The Minnesota Heart Health Program. Education for youth and parents

Mass media interventions for preventing smoking in young people

BACKGROUND

Mass media interventions can be used as a way of delivering preventive health messages. They have the potential to reach and modify the knowledge, attitudes and behaviour of a large proportion of the community.

OBJECTIVES

To assess the effects of mass media interventions on preventing smoking in young people, and whether it can reduce smoking uptake among youth (under 25 years), improve smoking attitudes, intentions and knowledge, improve self-efficacy/self-esteem, and improve perceptions about smoking, including the choice to follow positive role models.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE and Embase in June 2016. This is an update of a review first published in 1998.

SELECTION CRITERIA

Randomized trials, controlled trials without randomization and interrupted time-series studies that assessed the effect of mass media campaigns (defined as channels of communication such as television, radio, newspapers, social media, billboards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person-to-person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years. We define smoking behaviour as the presence or absence of tobacco smoking or other tobacco use, or both, and the frequency of tobacco use. Eligible comparators included education or no intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risks of bias. We combined studies using qualitative narrative synthesis. We assessed the risks of bias for each study using the Cochrane 'Risk of bias' tool, alongside additional domains to account for the nature of the intervention. We assessed the quality of evidence contributing to outcomes using GRADE.

MAIN RESULTS

We identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time-series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.Three studies (n = 17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school-based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n = 72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school-based intervention, and one interrupted time-series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school-based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school-based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.

AUTHORS' CONCLUSIONS

Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review. Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed.

Mass media interventions for preventing smoking in young people

BACKGROUND

The mass media have been used as a way of delivering preventive health messages. They have the potential to reach and to modify the knowledge, attitudes and behaviour of a large proportion of the community.

OBJECTIVES

To evaluate the effectiveness of mass media interventions to prevent smoking in young people in terms of reduced smoking uptake, in addition to secondary outcomes including improved smoking outcomes, attitudes, behaviours, knowledge, self-efficacy and perception.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of MEDLINE and EMBASE in July 2010.

SELECTION CRITERIA

Randomized trials, controlled trials without randomization and time series studies that assessed the effectiveness of mass media campaigns (defined as channels of communication such as television, radio, newspapers, bill boards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person to person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years.

DATA COLLECTION AND ANALYSIS

Information relating to the characteristics and the content of media interventions, participants, outcomes, methods of the study and risk of bias was abstracted by two independent reviewers. Studies were combined using qualitative narrative synthesis.

MAIN RESULTS

Seven out of a total of 84 studies reporting information about mass media smoking campaigns met all of the inclusion criteria. All seven studies used a controlled trial design. Three studies concluded that mass media reduced the smoking behaviour of young people. All of the effective campaigns had a solid theoretical basis, used formative research in designing the campaign messages, and message broadcast was of reasonable intensity over extensive periods of time.

AUTHORS' CONCLUSIONS

There is some evidence that mass media can prevent the uptake of smoking in young people, however the evidence is not strong and contains a number of methodological flaws.

The role of availability as a moderator of family fruit and vegetable consumption

The public health objective to improve the diet of Americans includes increasing the consumption of fruits and vegetables (F&V). The availability of F&V in the home has been suggested but not confirmed as one environmental factor that influences the types and quantities of F&V eaten by family members. Using a model of parental and child influences on a child's intake of F&V, the authors investigated F&V availability as a moderating variable for the relationships between the model constructs and how the relationships might change with varying levels of F&V availability. Path analysis and multigroup structural equation modeling were the analytic tools. Results indicated that homes with more F&V available had a richer and generally stronger set of motivating factors for parent and child F&V consumption than homes with low F&V availability. Findings have implications for parental involvement in interventions to enhance the diet of fourth-grade children.

Mass media interventions for preventing smoking in young people

BACKGROUND

The mass media have been used as a way of delivering preventive health messages. They have the potential to reach and to modify the knowledge, attitudes and behaviour of a large proportion of the community.

OBJECTIVES

To determine the effectiveness of mass media campaigns in preventing the uptake of smoking in young people.

SEARCH STRATEGY

We searched Medline, and 28 other electronic databases. Handsearching of key journals was also carried out, the bibliographies of identified studies were checked for additional references and contact with content area specialists was made. Date of last search June 1998.

SELECTION CRITERIA

Randomised trials, controlled trials without randomisation and time series studies that assessed the effectiveness of mass media campaigns (defined as channels of communication such as television, radio, newspapers, bill boards, posters, leaflets or booklets intended to reach large numbers of people and which are not dependent on person to person contact) in influencing the smoking behaviour (either objective or self-reported) of young people under the age of 25 years.

DATA COLLECTION AND ANALYSIS

Information relating to the characteristics and the content of media interventions, participants, outcomes and methods of the study was abstracted by one reviewer and checked by a second. Studies were combined using qualitative narrative synthesis.

MAIN RESULTS

Six out of a total of 63 studies reporting information about mass media smoking campaigns met all of the inclusion criteria. All six studies used a controlled trial design. Two studies concluded that the mass media were effective in influencing the smoking behaviour of young people. Both of the effective campaigns had a solid theoretical basis, used formative research in designing the campaign messages and message broadcast was of reasonable intensity over extensive periods of time.

