School-Based Tobacco Control and Smoking in Adolescents: Evidence from Multilevel Analyses

Estimated prevalence and trends in smoking among adolescents in South Korea, 2005-2021: a nationwide serial study

BACKGROUND

Although smoking is classified as a risk factor for severe COVID-19 outcomes, there is a scarcity of studies on prevalence of smoking during the COVID-19 pandemic. Thus, this study aims to analyze the trends of prevalence of smoking in adolescents over the COVID-19 pandemic period.

METHODS

The present study used data from middle to high school adolescents between 2005 and 2021 who participated in the Korea Youth Risk Behavior Web-based Survey (KYRBS). We evaluated the smoking prevalence (ever or daily) by year groups and estimated the slope in smoking prevalence before and during the pandemic.

RESULTS

A total of 1,137,823 adolescents participated in the study [mean age, 15.04 years [95% confidence interval (CI) 15.03-15.06]; and male, 52.4% (95% CI 51.7-53.1)]. The prevalence of ever smokers was 27.7% (95% CI 27.3-28.1) between 2005 and 2008 but decreased to 9.8% (95% CI 9.3-10.3) in 2021. A consistent trend was found in daily smokers, as the estimates decreased from 5.4% (95% CI 5.2-5.6) between 2005 and 2008 to 2.3% (95% CI 2.1-2.5) in 2021. However, the downward slope in the overall prevalence of ever smokers and daily smokers became less pronounced in the COVID-19 pandemic period than in the pre-pandemic period. In the subgroup with substance use, the decreasing slope in daily smokers was significantly more pronounced during the pandemic than during the pre-pandemic period.

CONCLUSIONS

The proportion of ever smokers and daily smokers showed a less pronounced decreasing trend during the pandemic. The findings of our study provide an overall understanding of the pandemic's impact on smoking prevalence in adolescents. Supplementary file2 (MP4 64897 KB).

Strategies to tackle non-communicable diseases in Afghanistan: A scoping review

Non-communicable diseases (NCDs) and their risk factors are the leading cause of death worldwide and contribute to 74.3% of deaths globally in 2019. The burden of NCDs is escalating in Afghanistan. Currently, every seconds, people in Afghanistan are dying of NCDs. Addressing this challenge in Afghanistan needs effective and practical interventions. This study aimed to identify the strategies developed and implemented in countries with low non-communicable premature death. To conduct a scoping review, we followed the six-step Arksey and O'Malley protocol and searched for eligible articles on eight international databases and the gray literature. The study followed the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were English documents and evidence produced up to 30 November 2021 for the control of NCDs. We excluded incomplete texts, duplicates, and dissertations due to lack of access. We used EndNote X9 and MaxQDA software for data management and analysis. We conducted content analysis for this study. A total of 122 documents developed between 1984 and 2021 met the inclusion criteria. We identified 35 strategies from which the most used strategies were related to unhealthy diets and smoking cessation programs. Canada (26.4%), Korea (19.8%), and the United Kingdom (19%) have the most publications on the control and prevention of NCDs among the countries included in the study. Most strategies were implemented over 2 years (41%). This study recommends specific interventions to control and prevent NCDs for the main risk factors of tobacco use, unhealthy diet, physical inactivity, and the main non-communicable diseases such as heart diseases, cancers, diabetes, and chronic obstructive pulmonary diseases. Afghanistan Ministry of Public Health, the WHO country office, and other involved stakeholders can use the findings of this review to design and implement strategies for controlling and preventing NCDs in Afghanistan. International organizations such as the World Health Organization, United Nations Agencies, the World Bank, and other involving communities should invest in strengthening good health governance in Afghanistan. The Afghan Government should focus on promoting and funding health literacy among the public and self-care to control and prevent NCDs.

Peer-led oral health education model for elementary school-aged children in British Columbia, Canada

OBJECTIVE

To examine the effectiveness of peer-led preventive oral health education for elementary school-aged children.

