School-based smoking prevention programs for adolescents in South Korea: a systematic review

The number of research papers evaluating programs designed to prevent adolescent smoking have increased in the last 13 years in Korea. The purpose of this study was to evaluate these programs, to review the features of the studies and to systemically assess the results on the knowledge about, and attitude to, smoking and smoking behavior. Database searched were national digital library (NDL) and the Research Information Service System, which are major literature search systems for all academic fields in South Korea, and the Research Information Center for Health, which is a database for health field. A total of 11 papers were included. Program contents are described under five categories and the mode of delivery is described. Methodological features were investigated and effect of the size of the study on variables investigated was computed. Knowledge was the main content of the program in most of the studies. Most studies delivered classroom-based instructions that were mainly didactic presentations. School-based smoking programs have not influenced adolescent smoking behavior as much as anticipated. Methodological problems were discussed. Several recommendations are made to improve effectiveness of smoking prevention programs and reduce methodological flaws in future studies.     

Exposure to, and perceived usefulness of, school-based tobacco prevention programs: associations with susceptibility to smoking among adolescents.

PURPOSE: To examine the relationships of exposure to school-based tobacco prevention programs and perceived usefulness of such programs to smoking susceptibility. METHODS: An ethnically representative sample of 6929 Grade 10 students participated in a cross-sectional survey of tobacco-related activities and behaviors. Perceived usefulness of prevention programs was investigated according to two dimensions: perceived helpfulness of information received at school with regard to making decisions about tobacco use and perceived availability of social resources that might help students cope with tobacco-related issues. RESULTS: The extent of exposure to school prevention programs and both dimensions of perceived usefulness of these programs were inversely associated with susceptibility to smoking. In addition, perceived information helpfulness mediated the effect of program exposure on susceptibility status, whereas perceived availability of social resources moderated that effect. The study also presented evidence suggesting ethnic/cultural variability in the status of susceptibility to smoking at this age. CONCLUSIONS: The study indicates a need to examine the perceptions of students receiving school prevention programs. Perceived usefulness of school prevention programs may be used to identify youth at high risk for smoking susceptibility. Future studies, however, should investigate other dimensions of perceived usefulness as well as intrapersonal, interpersonal, and environmental correlates of this construct.     

Tobacco industry youth smoking prevention programs: protecting the industry and hurting tobacco control

OBJECTIVES: This report describes the history, true goals, and effects of tobacco industry-sponsored youth smoking prevention programs. METHODS: We analyzed previously-secret tobacco industry documents. RESULTS: The industry started these programs in the 1980s to forestall legislation that would restrict industry activities. Industry programs portray smoking as an adult choice and fail to discuss how tobacco advertising promotes smoking or the health dangers of smoking. The industry has used these programs to fight taxes, clean-indoor-air laws, and marketing restrictions worldwide. There is no evidence that these programs decrease smoking among youths. CONCLUSIONS: Tobacco industry youth programs do more harm than good for tobacco control. The tobacco industry should not be allowed to run or directly fund youth smoking prevention programs.     

Interventions for prevention and treatment of tobacco smoking in school-aged children and adolescents: A systematic review and meta-analysis

ObjectivesTo determine the effectiveness of primary health care relevant interventions to prevent and treat tobacco smoking in school-aged children and adolescents.MethodsThis systematic review considered studies included in a prior review. We adapted and updated the search to April 2015. Titles, abstracts and full-text articles were reviewed in duplicate; data extraction and quality assessments were performed by one reviewer and verified by another. Meta-analyses and pre-specified sub-group analyses were performed when possible. PROSPERO #CRD42015019051.ResultsAfter screening 2118 records, we included nine randomized controlled trials. The mostly moderate quality evidence suggested targeted behavioral interventions can prevent smoking and assist with cessation. Meta-analysis showed intervention participants were 18% less likely to report having initiated smoking at the end of intervention relative to controls (Risk Ratio 0.82; 95% confidence interval 0.72, 0.94); the absolute effect is 1.92% for smoking initiation, Number Needed to Treat is 52 (95% confidence interval 33, 161). For cessation, meta-analysis showed intervention participants were 34% more likely to report having quit smoking at the end of intervention relative to controls (Risk Ratio 1.34; 95% confidence interval 1.05, 1.69); the absolute effect is 7.98% for cessation, Number Needed to Treat is 13 (95% confidence interval 6, 77). Treatment harms were not mentioned in the literature and no data were available to assess long-term effectiveness.ConclusionPrimary care relevant behavioral interventions improve smoking outcomes for children and youth. The evidence on key components is limited by heterogeneity in methodology and intervention strategy. Future trials should target tailored prevention or treatment approaches, establish uniform definition and measurement of smoking, isolate optimal intervention components, and include long-term follow-up.     

