Abstract
AimsTo investigate whether effects of the ASSIST (A Stop Smoking In Schools Trial) school‐based smoking prevention intervention diffused from students to the people they lived with.DesignSecondary analysis of a cluster‐randomized control trial (cRCT).SettingEngland and Wales.ParticipantsA total of 10 730 students aged 12–13 years in 59 schools assigned using stratified block randomization to the control (29 schools, 5372 students) or intervention (30 schools, 5358 students) condition.Intervention and comparatorThe ASSIST intervention involves 2 days of off‐site training of influential students to encourage their peers not to smoke during a 10‐week period. The control group continued with their usual education.MeasurementsThe outcomes were the proportion of students who self‐reported living with a smoker and the smoking status of each resident family member/caregiver. Follow‐up assessments were immediately after the intervention and at 1 and 2 years post‐intervention.FindingsThe odds ratio (OR) for living with a smoker in the intervention compared with the control groups was 0.86 [95% confidence interval (CI) = 0.72, 1.03] immediately after the intervention, OR = 0.84 (95% CI = 0.72, 0.97) at a 1‐year follow‐up and OR = 0.86 (95% CI = 0.75, 0.99) at 2‐year follow‐up. In a three‐tier multi‐level model with data from all three follow‐ups, student‐reported smoking by fathers (OR = 0.90, 95% CI = 0.80, 1.00), brothers (OR = 0.78, 95% CI = 0.67, 0.92) and sisters (OR = 0.80, 95% CI = 0.69, 0.92) was lower in the intervention compared with control group. Subgroup analyses by baseline smoking status suggested that these effects were more consistent with prevention of uptake than prompting cessation.ConclusionsA Stop Smoking In Schools Trial (ASSIST) school‐based smoking prevention intervention may have reduced the prevalence of smoking in people who lived with ASSIST‐trained students. This indirect transmission is consistent with the predictions of diffusion of innovations theory which underpins the design of ASSIST.
Highlights
A number of observational studies have found a concordance in smoking initiation, maintenance and cessation amongst peers.[1, 2, 3] In the Framingham Heart Study, social network data collected over a 29-year period showed smoking cessation by a spouse decreased a person's chances of smoking by 67%, a sibling by 25%, and a friend by 36%. 1 There has, been less examination on whether intervention effects are transmitted
The A Stop Smoking in Schools Trial (ASSIST) intervention may have reduced the prevalence of smoking in people who lived with students
This indirect transmission is consistent with the predictions of diffusion of innovations theory which underpins the design of ASSIST
Summary
A number of observational studies have found a concordance in smoking initiation, maintenance and cessation amongst peers.[1, 2, 3] In the Framingham Heart Study, social network data collected over a 29-year period showed smoking cessation by a spouse decreased a person's chances of smoking by 67%, a sibling by 25%, and a friend by 36%. 1 There has, been less examination on whether intervention effects are transmitted. ASSIST is a school-based smoking prevention intervention, found to be effective in reducing the prevalence of weekly smoking in students aged 12-13 years.[5] In ASSIST, influential students are identified and trained to diffuse non-smoking information and norms, principally through conversations with their friends. The intervention is delivered in many areas of the United Kingdom, with anecdotal reports from the team that trains ASSIST intervention delivery staff that students have conversations with their family about smoking, suggesting there may be a potential spill over effects. In the cluster randomised controlled trial (cRCT) of the ASSIST intervention, student reports on the smoking status of family/caregivers were collected, providing an unusual opportunity to explore whether intervention effects are diffused beyond the original intended group (students) to family members/caregivers. In sub-group analyses by families/caregivers baseline smoking status we explored potential effects on both smoking uptake and cessation
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