Objective: To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students. Design: Group randomised controlled trial. Setting: 26 Dutch schools that provided junior secondary education. Subjects: 1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years. Intervention: Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition. Main outcome measures: Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis. Results: In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant. Conclusions: In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect.

Multi-problem households are households with problems on more than one of the following core problem areas: socio-economic problems, psycho-social problems, and problems related to child care. The aim of this study was to examine barriers and facilitators for health behavior change among adults from multi-problem households, as well as to identify ideas for a health promotion program. A qualitative study involving 25 semi-structured interviews was conducted among Dutch adults who received intensive family home care for multi-problem households. Results were discussed with eight social workers in a focus group interview. Data were analyzed using the Framework Method. The results revealed that the main reason for not engaging in sports were the costs. Physical activity was facilitated by physically active (transport to) work and by dog ownership. Respondents who received a food bank package reported this as a barrier for healthy eating. Those with medical conditions such as diabetes indicated that this motivated them to eat healthily. Smokers and former smokers reported that stress was a major barrier for quitting smoking but that medical conditions could motivate them to quit smoking. A reported reason for not using alcohol was having difficult past experiences such as violence and abuse by alcoholics. Mentioned intervention ideas were: something social, an outdoor sports event, cooking classes, a walking group, and children’s activities in nature. Free or cheap activities that include social interaction and reduce stress are in line with the identified barriers and facilitators. Besides these activities, it may be important to influence the target group’s environment by educating social workers and ensuring healthier food bank packages.

A prevention program in elementary school seems to be effective in preventing smoking.

<p class="abstract"><strong>Background:</strong> Previous studies have shown that people living in multi-problem households are less physically active, eat less healthy, have unstable social networks, and worse self-perceived general health than other people. The aim of this paper is to describe the development and evaluation of a health promotion program called “Back2Balance” for low-income multi-problem households aimed at improving healthy nutrition, physical activity, social networks, and self-perceived health.</p><p class="abstract"><strong>Methods:</strong> The Back2Balance program was developed using input from two formative studies and a co-creation process together with the target group and social workers. We used the theoretical domains framework to identify the functional components of our program. The Back2Balance program consists of: 1) a walking group, 2) cooking workshops, 3) motivational talks, 4) discounts on existing health promotion programs, and 5) family trips and children’s activities. In a quasi-experimental study respondents in the intervention group receive the usual social services support for multi-problem households and have the possibility to enroll in the program. Respondents in the control group only receive usual social services support.<strong> </strong>The program will be evaluated among 272 respondents from low-income multi-problem households living in Apeldoorn, the Netherlands.</p><p class="abstract"><strong>Conclusions: </strong>This protocol describes the development and evaluation of the Back2Balance program. We hypothesize that the program will lead to increased physical activity, healthy nutrition, social networks enhancement, and self-perceived health. The results of this study can be used as input for other national or international initiatives aiming to increase health of low-income multi-problem households.</p><p class="abstract"><strong>Trial registration: </strong>NTR6512</p><p class="abstract"> </p>

European smokefree class competition: a measure to decrease smoking in youth This letter corrects misleading and incorrect statements about the smokefree class competition (SFC) in a recent paper.