Beauty and smoking: the utilization of public health programs in the prevention of tobacco use disorders

Research in tobacco prevention is increasingly showing that anti-smoking campaigns aimed at youth work. However, not all interventions are effective, and some have had unintended harmful effects, even to the point of increasing tobacco use by youth. In this commentary, we discuss potentials risks associated with interventions poorly supported by the evidence, using the example of tobacco prevention campaigns that focus on the effects of smoking on beauty. We conclude with two points: 1) the importance of using strategies based on evidence, and 2) the importance of rigorous evaluation of innovative strategies.     

A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: evaluating a provincial tobacco control strategy

This paper examined how smoking policies and programs are associated with smoking behavior among Grade 10 students (n = 4709) between 1999 and 2001. Data from the Tobacco Module from the School Health Action Planning and Evaluation System were examined using multilevel logistic regression analyses. We identified that (i) attending a school with smoking prevention programs only was associated with a substantial risk of occasional smoking among students with two or more close smoking friends and (ii) attending a school with both smoking prevention programs and policies was associated with substantial risk of occasional smoking among students who did not believe there were clear smoking rules present. Students attending schools where year of enrollment in high school starts in Grade 9 were more likely to be regular and occasional smokers. Each 1% increase in Grade 12 smoking rates increased the odds that a Grade 10 student was an occasional smoker. It appears that grade of enrollment, senior student smoking behavior, close friend's smoking behavior and clear rules about smoking at school can impact school-based tobacco control programming. These preliminary study findings suggest the need for further research targeting occasional smoking behavior and the transition stage into high school.     

The gendered experience of smoking stigma: implications for tobacco control

Tobacco denormalization is a widely accepted tobacco control strategy, shaping policies and programs throughout the United States as well as globally. In spite of widespread beliefs about the effectiveness of tobacco denormalization approaches, concerns about their emphasis on stigmatization have emerged. Social science research on smoking stigma raises questions about the potential iatrogenic consequences of tobacco denormalization approaches. Few studies have considered how smoking stigma may be internalized differently by different people, particularly those who experience stigmatization because of other socially ascribed makers of inequity (e.g. race, ethnicity, gender, sexuality). The intersection of multiple stigmas may work to intensify the ‘social isolation and marginalization’ that some people already experience. This paper presents results from a pattern-level analysis of focus group and interview data from a study investigating smoking-related stigma and perceptions of tobacco denormalization approaches among 15 low income Black women who smoke in the San Francisco Bay Area. Our analysis revealed a cycle where Black women’s experiences with structural oppression resulted in stress and the use of cigarettes to cope with that stress. Though the connection between smoking and stress is well documented in previous research, our analysis further revealed the additional contribution of the stigmatization of smoking and how it intensifies inequity for Black women who smoke. Implications of these findings for tobacco control and prevention are discussed.     

Counseling adolescents for smoking prevention: a survey of primary care physicians and dentists.

Pediatricians, family practitioners, and dentists were questioned in the spring of 1992 about whether they counseled adolescent patients (10 through 18 years old) not to smoke. Of the 674 questionnaires distributed, 443 (66%) were returned and analyzed. Most practitioners could not estimate cigarette use among their adolescent patients. Prevention counseling occurred infrequently, and least often among younger patients. Physicians were more likely than dentists to counsel adolescents. The data highlight the need for continuing training of primary health care practitioners about the importance of counseling adolescents not to smoke.     

Evaluation of a smoking prevention intervention aimed at youth: Pataclope

Tobacco is responsible for 66,000 deaths per year in France, which makes it one of the most important national public health priorities. Pre-adolescents, at the age where this addiction usually begins, are a particularly interesting target group for the implementation of prevention activities. It is for this reason that in 1990, the French National League against Cancer established a set of non-smoking youth clubs ("Pataclope") of which the main objective is to prevent adolescents from starting to smoke. An evaluation programme was put into place in 1999 in order to better understand the impact of these clubs on the prevalence of smoking in 15 year olds, which corresponds to the age of former participants one year after leaving the clubs. A comparison between a group of youth having participated in the Pataclope clubs and a group of adolescents taken from the general population was carried out at the national level. Those selected were 15 years of age and were in high school. An anonymous self-questionnaire on their tobacco habits and factors of addiction was distributed to the two groups. The analysis involved a total of 3274 questionnaires, 899 of which were from Pataclope participants and 2375 from the sample population. The primary results show that the prevalence rates according to sex essentially mirror those of the Baromètre santé 2000, among other accepted statistics (25.5% for girls and 19.9% for boys versus 31.6% for girls and 18.1% for boys in the Baromètre santé 2000). One year after leaving the clubs, the former Pataclope members see their risk of becoming a smoker reduced by 26% with respect to those who were not club members (OR = .74 adjusted for the factors of addiction), within a model which regroups smokers and ex-smokers versus non-smokers. In utilising this model which takes into account the ex-smokers and smokers as two distinct categories (the reference always being non-smokers), the reduction of risk in being a smoker is always significant, and goes up to 50% less risk (OR = 0.5) for members of Pataclope. The probability of being an ex-smoker is identical in the two groups: given that once one has taken up smoking, the Pataclope members present the same smoking behaviours as the general population (same consumption, same age of quitting, and the same frequency of quitting). The activity of the Pataclope clubs has been encouraging in at least slowing or hindering the commencement of smoking in youth aged 15 years. However, these results require a confirmation in the long term. The lack of impact on the ex-smokers tends to demonstrate that the message of clubs reinforces a non-smoking behaviour but remains ineffective on quitting, once smoking has been taken up.     

