A Smoking Prevention Program Delivered by Medical Students to Secondary Schools in Brazil Called “Education Against Tobacco”: Randomized Controlled Trial

Abstract

Background Smoking is the largest preventable cause of mortality in Brazil. Education Against Tobacco (EAT) is a network of more than 3500 medical students and physicians across 14 countries who volunteer for school-based smoking prevention programs. EAT educates 50,000 adolescents per year in the classroom setting. A recent quasi-experimental study conducted in Germany showed that EAT had significant short-term smoking cessation effects among adolescents aged 11 to 15 years. Objective The aim is to measure the long-term effectiveness of the most recent version of the EAT curriculum in Brazil. Methods A randomized controlled trial was conducted among 2348 adolescents aged 12 to 21 years (grades 7-11) at public secondary schools in Brazil. The prospective experimental design included measurements at baseline and at 6 and 12 months postintervention. The study groups comprised randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes in the same schools (no intervention). Data were collected on smoking status, gender, social aspects, and predictors of smoking. The primary endpoint was the difference in the change in smoking prevalence between the intervention group and the control group at 12-month follow-up. Results From baseline to 12 months, the smoking prevalence increased from 11.0% to 20.9% in the control group and from 14.1% to 15.6% in the intervention group. This difference was statistically significant ( P <.01). The effects were smaller for females (control 12.4% to 18.8% vs intervention 13.1% to 14.6%) than for males (control 9.1% to 23.6% vs intervention 15.3% to 16.8%). Increased quitting rates and prevented onset were responsible for the intervention effects. The differences in change in smoking prevalence from baseline to 12 months between the intervention and control groups were increased in students with low school performance. Conclusions To our knowledge, this is the first randomized trial on school-based tobacco prevention in Brazil that shows significant long-term favorable effects. The EAT program encourages quitting and prevents smoking onset, especially among males and students with low educational background. Trial Registration ClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.7134

A governmental program to encourage medical students to deliver primary prevention: experiment and evaluation in a French faculty of medicine

“…To our knowledge this kind of national initiative involving a mandatory service involving community-based prevention, and led to a large extent by students acting autonomously, in multiple places, on multiple prevention themes, is singular. The main programs in USA, Switzerland, Brazil, Germany and Wales that have reported positive results in students and beneficiaries in terms of skills and knowledge acquisition rely on voluntary participation; another difference is that the actions previously reported were not built by the students themselves [7,[16][17][18][19].…”

Spaces of possibilities: a theoretical analysis of mentoring from a regulatory perspective

“…Not only does a mentor need to know what mentoring is and how to conduct successful mentoring ( mentoring insight ), but they also need to know more about the field in which the mentoring is being conducted ( domain insight ). An example of this is youth mentoring on substance abuse 118–120 . Moreover, a mentor also needs detailed knowledge about the special situation of their mentee: her goals, action repertoire (e.g., her knowledge, skills), her environment (e.g., support by or problems with parents, peers, teachers), and subjective action space (e.g., her self‐confidence) as well as about the systemic interactions of these determinants (i.e., actiotope insight ).…”

“…For example, in‐person mentoring and online mentoring offer mentors different didactic options 125 . Mentees—factor (3)—bring different amounts of educational and learning capital to mentoring 19,76,89,119 . The availability or lack of a mentee's resources help determine the extent of a mentor's regulatory power.…”

“…An example of this is youth mentoring on substance abuse. [118][119][120] Moreover, a mentor also needs detailed knowledge about the special situation of their mentee: her goals, action repertoire (e.g., her knowledge, skills), her environment (e.g., support by or problems with parents, peers, teachers), and subjective action space (e.g., her self-confidence) as well as about the systemic interactions of these determinants (i.e., actiotope insight).…”

“…125 Mentees-factor (3)-bring different amounts of educational and learning capital to mentoring. 19,76,89,119 The availability or lack of a mentee's resources help determine the extent of a mentor's regulatory power. For example, if a mentee's family and friends value learning (cultural educational capital) and a mentee spends most of her time reading and learning (attentional educational capital), then a mentor has more regulatory power in talent development.…”