ObjectivesTo test the effects of a school-based prevention programme on students’ smoking-related behaviour, attitudes and knowledge 6 months after implementation over 2 school-years has ended.DesignTwo-arm prospective cluster randomised controlled trial with a follow-up survey 6 months after end of programme implementation, that is, 26 months after baseline.Setting45 public secondary schools from four federal states in Germany (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein).ParticipantsA total of 3444 students from 172 classes with a mean age of 10.37 years (SD=0.59) and 47.9% girls at baseline. Analysis sample with follow-up up data merged to baseline data comprises 2513 datasets (73%).Intervention‘Eigenständig werden 5+6’, a school-based prevention programme for grades 5 and 6 to enhance substance-specific and general life skills, consisting of 14 units (à 90 min) and two workshops (4–6 h) being taught over a time period of 2 school-years by trained teachers.Outcome measuresLifetime and current smoking, incidence of smoking in baseline never smokers, smoking-related knowledge, attitudes, perceived norms of smoking and self-efficacy to refuse cigarette offers were assessed in students.Results6 months after the end of programme implementation, students of intervention classes showed significantly lower rates for lifetime smoking (adjusted OR=0.63; 95% CI 0.41 to 0.96; p=0.026) and incidence of smoking (adjusted OR=0.66; 95% CI 0.43 to 1.00; p=0.047), a higher increase of smoking-related knowledge (adjusted β=9.38; 95% CI 6.73 to 12.04; p<0.001) and a greater change in attitudes towards a more critical perception of risks and disadvantages of smoking (adjusted β=0.10; 95% CI 0.03 to 0.16; p=0.002). No group differences were found for current smoking, perceived norms of smoking and self-efficacy to refuse cigarette offers.ConclusionsParticipation in the school-based prevention programme ‘Eigenständig werden 5+6’ may have small effects on smoking behaviour and attitudes and a moderate effect on smoking-related knowledge.Trial registrationCurrent Controlled Trials ISRCTN99442407
Trial registration ISRCTN27091233 in Current Control Trial Register.
ObjectiveTo implement and evaluate ‘Eigenständig werden 5+6’ (‘Becoming Independent 5+6’), a school-based curriculum for grades 5 and 6 developed on the basis of evidence-based criteria for effective drug prevention curricula in schools. Evaluation of the programme includes efficacy, feasibility and practicability in daily school routine.Methods and resultsThe intervention ‘Eigenständig werden 5+6’ consists of 14 teaching units evenly distributed over grades 5 and 6 which are interactively delivered, and a parent component. Programme effects are studied in a four wave cluster randomised controlled trial with two arms, an intervention and a control group. Self-completed questionnaires from students and teachers are collected by trained research staff. 45 schools, 172 classes and 3444 students with a mean age of 10.37 years (SD=0.59) and 47.9% girls from four federal states in Germany were assessed at baseline. 1685 students in 81 classes were assigned to intervention classes, 1759 students in 91 classes to the control arm. No differences between conditions were found for age, gender, immigration background, socioeconomic status, substance use or life skills at baseline. Exceptions were higher self-efficacy (t(3438)=2.34, p=0.02, d=0.08) and empathy (t(3302)=2.4, p=0.02, d=0.09) in the control group, whereas class climate seemed better in the intervention group (t(3037)=2.01, p=0.05, d=0.07), but effect sizes state marginal differences.ConclusionBaseline data suggest that the initial conditions are favourable for testing programme efficacy since distribution of baseline levels of the outcomes did not differ in the intervention and control groups, except for negligible differences between self-efficacy and empathy, which were higher in the control group, and class climate, which was higher in the intervention group.Trial registration numberCurrent Controlled Trials ISRCTN99442407.
Participation in the intervention had no effect on bullying or perceptions of isolation. TRIAL REG NO: ISRCTN27091233 in Current Control Trial Register.
"Eigenständig werden 5+6" (Becoming independent 5+6) is a German school-based smoking prevention program that draws on social competence and social influence approaches. It was investigated whether the program's effect on smoking onset is mediated by substance-specific skills and cognitions such as knowledge, attitudes/risk perception, normative expectations, resistance skills, and refusal self-efficacy. Multiple mediation analyses revealed a statistically significant total indirect effect that accounted for 30.8% of the total effect. When considered separately, significant indirect effects could be found for normative expectations concerning peer smoking and the resistance skill of saying 'no'. Between these two mediators, the percentage of total effect mediated varied between 9.8% and 10.3%. Results of the current study emphasize the importance of substance-specific skills and cognitions in the effectiveness of school-based programs combining social competence and social influence curricula in preventing adolescent smoking onset.
