Commentary on Valdivieso Lopez et al. (2015): Lessons to be learnt from a randomized controlled trial of smoking prevention in secondary schools

Abstract

Commentary on Valdivieso Lopez et al. (2015): Lessons to be learnt from a randomized controlled trial of smoking prevention in secondary schools Lopez et al., the team of authors of the Catalan secondary schools smoking prevention programme, are to be commended for their innovative intervention and associated valuation in students across 29 participating schools with follow-up over 4 years [1]. The investigators summarize that their study could not claim any clear benefit for their school-based intervention for reducing prevalence and incidents of smoking in 12-15-year-old students. While this is correct from a statistical perspective, this is an occasion where it is worth looking beyond the nonsignificant P-value, and noting what was initially an appropriately designed and powered study. The financial crisis and associated considerable school dropouts well above those factored into sample size calculations rendered the final analysis unlikely to demonstrate a statistical benefit. Nevertheless, the multi-faceted intervention arm reduced the risk of prevalence in incidences of smoking by 25 and 26%, respectively, in relative terms after 4 years of follow up.The multi-faceted intervention combines not only the usual forms of education such as exposing the students to patients who have had smoking-related health issues, including laryngectomy, but also more novel components. These include the use of social media, which is currently underutilized as an effective means of youth engagement [2], and raising awareness of how movies and television shows covertly persuade young people to be manipulated to take up and continue smoking, as evident in the current literature [3][4][5]. Such novel interventions have appeal, as they counter what the tobacco industry itself is doing with advertising that affects youth [6] and their own ineffective tobacco prevention programmes [7] head-to-head. While it is difficult to tease out which of the seven module components of the intervention drove the albeit non-statistically significant reduction in smoking incidents and prevalence, the authors point out correctly that further research into each module on a more individual basis and into subject subgroups is an important way forward. Declaration of interestsNone.