Predicting the life-time benefit of school-based smoking prevention programmes

A theater production to promote a smoke-free life to secondary students

Background:

Peer-led school-based anti-smoking programs have been shown to affect the smoking behaviors of students. The aim of this study was to examine the effectiveness of a school-based peer-led live theater production advocating a smoke-free life.

Methods:

This is a cross-section design study. Students from the drama club were recruited as School Health Ambassadors (SHAs). The SHAs were to involve in a theater production in advocating a smoke-free life, and were provided a health education workshop from the project team on facts relating to smoking and smoke-free life. All the students in the school were to watch the theater production as school peer audience members (SPAs). Comparison will be made between the two groups of students in their attitude and decision towards living a smoke-free life after being involved in the theater production or in watching the drama.

Results:

A total of 409 students, 21 SHAs, and 388 SPAs were included in the project. Both the SHAs and the SPAs reported confidently about their ability to resist offers or temptation to smoke, and were determined to live a smoke-free life and refrain from smoking the first cigarette.

Conclusions:

A peer-led theater production advocating a smoke-free life shows some effects on students’ attitude and decision to resist offers and the temptation to smoke, and to come to the decision to live a smoke-free life and refrain from smoking the first cigarette.

Harms of cigarette smoking: call to increase knowledge among children

Although the major burden of disease caused by smoking is observed in the adult population, two-third of smokers start before the age of 18 years. Reducing the number of young smokers could lead to marked improvements to the health of the UK population and save billions of pounds in National Health Service finances. However, very little is known about what makes children decide to not smoke or to quit early. We believe that increased awareness of the health risks associated with smoking will reduce smoking uptake among children. This study identifies a significant lack of knowledge among children aged 11-17 years at two London secondary schools and potentially identifies an area for improving our antismoking programmes. Although 80% of pupils cited lung cancer as being a smoking-related disease, very few other conditions could be recalled. We must do all we can to reduce smoking uptake in children. Understanding their baseline knowledge is the first step towards addressing the deficits in our current antismoking programmes.

Long-Term Effects of the Life Skills Program IPSY on Substance Use: Results of a 4.5-Year Longitudinal Study

This study investigated the long-term effectiveness of a Life Skills program with regard to use and proneness to legal and illicit drug use across a 4.5-year study interval. The universal school-based Life Skills program IPSY (Information + Psychosocial Competence = Protection) against adolescent substance use was implemented over 3 years (basic program in grade 5 and booster sessions in grades 6 and 7). Over the same time period, it was evaluated based on a longitudinal quasi-experimental design with intervention and control group, including two follow-up assessments after program completion [six measurement points; N (T1) = 1657 German students; M age (T1) = 10.5 years]. Applying an HLM approach, results showed that participation in IPSY had a significant effect on the frequency of smoking, and proneness to illicit drug use, across the entire study period. In addition, shorter-term effects were found for the frequency of alcohol use in that intervention effects were evident until the end of program implementation but diminished 2 years later. Thus, IPSY can be deemed an effective intervention against tobacco use and proneness to and use of illicit drugs during adolescence; however, further booster sessions may be necessary in later adolescence to enhance youths' resistance skills when alcohol use becomes highly normative among peers.

Youth tobacco cessation: quitting intentions and past-year quit attempts

BACKGROUND

Despite declining use of conventional tobacco products, youth use of non-cigarette tobacco has become prevalent; however, quitting behaviors remain largely unexplored.

PURPOSE

To examine nationally representative data on quit intentions and past-year attempts to quit all tobacco use among current youth tobacco users.

METHODS

In 2013, data were analyzed from the 2012 National Youth Tobacco Survey (NYTS). Weighted prevalence estimates of quit intentions and past-year quit attempts for current youth tobacco users are presented.

RESULTS

Prevalence of quit intentions and past-year attempts to quit all tobacco use were 52.8% and 51.5%, respectively, among current youth tobacco users. Among non-mutually exclusive groups, current cigarette smokers had the highest prevalence of quit intentions (56.8%) and past-year quit attempts (52.5%), whereas current hookah users had the lowest prevalence of quit intentions (41.5%) and past-year quit attempts (43.7%). Quit intentions among black, non-Hispanics (65.0%) and Hispanics (60.4%) were significantly higher versus white, non-Hispanics (47.5%). Youth reporting parental advice against tobacco had significantly higher prevalence of quit intentions (56.7%) and past-year quit attempts (55.0%) than those not reporting parental advice. Youth who agreed all tobacco products are dangerous (58.5%) had significantly higher prevalence of quit intentions than those who disagreed (37.0%).