METHODS

A controlled, non-randomized interventional study included children in grades 4 to 6 (N = 372) from 6 schools in British Columbia, Canada. The control group (3 schools) received a class-based lecture on oral health. In the intervention group (3 schools), each sixth grader mentored a small group of fourth and fifth graders. The study outcomes were 1) need for oral care referrals (visual screening); 2) oral health knowledge (self-reports); 3) oral self-care practice (OSC-P); and 4) oral self-care skills (OSC-S). Assessments of OSC-P and OSC-S were based on disclosed dental biofilm levels. Study group comparisons were done at baseline and 8 to 12 months.

RESULTS

A high need for oral care referrals was found, with a substantial reduction achieved during the study period. Dietary knowledge improved minimally in the intervention group. In both study groups and within age groups, there was a wide variation in OSC-P and OSC-S. Overall, children's OSC-P scores were substantially higher than their OSC-S scores. Oral self-care outcomes improved over time in both groups (except for fourth graders in the control group), with a more substantial improvement in the intervention group. From baseline to study end, the mean OSC-P improved by 11.9% (intervention group) and 5.9% (control group). Improvement values for OSC-S were 12.8% and 5.2%.

CONCLUSIONS

The need for oral care referrals was reduced, but improvement in oral health knowledge was minimal. Oral self-care outcomes improved more in the intervention than in the control group.

The tween years: A systematic literature review for services for children aged 10-13 years

AIM

To explore the literature about services and interventions provided to tween children as the basis for informing future practice and policy.

BACKGROUND

The tween years (10-13 years) is a period in human development where children experience rapid physical and mental development; their thinking and actions are influenced by peer pressure, risk taking, concerns about their body image, size, and gender, and may become victims to bullying and increasing levels of mental ill-health. It may also be a time of transition between schooling institutions. Despite the multiplicity of these factors, pre-adolescents appear to be receiving little attention from both service providers and policy makers.

METHODS

Following the PRISMA reporting guidelines, a systematic search of peer-reviewed papers was conducted between June 2020 and April 2021. Studies were selected by screening their abstracts and titles. In total, 44 articles were included for in-depth analysis. Of these, 17 were randomised studies and 10 were non-randomised, and all were subjected to the assessment of risk of bias using the Review Manager Tool and ROBINS-I Tool respectively.

DATA EXTRACTION AND SYNTHESIS

Data was extracted by type of service/intervention/program, country, and type of study/methodology, aim, sample size, age range, and findings. Data synthesis was performed using thematic analysis and content analysis. The results are presented in an outcome summary table highlighting the study's outcomes including the provided programs, their acceptability, and their impacts on factors such as anxiety and depression levels, change of attitude, behavioural control, weight loss, resilience and coping, emotional regulation, self-esteem, and improved well-being.

CONCLUSION

The majority of programs described in this review reported positive results, and as a result have the potential to make a valuable contribution to future practice, policy, and research involving the tweens.

Experiences of the First Year Implementation of a Nationwide School-Based Smoking Prevention Program in Korea

Encouraged by the Framework Convention on Tobacco Control, Korea has implemented a nationwide School-based Smoking Prevention Program (SSPP) to reduce the prevalence of youth smoking. This qualitative study explored the school contexts of launching the SSPP in Seoul, Korea. Five focus groups were studied with 29 lead teachers in charge of the SSPP. Thematic analysis reveals three key findings. First, while infrastructure was insufficiently prepared due to the abrupt implementation, lead teachers agreed on the purpose of the SSPP. However, they perceived the program as myopic in only targeting smoking students and spending the mandatory budgets as a burdensome task. Second, the SSPP increased experience-based activities, influenced smoking family members, and created a smoke-free school environment. Third, to ensure more effective implementation, school principals should support inducing staff engagement. The teachers also maintained that the SSPP must be institutionalized as part of regular curricula with standardized books. For a more meaningful impact, the SSPP needs instructors and counselors to support smoking cessation programs that reflect school contexts. The teachers urged tobacco prevention measures at community, policy, and society levels. This study provides insights into a nationwide approach to initiating school-based smoking prevention program to achieve a tobacco-free generation.