Abstract
BackgroundMore than 8.5 million Germans suffer from chronic diseases attributable to smoking. Education Against Tobacco (EAT) is a multinational network of medical students who volunteer for school-based prevention in the classroom setting, amongst other activities. EAT has been implemented in 28 medical schools in Germany and is present in 13 additional countries around the globe. A recent quasi-experimental study showed significant short-term smoking cessation effects on 11-to-15-year-old adolescents.ObjectiveThe aim of this study was to provide the first randomized long-term evaluation of the optimized 2014 EAT curriculum involving a photoaging software for its effectiveness in reducing the smoking prevalence among 11-to-15-year-old pupils in German secondary schools.MethodsA randomized controlled trial was undertaken with 1504 adolescents from 9 German secondary schools, aged 11-15 years in grades 6-8, of which 718 (47.74%) were identifiable for the prospective sample at the 12-month follow-up. The experimental study design included measurements at baseline (t1), 6 months (t2), and 12 months postintervention (t3), via questionnaire. The study groups consisted of 40 randomized classes that received the standardized EAT intervention (two medical student-led interactive modules taking 120 minutes total) and 34 control classes within the same schools (no intervention). The primary endpoint was the difference in smoking prevalence from t1 to t3 in the control group versus the difference from t1 to t3 in the intervention group. The differences in smoking behavior (smoking onset, quitting) between the two groups, as well as gender-specific effects, were studied as secondary outcomes.ResultsNone of the effects were significant due to a high loss-to-follow-up effect (52.26%, 786/1504). From baseline to the two follow-up time points, the prevalence of smoking increased from 3.1% to 5.2% to 7.2% in the control group and from 3.0% to 5.4% to 5.8% in the intervention group (number needed to treat [NNT]=68). Notable differences were observed between the groups for the female gender (4.2% to 9.5% for control vs 4.0% to 5.2% for intervention; NNT=24 for females vs NNT=207 for males), low educational background (7.3% to 12% for control vs 6.1% to 8.7% for intervention; NNT=30), and migrational background (students who claimed that at least one parent was not born in Germany) at the 12-month follow-up. The intervention appears to prevent smoking onset (NNT=63) but does not appear to initiate quitting.ConclusionsThe intervention appears to prevent smoking, especially in females and students with a low educational background.
Highlights
Most smokers start smoking during their early adolescence with the idea that smoking is glamorous; the problems related to vascular disease, lung cancer, chronic pulmonary disease and cataracts are too far in the future to fathom [1]
Notable differences were observed between the groups for the female gender (4.2% to 9.5% for control vs 4.0% to 5.2% for intervention; number needed to treat (NNT)=24 for females vs NNT=207 for males), low educational background (7.3% to 12% for control vs 6.1% to 8.7% for intervention; NNT=30), and migrational background at the 12-month follow-up
Despite the fact that effectiveness of inpatient smoking cessation was demonstrated in major trials [3] and was implemented in guidelines of almost all medical specialties [4], research has shown that physicians in Germany lack both the motivation and education to deliver smoking cessation advice [5,6,7,8], especially before the onset of chronic disease [6]
Summary
Most smokers start smoking during their early adolescence with the idea that smoking is glamorous; the problems related to vascular disease, lung cancer, chronic pulmonary disease and cataracts are too far in the future to fathom [1]. Education Against Tobacco (EAT) is a multinational network of medical students that aims to provide science-based tobacco prevention to a large number of adolescents, and sensitize prospective physicians to the importance of inpatient smoking cessation [11,12]. The broad availability of smartphones and adolescents' interest in their appearance [36] were harnessed to create the free 3D-photoaging smartphone app Smokerface [15] which animates the users’ selfies and reacts to touch (Multimedia Appendix 1) This app is downloaded 200 times per day and the current version of the app has a rating of 4.2/5 stars in the Playstore (Android, USA). The aim of this study was to provide the first randomized long-term evaluation of the optimized 2014 EAT curriculum involving a photoaging software for its effectiveness in reducing the smoking prevalence among 11-to-15-year-old pupils in German secondary schools. A recent quasi-experimental study showed significant short-term smoking cessation effects on 11-to-15-year-old adolescents
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