Reducing smoking in youth by a smoke-free school environment: A stratified cluster randomized controlled trial of Focus, a multicomponent program for alternative high schools.

Gitte Jakobsen,Charlotta Pisinger,Dina Danielsen,Susan Andersen,Marie Jensen,Johan Vinther,Teresa Holmberg,Rikke Krølner

doi:10.18332/tpc/133934

Abstract

Youth smoking remains a major challenge for public health. Socioeconomic position influences the initiation and maintenance of smoking, and alternative high school students are at particularly high risk. The school environment is an important setting to promote health, however there is a lack of evidence-based school intervention programs. This article presents the Focus study, which aims to test the implementation and effectiveness of a school-based intervention integrating1 a comprehensive school smoking policy [i.e. smoke-free school hours (SFSH)]2, a course for school staff in short motivational conversations3, school class-based teaching material4, an edutainment session5, a class-based competition, and6 access to smoking cessation support. Together these intervention components address students’ acceptability of smoking, social influences, attitudes, motivation, and opportunities for smoking. The setting is alternative high schools across Denmark, and the evaluation design is based on a stratified cluster randomized controlled trial comparing the intervention group to a control group. Outcome data is collected at baseline, midway, and at the end of the intervention period. Moreover, a detailed process evaluation, using qualitative and quantitative methods, is conducted among students, teachers, and school principals. The results from this trial will provide important knowledge on the effectiveness of a smoke-free school environment. The findings will lead to a better understanding of which policies, environments, and cognitions, contribute to preventing and reducing cigarette use among young people in a diverse and high-risk school setting, and illuminate which complementary factors are significant to achieve success when implementing SFSH.

Highlights

Tobacco use is the leading cause of preventable disease and premature death, and in Europe and North America, and smoking imposes a heavy health burden and labor loss[1]
The prevalence of smoking has been declining in Europe, which is mainly related to more restrictive national regulations and tobacco tax increases that have been introduced over time[2]
The challenges are to: 1) stop students to find alternative place to smoke; 2) avert students from developing counterproductive views about the purpose and legitimacy; 3) prevent smoking outside the school premises, as it is more visible and the temptation greater; and 4) prevent inconsistent enforcement by staff who undermine adequate implementation[17,46]. This will be investigated through the process evaluation. This is the first study with an RCT design that investigates the effect of smokefree school hours (SFSH) in alternative high schools (AHS) in Denmark

Summary

Introduction

Tobacco use is the leading cause of preventable disease and premature death, and in Europe and North America, and smoking imposes a heavy health burden and labor loss[1]. The prevalence of smoking has been declining in Europe, which is mainly related to more restrictive national regulations and tobacco tax increases that have been introduced over time[2]. In Denmark, the smoking prevalence has declined in all age groups except for adolescents and young adults[3]. The majority of smokers start smoking at an early age and it is estimated that smoking uptake peaks at 16 years[4]. Adolescents are susceptible to nicotine addiction[5]. Youth smoking remains a major challenge for public health.

Methods

Findings

Discussion

Conclusion