CONCLUSIONS

Continued efforts are needed to better understand youth motivation for quitting all tobacco products. Public health messaging about the dangers of all tobacco and cessation efforts should be aimed at the full range of tobacco products, not just cigarettes, and tailored to meet the needs of youth polytobacco users.

Systematic review and meta-analysis: influence of smoking cessation on incidence of pneumonia in HIV

BACKGROUND

Smoking is common in people infected with HIV but cessation support is not a routine part of clinical care. The aim was to assess whether smoking is a risk factor for pneumonia in people with HIV and whether smoking cessation ameliorates excess risk.

METHODS

We performed MEDLINE and Embase database searches and included cohort or case-control studies conducted in adult patients infected with HIV extracting a hazard ratio (HR) or odds ratio (OR) that compared the incidence of bacterial pneumonia or pneumonia caused by Pneumocystis jiroveci (PCP) between two smoking categories. Studies were appraised for quality and combined using inverse variance meta-analysis.

RESULTS

Fourteen cohort and case-control studies were included. Assessment of outcome was good, but assessment of exposure status was poor. Current smokers were at higher risk of bacterial pneumonia than former smokers: HR 1.37 (95% confidence interval (CI): 1.06, 1.78). There was no evidence that former smokers were at higher risk than never smokers: HR 1.24 (95%CI: 0.96, 1.60). Current smokers were at higher risk of bacterial pneumonia than current non-smokers: HR of 1.73 (95%CI: 1.44, 2.06). There was no evidence that smoking increased the incidence of PCP. The HR for current versus non-smokers was 0.94 (95%CI: 0.79, 1.12), but from case-control studies the OR was 1.76 (95%CI: 1.25, 2.48) with heterogeneity. Confined to higher quality studies, the OR was 0.97 (95%CI: 0.81, 1.16). Residual confounding is possible, but available data suggest this is not an adequate explanation.

CONCLUSIONS

Smoking is a risk factor for bacterial pneumonia but not PCP and smoking cessation reduces this risk.See related article: http://www.biomedcentral.com/1741-7015/11/16.

Reducing smoking in adolescents: cost-effectiveness results from the cluster randomized ASSIST (A Stop Smoking In Schools Trial)

Introduction:

School-based smoking prevention programmes can be effective, but evidence on cost-effectiveness is lacking. We conducted a cost-effectiveness analysis of a school-based “peer-led” intervention.

Methods:

We evaluated the ASSIST (A Stop Smoking In Schools Trial) programme in a cluster randomized controlled trial. The ASSIST programme trained students to act as peer supporters during informal interactions to encourage their peers not to smoke. Fifty-nine secondary schools in England and Wales were randomized to receive the ASSIST programme or usual smoking education. Ten thousand seven hundred and thirty students aged 12–13 years attended participating schools. Previous work has demonstrated that the ASSIST programme achieved a 2.1% (95% CI = 0%–4.2%) reduction in smoking prevalence. We evaluated the public sector cost, prevalence of weekly smoking, and cost per additional student not smoking at 24 months.

Results:

The ASSIST programme cost of £32 (95% CI = £29.70–£33.80) per student. The incremental cost per student not smoking at 2 years was £1,500 (95% CI = £669–£9,947). Students in intervention schools were less likely to believe that they would be a smoker at age 16 years (odds ratio [OR] = 0.80; 95% CI = 0.66–0.96).

Conclusions:

A peer-led intervention reduced smoking among adolescents at a modest cost. The intervention is cost-effective under realistic assumptions regarding the extent to which reductions in adolescent smoking lead to lower smoking prevalence and/or earlier smoking cessation in adulthood. The annual cost of extending the intervention to Year 8 students in all U.K. schools would be in the region of £38 million and could result in 20,400 fewer adolescent smokers.