 9th grade intervention students (OR = 0.33) reported using tobacco at least once in the last 30 days, compared to 8.7% of students in the control schools. Intervention group students were also significantly more knowledgeable about tobacco and related legislation, reported more efforts to prevent tobacco use among others, and reported stronger life skills and self-efficacy than students in control schools. Limitations to the study include schools not being randomly assigned to condition and tobacco use being measured by self-report. Conclusions This program represents an effective model of school-based tobacco use prevention that low-income schools in India and other low- and middle-income countries can replicate.
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Shek DTL, Yu L. A review of validated youth prevention and positive youth development programs in Asia. Int J Adolesc Med Health 2012; 23:317-24. [PMID: 22416499 DOI: 10.1515/ijamh.2011.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In view of the intensification of adolescent developmental issues in different Asian contexts, there is an urgent need for developing prevention and positive youth development programs in different Asian communities. In this paper, adolescent prevention and positive youth development programs in Asia which have been evaluated by studies adopting true experimental or quasi-experimental designs are reviewed. Several observations are highlighted from this review. First, compared with Western societies, the number of validated programs in different Asian communities was extremely low. Second, there were comparatively more programs addressing substance abuse than other mental health problems. Third, compared with evaluated prevention programs, there were very few positive youth development programs. Finally, there were very few rigorously designed evaluative studies of prevention and positive youth development programs over a long period of time.
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Affiliation(s)
- Daniel T L Shek
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Faculty of Health and Social Sciences, Hong Kong, P.R. China.
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