Abstract
BackgroundTo date, no school-based intervention has been proven to be effective in preventing adolescent smoking, despite continuing concern about smoking levels amongst young people in the United Kingdom. Although formal teacher-led smoking prevention interventions are considered unlikely to be effective, peer-led approaches to reducing smoking have been proposed as potentially valuable.Methods/designASSIST (A Stop Smoking in Schools Trial) is a comprehensive, large-scale evaluation to rigorously test whether peer supporters in Year 8 (age 11–12) can be recruited and trained to effect a reduction in smoking uptake among their fellow students. The evaluation is employing a cluster randomised controlled trial (RCT) design with secondary school as the unit of randomisation, and is being undertaken in 59 schools in South East Wales and the West of England. Embedded within the trial are an economic evaluation of the intervention costs, a process evaluation to provide detailed information on how the intervention was delivered and received, and an analysis of social networks to consider whether such a peer group intervention could work amongst schoolchildren in this age group.Schools were randomised to either continue with normal smoking education (n = 29 schools, 5562 students), or to do so and additionally receive the ASSIST intervention (n = 30 schools, 5481 students). No schools withdrew once the trial had started, and the intervention was successfully implemented in all 30 schools, with excellent participation rates from the peer supporters. The primary outcome is regular (weekly) smoking, validated by salivary cotinine, and this outcome has been obtained for 94.4%, 91.0% and 95.6% of eligible students at baseline, immediate post-intervention, and one-year follow-up respectively.DiscussionComprehensive evaluations of complex public health interventions of this scale and nature are rare in the United Kingdom. This paper demonstrates the feasibility of conducting cluster RCTs of complex public health interventions in schools, and how the rigour of such designs can be maximised both by thorough implementation of the protocol and by broadening the scope of questions addressed in the trial by including additional evaluative components.
Highlights
To date, no school-based intervention has been proven to be effective in preventing adolescent smoking, despite continuing concern about smoking levels amongst young people in the United Kingdom
Comprehensive evaluations of complex public health interventions of this scale and nature are rare in the United Kingdom
This paper demonstrates the feasibility of conducting cluster randomised controlled trial (RCT) of complex public health interventions in schools, and how the rigour of such designs can be maximised both by thorough implementation of the protocol and by broadening the scope of questions addressed in the trial by including additional evaluative components
Summary
Key issues in conduct of evaluation Particular issues arise in conducting such an evaluation in secondary school settings, which are likely to be of interest to researchers considering undertaking similar work. Schools' individual needs and circumstances have been taken into account as far as possible (for example if extra data collection staff would be required to provide support in schools with high numbers of students with learning difficulties) This planning stage started the process of building good working relationships with school staff who are acting as key contacts for the study teams throughout the trial. An alternative method of collecting data from absent students was tested during the immediate post-intervention data collection sweep, whereby school staff were given absent students' questionnaires and asked to arrange their completion and return (by 'freepost') This method was found to be less effective in maximising participation rates and its use has been discontinued. It is hoped that the clear exposition of the study design and methodology in this paper, reinforced as good practice by the high recruitment and participation rates being achieved, will help to inform planning and implementation of future schoolbased cluster randomised trials, and facilitate the design of comprehensive, rigorous evaluations of complex public health interventions
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