Fragestellung: Wie wirkt sich das Grundschulprogramm Klasse2000 auf den Einstieg in den Zigaretten- und/oder heimlichen Alkoholkonsum aus? Methodik: Aufgeteilt auf die beiden Bedingungen „Teilnahme an Klasse2000“ vs. „Keine Teilnahme an Klasse2000“ wurden Schüler (MAlter = 9,0, SD = 0,5), die am Ende der dritten Klasse als Nie-Raucher (N = 1.027), als Nie-Trinker (N = 1.072) bzw. sowohl als Nie-Raucher und -Trinker (N = 979) identifiziert wurden, zum Ende der vierten Klasse hinsichtlich der Inzidenz des Substanzkonsums verglichen. Multiple hierarchische Poisson-Regressionen unter Kontrolle soziodemgraphischer Charakteristika sowie sozialer Einflussfaktoren wurden berechnet. Ergebnisse: Es konnte ein signifikanter Effekt von Klasse2000 auf den Einstieg in den Zigarettenkonsum sowie den Konsum mindestens einer der beiden Substanzen gefunden werden (p = 0,031 bzw. p = 0,010). Die Number needed to treat betrug für den Einstieg in den Zigarettenkonsum 28, für den Einstieg in den Substanzkonsum allgemein 19. Bezüglich des Einstiegs in den heimlichen Alkoholkonsum konnten keine Programmeffekte gefunden werden. Schlussfolgerungen: Es deutet sich ein primärpräventiver Effekt von Klasse2000 auf den Konsum psychotroper Substanzen an.
In accordance with the conclusion of the US National Cancer Institute to consider smoking in films, in addition to other factors, as one risk factor for the initiation of smoking among children and adolescents, the World Health Organization has invited its member states to implement rules for limiting smoking depictions in films. Results of methodically high-value longitudinal and experimental studies which provide empirical evidence for the association between smoking depictions in films and smoking among children and adolescents are presented. Interpretation of this association as causal according to Hill criteria is discussed. In this systematic review, future personal and structural preventive interventions to address this problem in Germany are presented and discussed. Of special importance is the enhancement of both parental competence in media education as well as media literacy in children and adolescents. Rating films depicting smoking as approved for adults only could yield the largest effect, since it leads to an enduring reduction of exposure.
Zielsetzung: Untersuchung der langfristigen Auswirkungen des für die Grundschule konzipierten Präventionsprogramms Klasse2000 auf den Substanzkonsum. Methodik: Klasse2000 will mittels interaktiver Methoden die Lebenskompetenzen fördern und zu einem gesunden Lebensstil motivieren. Die Daten wurden in schriftlichen Nachbefragungen einer Kontrollgruppenstudie mit Messwiederholung 16 Monate (N = 501, mittl. Alter 11,4 Jahre, 43,7 % männlich) und 36 Monate (N = 408, mittl. Alter 12,9 Jahre, 43,1 % männlich) nach Ende der Intervention gewonnen. Die Zuteilung zu den Gruppen erfolgte in der Ursprungsstudie auf Ebene der Schulen unter Berücksichtigung der Präferenz der Schulen. Ergebnisse: In beiden Nachbefragungen waren Lebenszeitprävalenz und Inzidenz des Rauchens in der Interventionsgruppe statistisch bedeutsam geringer als in der Kontrollgruppe. Beim Alkoholkonsum konnte nur in der ersten Nachbefragung eine signifikant geringere Lebenszeitprävalenz in der Interventionsgruppe gefunden werden. In der zweiten Nachbefragung war in der Untergruppe derjenigen Jugendlichen, die bereits Alkohol konsumiert hatten, in der Interventionsgruppe die Intensität des Alkoholkonsums geringer als in der Kontrollgruppe. Schlussfolgerungen: 16 bzw. 36 Monate nach Abschluss der Intervention finden sich Hinweise auf präventive Effekte des Programms Klasse2000 auf das Rauchverhalten. Für den Alkoholkonsum ist die Befundlage weniger überzeugend.
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