Correlates of participation in a family-directed tobacco and alcohol prevention program for adolescents.

This study examined correlates of program initiation and completion in a family-directed program that involved families of adolescents throughout the United States. Correlates varied by whether program initiation, program completion, or the number of activities completed was the indicator of participation. In final regression models, participation was relatively likely by non-Hispanic whites when compared with persons of race/ethnicity other than white, black, and Hispanic; by families with a female adolescent as the program recipient; by families with mothers who had many years of education; and by families with both parents living in the household. There was more participation if parents thought their child would smoke in the future and if the parent thought the adolescent did not smoke currently. Participation was higher if the adolescent felt strongly attached to the parent and if parents did not smoke. The findings are considered in the context of similar programs and future research on family-directed programs to prevent adolescent tobacco and alcohol use.     

Patterns of cigarette smoking among Bristol schoolchildren: implications for educational intervention

A questionnaire on smoking behaviour and related issues wasadministered to 10 579 11- to 16- year-old children from 10co-educational secondary schools randomly selected from theBristol conurbation. The results show that children start experimentingwith cigarettes at a very early age and that over half reporttrying a cigarette before 11 years of age. The most dramaticincrease in regular smoking occurs at about age 14 for bothboys and girls, although the level of regular smoking reportedis consistently higher among girls than boys at ages 13–15years. By age 16 this sex difference disappears, with 27% ofteenagers reporting regular cigarette smoking. The vast majorityof regular smoking report some perceived dependence of cigarettesin terms of craving cigarettes at least occasionally (79%) andbelieving it would be difficult for them to give up smoking(67%). The implications of these results for health educationprogrammes are discussed and a two-tier approach is suggested.     

The role of tobacco outlet density in a smoking cessation intervention for urban youth

This study investigates the role of tobacco outlet density in a randomized controlled trial of a text messaging-based smoking cessation intervention conducted among a sample of 187 primarily African American youth in a midsize U.S. city. A moderated mediation model was used to test whether the indirect effect of residential tobacco outlet density on future smoking was mediated by the intention to smoke, and whether this indirect effect differed between adolescents who received the intervention and those who did not. Results indicated that tobacco outlet density is associated with intention to smoke, which predicts future smoking, and that the indirect effect of tobacco outlet density on future smoking is moderated by the intervention. Tobacco outlet density and the intervention can be viewed as competing forces on future smoking behavior, where higher tobacco outlet density acts to mitigate the sensitivity of an adolescent to the intervention's intended effect. Smoking cessation interventions applied to youth should consider tobacco outlet density as a contextual condition that can influence treatment outcomes.     

深圳儿童少年心理行为问题社区干预模式探讨

目的调查深圳市儿童少年心理行为问题现状,制定干预模式和矫治措施.方法采用国内修订版四套评估工具Achenbach儿童行为量表中国标准化版增订版、学习障碍筛查量表、conners儿童行为问卷父母量表、教师量表以及自行设计的一般情况调查表,对深圳市城区分层随机整群抽样的2 600名儿童少年进行了测评分析.结果深圳市儿童少年心理卫生问题检出率13.97%,男、女分别为14.76%、12.99%;学习障碍筛出率12.20%,其中男17.00%,女7.30%.基于调查结果建立了儿童少年心理行为问题系统社区干预模式.结论建立家庭-学校-社区-医疗机构分级多向管理的干预模式是儿童少年心理行为问题理想的预防和诊治措施.     

Prevention of smoking in adolescents with lower education: a school based intervention study

OBJECTIVE: To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students. DESIGN: Group randomised controlled trial. SETTING: 26 Dutch schools that provided junior secondary education. SUBJECTS: 1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years. INTERVENTION: Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition. MAIN OUTCOME MEASURES: Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis. RESULTS: In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant. CONCLUSIONS: In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect.     

Web-based tailored lifestyle programs: exploration of the target group's interests and implications for practice

An important challenge in Web-based health promotion is to increase the reach of the target audience by taking the target groups' desires into consideration. Data from 505 members of a Dutch Internet panel (representative for Dutch Internet users) were used to asses the target group's interests and needs. 28% participated in Web-based tailored lifestyle programs, 57% expressed an interest in such programs, and 15% expressed no interest. Interest in Web-based programs was predominantly caused by a general interest in lifestyle and online tests. Participation in Web-based tailored lifestyle programs should not take more than 17 minutes per occasion. 84% were interested in follow-up testing after the initial participation. Responders were particularly interested in physical activity and nutrition. Hardly anyone was willing to pay for participation. The results from this study support the use of Web-based tailored lifestyle programs in behavior change efforts.