Effects of a school-based prevention programme on smoking in early adolescence: a 6-month follow-up of the ‘Eigenständig werden’ cluster randomised trial

Abstract

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

Six-months follow-up of a cluster randomized trial of school-based smoking prevention education programs in Aceh, Indonesia

“…After initial effects in increasing knowledge scores for participants in both the health and Islamic-based intervention programs over 1 week of the programs completion [ 12 ], sustained effects were observed at 6 months follow-up. This finding supports previous studies [ 25 , 26 ] regarding the long-term effectiveness of school-based smoking programs on knowledge improvement. It must be noted, however, that the combined program was not effective in retaining an increase in participants’ Islamic knowledge at 6 months follow-up.…”

“…Previous studies have provided mixed conclusions about program effects on smoking attitude. Although some studies [ 26 – 28 ] found significant longer term effects, others have not [ 25 ]. A religion-based intervention has also been reported to have had a positive impact on anti-smoking attitudes among students [ 29 ].…”

Risk factors for e-cigarette, conventional cigarette, and dual use in German adolescents: A cohort study

“…We used data from a randomized-controlled school-based smoking prevention study described in detail elsewhere (Hansen et al, 2011;Isensee et al, 2014). A two-arm (intervention vs. control) prospective cluster randomized controlled trial with five waves was conducted in four federal states in Germany (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein).…”

Preventing Binge Drinking in Adolescents

“…The codes were generated by the students themselves. This procedure had already been used in previous school-based longitudinal studies (25). These codes cannot be used to trace students' identities.…”