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A randomised controlled trial of a school-based intervention to prevent tobacco use among children and adolescents in Italy

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Abstract

Aim

A randomised field trial was conducted to evaluate a school-based programme to prevent tobacco use in children and adolescents.

Subject and methods

The trial included 534 children and 308 adolescents who were randomly selected to receive or not to receive the prevention programme. The prevention programme included: (a) health facts and the effect of smoking, (b) analysis of the mechanisms underlying intiation of smoking and (c) refusal skills training to deal with the social pressures to smoke. A questionnaire was administered before the intervention programme and 2 years later.

Results

The prevalence rates of smoking in both groups of children and adolescents were increased at the end of the study. Anyway, the difference of smoking prevalence between the intervention and control groups was statistically significant only for the children’s group (from 18.3 to 18.8% for the intervention group and from 17.8 to 26.9% in the control group) (p = 0.035). As regards reasons that induced the start of smoking, there was a significant increase of the issue “because smokers are fools” (p = 0.004 for children; p < 0.001 for adolescents) and “because smokers are irresponsible” (p ≤ 0.001 for both children and adolescents) in the experimental groups.

Conclusion

The results suggest that a school-based intervention programme addressing tobacco use among children and adolescents, based on the development of cognitive and behavioural aspects, can be effective. After 1 year of intervention, smoking prevalence was significantly lower in children belonging to the intervention group than in children not randomised to intervention. Targeting young children before they begin to smoke can be a successful way of prevention.

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References

  • Adelman WP, Duggan AK, Hauptman P, Joffe A (2001) Effectiveness of a high school smoking cessation program. Pediatrics 107:E50–E56

    Article  CAS  PubMed  Google Scholar 

  • Ajzen I, Fishbein M (1980) Understanding attitudes and predicting social behavior. Prentice-Hall, Englewood Cliffs

    Google Scholar 

  • Best JA, Thomson SJ, Santi SM, Smith E, Brown KS (1988) Preventing cigarette smoking among school children. Annu Rev Public Health 9:161–201

    CAS  PubMed  Google Scholar 

  • Botvin GJ, Griffin KW (2007) School-based programmes to prevent alcohol, tobacco and other drug use. Int Rev Psychiatry 19:607–615

    Article  PubMed  Google Scholar 

  • Bruvold WH (1993) A meta-analysis of adolescent smoking prevention programs. Am J Public Health 83:872–880

    Article  CAS  PubMed  Google Scholar 

  • Campbell R, Starkey F, Holliday J, Audrey S, Bloor M, Parry-Langdon N, Hughes R, Moore L (2008) An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. Lancet 371:1595–1602

    Article  CAS  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention (1994) Guidelines for school health programs to prevent tobacco use and addiction. MMWR Recomm Rep 43:1–18

    Google Scholar 

  • Clarke JH, MacPherson B, Holmes DR, Jones R (1986) Reducing adolescent smoking: a comparison of peer-led, teacher-led, and expert interventions. J Sch Health 56:102–106

    Article  CAS  PubMed  Google Scholar 

  • Donner A, Klar N (2000) Design and analysis of cluster randomization trials in health research. Arnold, London

    Google Scholar 

  • Errecart MT, Walberg HJ, Ross JG, Gold RS, Fiedler JL, Kolbe LJ (1991) Effectiveness of teenage health teaching modules. J Sch Health 61:26–30

    Article  CAS  PubMed  Google Scholar 

  • Evans RI (1976) Smoking in children: developing a social psychological strategy of deterrence. Prev Med 5:122–127

    Article  CAS  PubMed  Google Scholar 

  • Faggiano F, Galanti MR, Bohrn K et al (2008) The effectiveness of a school-based substance abuse prevention program: EU-Dap cluster randomised controlled trial. Prev Med 47:537–543

    Article  PubMed  Google Scholar 

  • Farrelly MC (2009) Monitoring the tobacco use epidemic V. The environment: factors that influence tobacco use. Prev Med 48:S35–S43

    Article  PubMed  Google Scholar 

  • Ferketich AK, Gallus S, Iacobelli N, Zuccaro P, Colombo P, La Vecchia C (2008) Smoking in Italy 2007, with a focus on the young. Tumori 94:793–797

    PubMed  Google Scholar 

  • Garrison MM, Christakis DA, Ebel BE, Wiehe SE, Rivara FP (2003) Smoking cessation interventions for adolescents: a systematic review. Am J Prev Med 25(4):363–367

    Article  PubMed  Google Scholar 

  • Gianti A, Vianello S, Casinghini C, Roncarolo F, Ramella F, Maccagni M, Tenconi MT (2007) The “Quit and Win” campaign to promote smoking cessation in Italy: results and one year follow-up across three Italian editions (2000–2004). Ital J Public Health 5:59–64

    Google Scholar 

  • Hatsukami DK, Stead LF, Gupta PC (2008) Tobacco addiction. Lancet 371:2027–2038

    Article  CAS  PubMed  Google Scholar 

  • Hiemstra M, Ringlever L, Otten R, Jackson C, van Schayck OC, Engels RC (2009) Efficacy of smoking prevention program ‘Smoke-free Kids’: study protocol of a randomized controlled trial. BMC Public Health 9:477

    Article  PubMed  Google Scholar 

  • Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York

    Google Scholar 

  • Hwang MS, Yeagley KL, Petosa R (2004) A meta-analysis of adolescent psychosocial smoking prevention programs published between 1978 and 1997 in the United States. Health Educ Behav 31:702–719

