Youth smoking interventions in school: Desk research
Summary of findings
The research and analysis process produced five candidates for piloting:
- The ASSIST (A Stop Smoking in Schools Trial, UK) intervention is adapted from the ‘Popular Opinion Leader’ initiative for the promotion of sexual health. It is a peer-based intervention that informally targets students aged 12-13 years (Year 8) out-of class. It aims to spread and sustain new norms of non-smoking behaviour through social networks in schools. Following a recent, large-scale research project, the authors concluded that results were significant up to two years after the intervention and that, if implemented widely, the ASSIST intervention could reduce the prevalence of adolescent smoking. It has been shown to be effective across different locations.
- The LifeSkills Training programme (peer-led variant, USA) is a universal preventive intervention programme based on social/cognitive learning theory and problem behaviour theory. Unlike ASSIST, it is class-based and teacher-led, although can involve elements of peer-led activity. The programme aims to provide students with the necessary skills to resist the social pressure to smoke, drink, and use drugs. LifeSkills Training is one of the most extensively and rigorously tested approaches to substance abuse prevention. The results of numerous studies generally indicate its effectiveness in tackling smoking prevalence. It has also been shown to be effective across differing cohorts.
- The Towards No Tobacco Use (TNT, USA) programme is based on the Social Influence Model and addresses the multiple determinants of tobacco use. It is teacher-led and designed for young people in Grades 5 to 10 (ages 10 to 15 years). It teaches awareness of misleading social information, develops skills that counteract social pressure to use tobacco, and provides information about the physical consequences of tobacco use, such as addiction. The relatively small amount of robust evidence available shows sustained impact on tobacco use. It has been shown to be effective across differing cohorts in the USA.
- The Tobacco Use Prevention Programme (The Netherlands) is a class-based programme which involves pupils’ peers in the delivery process and is based on the Social Influence Model. It places particular focus on smoking prevention but is also relevant to smoking cessation. The small amount of robust research evidence available shows a significantly lower increase in smoking rates among the intervention group. It has been shown to some extent to be effective across differing cohorts in the Netherlands.
- The Project SHOUT programme (USA) uses undergraduate university students to deliver an anti-smoking, class-based programme to pupils in school grades seven and eight (ages 12 to 15). Undergraduates are sourced as volunteers from universities and receive course credit for their participation in the programme. The robust evidence on this intervention shows some evidence of sustained impact following booster sessions. It is less clear the extent to which the intervention is effective across differing cohorts although there is some evidence of the intervention being effective across diverse social, economic and demographic groups.
The objectives for this research were to:
- identify high potential school based programmes through the review of evidence
- identify which school based programmes are being advertised/marketed (by companies) to schools and review the evidence for their effectiveness
- to prioritise high potential programmes by ranking them in terms of potential impact upon youth smoking prevalence
- to make formal recommendations on up to three school-based programmes (in addition to ASSIST) that have sufficient evidence of impact on youth smoking prevalence to justify conducting a regional pilot
Smoking is the principal avoidable cause of premature deaths in the UK. The ‘Smoking Kills’ strategy was published in 1998, and has led to encouraging progress in reducing smoking prevalence. DH is in the process of developing a new tobacco control strategy for use from 2011. One part of the strategy will consider how best to impact on youth smoking uptake rates. Recent work by NICE (2007) and the US National Cancer Institute (NCI) (2008) suggests there may be advantages in directly approaching young people with tobacco control interventions.
As part of the strategic development process, COI commissioned, on behalf of the tobacco control team at DH, an independent piece of desk research to review the key evidence and recommend which, if any, school based interventions, in addition to ASSIST, have the potential to reduce youth smoking prevalence and should be piloted in England.
Desk research on youth smoking interventions in schools to identify high potential school based programmes through the review of evidence