1. Overall, school-based programs that aim to prevent student from starting smoking are effective, reducing the rate of smoking initiation by 12%.
2. These interventions are more effective if taught by adults, and if they include a social competence approach.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Especially in poorer countries, youth are beginning to smoke at earlier ages. To counter this trend, many schools have incorporated programs to prevent students from starting to smoke. This meta-analysis studied these interventions and found that, at longer than a year, programs aimed at preventing never-smokers from starting smoking were effective overall. Those programs that used a social competence approach and focused on resisting social influences were most effective. However, among trials that aimed to reduce smoking among all students, including current smokers, students in the intervention groups smoked more than those in control groups.
These findings demonstrate that smoking prevention is complex, and that school-based interventions must be carefully designed. All such programs have the potential to increase students’ exposure to and curiosity surrounding smoking. Further studies are necessary to determine how best to leverage social competence to equip youth to resist smoking and other unhealthy behaviors.
Relevant Reading: Incentives for preventing smoking in children and adolescents
In-Depth [meta-analysis of randomized controlled trials]: This study aimed to determine whether school-based interventions were effective in preventing smoking among youth and, secondarily, to assess which types of interventions were most effective. A literature review was performed to identify randomized controlled trials (RCTs) of school-based smoking cessation programs in which students, classrooms, schools, or school districts were assigned to interventions and compared against a control group on outcomes such as never smoking, frequency of smoking, number of cigarettes smoked, or smoking indices. The 133 studies that met inclusion criteria were divided into three groups for analysis: pure prevention cohorts (49 studies), change in smoking behavior over time (15 studies), and point prevalence of smoking (25 studies).
Subgroup analysis among the pure prevention cohorts demonstrated a significant effect of programs with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (0.50, 0.28 to 0.87), but not in those programs with information only, social influence only, and multimodal programs. There was a significant trend favoring adult over peer presenters (0.88, 0.81 to 0.96). The gender of students, focus of curricula (tobacco-only vs multifocal), and booster sessions did not significantly influence outcomes. Overall, no effect was detected at one year or less, though at longest follow-up, pure prevention cohorts demonstrated an average 12% reduction in starting smoking compared to control groups.
By Elizabeth Kersten and Andrew Bishara
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