    Article  PubMed  Google Scholar 

  • Istat (2000) I cittadini e l’ambiente. Indagine multiscopo sulle famiglie. Aspetti della vita quotidiana [The citizens and the environment. A multiscope survey on families, daily aspects]. Istat, Roma

  • Johnson CC, Myers L, Webber LS, Boris NW, He H, Brewer D (2009) A school-based environmental intervention to reduce smoking among high school students: the Acadiana Coalition of Teens against Tobacco (ACTT). Int J Environ Res Public Health 6:1298–1316

    Article  PubMed  Google Scholar 

  • La Torre G, Langiano E, De Vito E, Soave G, Ricciardi G (1998) Abitudine al fumo di tabacco negli studenti universitari: risultati di un'indagine campionaria sugli studenti di Cassino. [Tobacco smoking habits among university students: results of a sample survey in Cassino]. Ig Mod 110:377–387

    Google Scholar 

  • La Torre G, Moretti C, Capitano D, Alonzi MT, Ferrara M, Gentile A, Mannocci A, Capelli G (2004) La prevenzione del tabagismo: risultati di uno studio controllato randomizzato in adolescenti scolarizzati in Cassino. [Tobacco prevention: results of a randomised controlled trial among adolescents in Cassino]. Riv Ital Med Adolesc 2:36–40

    Google Scholar 

  • La Torre G, Chiaradia G, Ricciardi G (2005) School-based smoking prevention in children and adolescents: review of the scientific literature. J Public Health 13:285–290

    Article  Google Scholar 

  • Pampel FC, Aguilar J (2008) Changes in youth smoking, 1976–2002: a time-series analysis. Youth Soc 39:453–479

    Article  PubMed  Google Scholar 

  • Perry CL, Kelder SH, Murray DM et al (1992) Communitywide smoking prevention: long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study. Am J Public Health 82:1210–1216

    Article  CAS  PubMed  Google Scholar 

  • Perry CL, Stigler MH, Arora M, Reddy KS (2009) Preventing tobacco use among young people in India: Project MYTRI. Am J Public Health 99:899–906

    Article  PubMed  Google Scholar 

  • Peters LW, Wiefferink CH, Hoekstra F, Buijs GJ, Ten Dam GT, Paulussen TG (2009) A review of similarities between domain-specific determinants of four health behaviors among adolescents. Health Educ Res 24:198–223

    Article  PubMed  Google Scholar 

  • Puska P, Vartiainen E, Pallonen U et al (1981) The North Karelia Youth Project. A community-based intervention study on CVD risk factors among 13- to 15-year-old children: study design and preliminary findings. Prev Med 10:133–148

    Article  CAS  PubMed  Google Scholar 

  • Rasmussen M, Damsgaard MT, Due P, Holstein BE (2002) Boys and girls smoking within the Danish elementary school classes: a group-level analysis. Scand J Public Health 30:62–69

    PubMed  Google Scholar 

  • Resnicow K, Reddy SP, James S et al (2008) Comparison of two school-based smoking prevention programs among South African high school students: results of a randomized trial. Ann Behav Med 36:231–243

    Article  PubMed  Google Scholar 

  • Richardson L, Hemsing N, Greaves L, Assanand S, Allen P, McCullough L, Bauld L, Humphries K, Amos A (2009) Preventing smoking in young people: a systematic review of the impact of access interventions. Int J Environ Res Public Health 6:1485–1514

    Article  PubMed  Google Scholar 

  • Rooney BL, Murray DM (1996) A meta-analysis of smoking prevention programs after adjustment for errors in the unit of analysis. Health Educ Q 23:48–64

    CAS  PubMed  Google Scholar 

  • Rundall TG, Bruvold WH (1988) Meta-analysis of school-based smoking and alcohol use prevention programs. Health Educ Q 15:317–334

    CAS  PubMed  Google Scholar 

  • Sherman E, Primack BA (2009) What works to prevent adolescent smoking? A systematic review of the National Cancer Institute’s research-tested intervention programs. J Sch Health 79:391–399

    Article  PubMed  Google Scholar 

  • Sowden A, Arblaster L, Stead L (2003) Community interventions for preventing smoking in young people. Cochrane Database Syst Rev 1:CD001291

    PubMed  Google Scholar 

  • Thomas R (2002) School-based programmes for preventing smoking. Cochrane Database Syst Rev 4:CD001293

    PubMed  Google Scholar 

  • Thomas RE, Perera R (2006) School-based programmes for preventing smoking. Cochrane Database of Syst Rev 3:CD001293

    CAS  Google Scholar 

  • Wold B, Torsheim T, Currie C, Roberts C (2004) National and school policies on restrictions of teacher smoking: a multilevel analysis of student exposure to teacher smoking in seven European countries. Health Educ Res 19:217–226

    Article  PubMed  Google Scholar 

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Acknowledgments

We wish to thank the Heads and the teachers of the schools involved, particularly for their valuable contribution Prof. Lea Monte of “Comprensivo di Capodrise” (CE) and Prof. Claudia Moretti of Liceo Scientifico “Pellecchia”, Cassino (FR).

Conflict of interests

The authors declare that they have no conflict of interests.

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Correspondence to Giuseppe La Torre.

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La Torre, G., Chiaradia, G., Monte, L. et al. A randomised controlled trial of a school-based intervention to prevent tobacco use among children and adolescents in Italy. J Public Health 18, 533–542 (2010). https://doi.org/10.1007/s10389-010-0328-8

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  • DOI: https://doi.org/10.1007/s10389-010-0328-8

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