REVIEWER'S CONCLUSIONS

There is some evidence that the mass media can be effective in preventing the uptake of smoking in young people, but overall the evidence is not strong.

Hazards of smoking initiation among Asian American and non-Asian adolescents in California: a survival model analysis

BACKGROUND

Information about the risk of smoking initiation among whites, African Americans, and Latino Americans has provided an important information base for smoking prevention programs among adolescents from these ethnic backgrounds. Unfortunately, there is a lack of such information for Asian Americans, a fast-growing ethnic minority group with much internal diversity.

METHOD

This study used cross-sectional data from 20,482 subjects 12-17 years of age, randomly sampled in California, to describe and compare the risk of smoking initiation for adolescents by age among Asian American and other non-Asian ethnic groups, using survival analysis. Computer-aided telephone interview techniques were used in data collection.

RESULT

The risk of early smoking initiation among Asian American adolescents is about a third of that of Caucasians. However, the risk among Asian Americans continues to increase throughout adolescence, while the same risk among Caucasians and African Americans plateaus around 14-15 years of age. Significant differences in the levels and patterns of smoking initiation among Asian American subgroups were observed, with Chinese Americans showing the lowest risk of smoking initiation and Filipino Americans the highest, Japanese and Korean Americans being in-between.

CONCLUSION

Asian American adolescents may be especially at risk of smoking initiation later in adolescence, even though they are at lower risk early in adolescence. Smoking prevention programs for Asian Americans should continue throughout adolescence and early adulthood.

Teens teach skin cancer prevention

Cumulative sun exposure has been linked to about 95 percent of all skin cancers. Farmers and their families, by nature of their occupations, are exposed to an abundance of sun over a long period of time and, therefore, are at an increased risk for skin cancer. Because education is known to be a primary means of health, Future Farmers of America (FFA) peer facilitators (teen educators) provided third graders in rural communities sun protection education with the hope that the message would reach the entire family. The FFA facilitators (n = 217) from 39 FFA organizations throughout Wisconsin were trained with skin cancer and sun protection information. The FFA facilitators then gave presentations on sun protection to third graders (n = 2,007) in their school districts. Control schools included 57 facilitators and 669 third graders. Evaluation involved pre-, post-, and six-month follow-up surveys testing knowledge gained by the third graders. Students who correctly responded to a question on the post-survey after incorrectly answering it on the pre-survey were said to have had a knowledge gain for that question. By using chi-square tests, the intervention group demonstrated a statistically significant (P < 0.001) higher proportion of students experiencing knowledge gain than did the control group from pre- to post-surveys for nine of the 10 questions. Summary statistics were used to describe the study population. In addition to skin cancer knowledge questions, the survey of facilitators included sun protection behavior and attitude questions. This intervention was able to use peer educators as instructors to demonstrate knowledge gain in the youths of the target population. The pilot project materials costs were +0.55 per third grade student and +3.50 per facilitator. Using a school-based organization such as FFA provided a cost-effective means of reaching the rural population.

[Study of parental participation in curricular and extracurricular activities]

This preliminary study of parental participation in curricular and extra-curricular activities was conducted in the general framework of the healthy heart project in St. Louis du Parc, an underprivileged and multiethnic neighbourhood in Montreal. A general understanding of this type of participation is essential in order to adapt the role parents play in health programs developed in conjunction with the school. A conceptual framework was developed to help understand how and why parents of primary school children participate in school activities. Qualitative analysis of 15 semi-directed interviews conducted with various schools and other organizations revealed those obstacles to parental involvement, and the factors that encourage parents to participate. It was clear that there were wide social and cultural gaps between parents and schools. An important factor is how people perceive those barriers. Teachers stressed organizational and language communications difficulties. Others pointed to the lack of knowledge of the community, to poor communications skills and the parents' lack of those skills that would allow them to participate actively. A more open-minded attitude by school authorities and a more proactive and positive attitude of teachers toward parents are essential requirements, but not the only ones. Further interviews with parents should help provide more details and information.

Effects of an obesity prevention program on the eating behavior of African American mothers and daughters

Cardiovascular disease (CVD) is the number one cause of death in the United States. Obesity is highly related to CVD risk, especially in African American women. This study explored the efficacy of a culturally specific obesity prevention program. Designed for low-income, inner-city African American girls and their mothers, the program addressed the importance of eating a low-fat, low-cholesterol diet and increasing activity. Mother-daughter dyads were randomly assigned to a 12-week treatment or an attention placebo group. Participants were assessed at pre- and posttreatment on dietary intake, including daily fat intake, daily saturated fat intake, percentage of daily calories from fat, and daily cholesterol intake. Results showed significant differences between the treatment and control mothers for daily saturated fat intake and percentage of calories from fat. Differences among treatment and control groups were also noted for the daughters on percentage of daily calories from fat. Implications of the findings for developing culturally specific health risk reduction programs are discussed.