Association of School Characteristics and Implementation in the X:IT Study—A School‐Randomized Smoking Prevention Program

Bast, Lotus Sofie; Due, Pernille; Ersbøll, Annette Kjær; Damsgaard, Mogens Trab; Andersen, Anette

doi:10.1111/josh.12500

Cited by 11 publications

(12 citation statements)

References 35 publications

(54 reference statements)

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“…Most school-based tobacco control programs are ineffective, but data from Brazil remain scarce [3-5]. Recent trials on tobacco prevention in the school setting have focused on including school teachers in the intervention [6-8], with others involving families [9,10]. However, these studies concluded that the students’ environment (ie, peer group as well as parental behavior and school policies) plays a role in smoking initiation in adolescence.…”

Section: Introductionmentioning

confidence: 99%

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

Lisboa¹,

Bernardes‐Souza²,

Xavier³

et al. 2019

J Med Internet Res

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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

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Section: Introductionmentioning

confidence: 99%

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

Lisboa¹,

Bernardes‐Souza²,

Xavier³

et al. 2019

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…Most school-based curricula are ineffective, and data from Brazil remain scarce. 18–20 The most recent trials on tobacco prevention in the school setting have focused on including school personnel or sports trainers in the intervention 21–23 and others focused on involving the families, 24 25 but all of these studies concluded that the environment of the student (ie, the peer group but also parental behaviour, school policies, etc) plays a role in smoking initiation in adolescence.…”

Section: Introductionmentioning

confidence: 99%

A smoking prevention photoageing intervention for secondary schools in Brazil delivered by medical students: protocol for a randomised trial

et al. 2017

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IntroductionMost smokers start smoking during their early adolescence, often with the idea that smoking is glamorous; the dramatic health consequences are too far in the future to fathom. We recently designed and tested an intervention that takes advantage of the broad availability of mobile phones as well as adolescents’ interest in their appearance. A free photoageing mobile app (Smokerface) was implemented by medical students in secondary schools via a novel method called mirroring. The pupils’ altered three-dimensional selfies on tablets were ‘mirrored’ via a projector in front of their whole grade. This is the first randomised trial to measure the effectiveness of the mirroring approach on smoking behaviour in secondary schools.Methods and analysisThe mirroring intervention, which lasts 45 min, is implemented by Brazilian medical students in at least 35 secondary school classes with 21 participants each (at least 35 classes with 21 participants for control) in February 2018 in the city of Itauna, Brazil. External block randomisation via computer is performed on the class level with a 1:1 allocation. In addition to sociodemographic data, smoking behaviour is measured via a paper–pencil questionnaire before, 3 and 6 months postintervention plus a random carbon monoxide breathing test at baseline and end line. The primary outcome is cigarette smoking in the past week at 6 months follow-up. Smoking behaviour (smoking onset, quitting) and effects on the different genders are studied as secondary outcomes. Analysis is by intention to treat.Ethics and disseminationEthical approval is obtained from the ethics committee of the University of Itauna in Brazil. Results will be disseminated at conferences, in peer-reviewed journals, throughout the Education Against Tobacco network social media channels and on our websites.Trial registration numberNCT03178227.

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“…As was the case for the evaluation of X:IT [19–21, 25], we will conduct a detailed process evaluation among teachers and students focusing especially on those from low SEP. The process evaluation is based on questions added to the student and school coordinator questionnaires concerning the implementation of the study, e.g.…”

Section: Methods and Designmentioning

confidence: 99%

“…The intervention was developed and implemented by the Danish Cancer Society. The Centre for Intervention Research was responsible for thorough scientific evaluation of implementation and effect of the intervention [18–21]. The X:IT intervention was developed using the Intervention Mapping Protocol as a systematic planning tool [22] and the Theory of Triadic Influences as theoretical framework [23].…”

Section: Introductionmentioning

confidence: 99%

Study protocol of the X:IT II - a school-based smoking preventive intervention

et al. 2019

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Background The X:IT intervention, conducted in 2010 to 2013, showed overall smoking preventive effect. However, parts of the intervention appeared less appealing to children from families with lower socioeconomic backgrounds. Therefore, the intervention components were modified and an evaluation of the amended intervention X:IT II is needed to show the effect of this revised intervention and whether children from different social backgrounds benefits equally from the current intervention. Methods Main intervention components are smoke free schools, a curricular component, and parental involvement (smoke free agreements and talks about tobacco). Components have been revised from the first version; 1) previously, schools should be smoke free on the school ground and were encouraged to hide smoking so that it wasn’t visible to pupils from the school ground. Now they are encouraged to tighten the rules so that no pupils or teachers smoke during the school day, no matter where they are; 2) the specifically developed educational material (Up in Smoke) has been revised so that all materials are online and all texts has a ARI; 3) the parental involvement is now targeted multiple groups of parents, e.g. parents that are smokers, and parents of children that smoke. Language used is simpler and the website for parents presents very specific examples. X:IT is implemented in 46 Danish public schools from fall 2017 until summer 2020. Data is collected through electronic questionnaires to students and coordinators four times (fall 2017, spring/summer 2018, 2019 and 2020). Further, qualitative interviews and observations are conducted. Discussion Prevalence of smoking among Danish adolescents is high compared to other Nordic countries and there is social inequality in smoking, leaving individuals from the lowest social backgrounds at higher risk. Although there has been an overall decline in smoking among Danish adolescents over the last decades, a recent levelling of this development indicates an urgent need for smoking prevention in Denmark. The X:IT intervention has the potential to prevent uptake of smoking among adolescents. However, there is a particular need for evaluating the effectiveness of the revised X:IT intervention, X:IT II, with focus on the effect across socioeconomic groups of adolescents. Trial registration Current Controlled Trials ISRCTN31292019 , date of registration 24/10/2017. Retrospectively registered.

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Association of School Characteristics and Implementation in the X:IT Study—A School‐Randomized Smoking Prevention Program

Abstract: Our findings highlight the importance of considering the school context in future health prevention initiatives.

Cited by 11 publications

References 35 publications

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

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

A smoking prevention photoageing intervention for secondary schools in Brazil delivered by medical students: protocol for a randomised trial

Study protocol of the X:IT II - a school-based smoking preventive intervention

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