School-based Smoking Prevention Programs Research Articles

Factors influencing the overall satisfaction of teachers participating in a nationwide school-based smoking prevention program in Korea.

Numerous studies of school-based smoking prevention programs (SSPPs) exist; however, most have been conducted from the students' perspective, and insufficient research has explored teachers' perceptions. Our study aimed to identify factors affecting overall satisfaction and operational status from the perspective of teachers participating in the SSPP. This is a cross-sectional study analyzing data from a survey regarding the operation of an SSPP conducted by the Korea Health Promotion Institute in 2022. The study sample comprised 669 teachers involved in the SSPP: 215 from elementary schools, 212 from middle schools, and 242 from high schools. To identify factors influencing teachers' overall satisfaction, independent variables were categorized into three types of factors: personal, school, and teacher perceptions. Multiple linear regression analysis was performed for each factor to test the independent association. For elementary school teachers, as the necessity of smoking prevention and cessation education (β=0.292; 95% CI: 0.182-0.382) increased, the overall satisfaction with the operation of the SSPP significantly improved. Similarly, for middle school teachers, as the necessity of smoking prevention and cessation education (β=0.231; 95% CI: 0.104-0.336) increased, the overall satisfaction significantly improved. Conversely, for high school teachers, the effectiveness (β=0.347; 95% CI: 0.184-0.520) was the variable that significantly improved overall satisfaction with the SSPP operation. The variables affecting teacher satisfaction across all school levels were the necessity of smoking prevention and cessation education, the effectiveness of the SSPP, and its impact on smoking cessation among smoking students, all of which belonged to the teacher perceptions factor. Smoking education in schools requires teachers to play a crucial role. Among participating teachers, overall satisfaction with SSPP operations and the influencing factors differed according to school level, highlighting the importance of careful consideration to establish a more effective operational environment tailored to each school level.

Selection homophily and peer influence for adolescents’ smoking and vaping norms and outcomes in high and middle-income settings

The MECHANISMS study investigates how social norms for adolescent smoking and vaping are transmitted through school friendship networks, and is the first study to use behavioral economics methodology to assess smoking-related social norms. Here, we investigate the effects of selection homophily (the tendency to form friendships with similar peers) and peer influence (a social process whereby an individual’s behavior or attitudes are affected by peers acting as reference points for the individual) on experimentally measured smoking and vaping norms, and other smoking outcomes, in adolescents from high and middle-income settings. Full school year groups in six secondary schools in Northern Ireland (United Kingdom) and six secondary schools in Bogotá (Colombia) participated (n = 1344/1444, participation = 93.1%, target age 12–13 years). Over one semester, pupils received one previously tested school-based smoking prevention program (ASSIST or Dead Cool). Outcomes included experimentally measured smoking/vaping norms, self-report and objectively measured smoking behavior, and self-report smoking norms, intentions, susceptibility, attitudes, and psycho-social antecedents. We investigated selection homophily and peer influence using regressions and SIENA modeling. Regression results demonstrate lagged and contemporaneous selection homophily (odds ratios [ORs] = 0.87–1.26, p ≤ 0.01), and peer influence effects for various outcomes from average responses of friends, school classes, or school year groups (standardized coefficients [βs] = 0.07–0.55, ORs = 1.14–1.31, p ≤ 0.01). SIENA models showed that comparable proportions of smoking/vaping-based similarity between friends were due to selection homophily (32.8%) and peer influence (39.2%). A higher percentage of similarity between friends was due to selection homophily and/or peer influence for ASSIST schools compared to Dead Cool. Selection homophily was also more important in Bogotá, whilst peer influence was stronger in Northern Ireland. These findings support using social norms strategies in adolescent smoking prevention interventions. Future research should consider selection homophily and social influence jointly, and examine whether these findings translate to other high and low-middle-income settings with varying cultures and norms.

Evaluation of a school-based, experiential-learning smoking prevention program in promoting attitude change in adolescents.

INTRODUCTIONSchool-based tobacco control programs exhibit great variety. Our study aimed to evaluate the effectiveness of an experiential learning smoking prevention program in facilitating knowledge acquisition, forging healthy attitudes, and decreasing intention to smoke.METHODSA school-based intervention-control study was implemented during the 2016–2017 academic year among middle-school students in Athens, Greece. The experiential learning intervention was delivered using an interdisciplinary approach, bridging excerpts from ancient classical Greek myths, Aesop fables and ancient classical literature (Aristotle, Herodotus, Plutarch, Xenophon, Homer’s Epics), with their decoded archetypal symbols applied in a smoking and tobacco control paradigm. An anonymous self-administered questionnaire was used at baseline and at follow-up at 3 months to evaluate program effectiveness.RESULTSA total of 351 students participated in our study; 181 (51.6%) in the intervention group and 170 (48.4%) in the control group. The mean age of student participants was 13 years (SD=0.96). Students in the intervention group were more likely to improve their knowledge of the adverse effects of smoking, develop attitudes against smoking and report a negative intention to smoke in the first year following the intervention, compared to the control group.CONCLUSIONSThis study provides evidence that school-based experiential learning smoking prevention programs improve smoking-related knowledge, enhance anti-smoking attitudes and reinforce negative intentions toward tobacco products.

Cultural adaptation of two school-based smoking prevention programs in Bogotá, Colombia

Smoking prevention among adolescents is a public health challenge that is even more significant in low- and middle-income countries where local evidence is limited and smoking rates remain high. Evidence-based interventions could be transferred to low- and middle-income country settings but only after appropriate cultural adaptation. This paper aims to describe the process of the cultural adaptation of two school-based smoking prevention interventions, A Stop Smoking in Schools Trial and Dead Cool, to be implemented in Bogotá, Colombia. A recognized heuristic framework guided the cultural adaptation through five stages. We conducted a concurrent nested mixed-methods study consisting of a qualitative descriptive case study and a quantitative pre- and post quasi-experiment without a control. Contextual, content, training, and implementation modifications were made to the programs to address cultural factors, to maintain the fidelity of implementation, and to increase the pupils’ engagement with the programs. Modifications incorporated the suggestions of stakeholders, the original developers, and local community members, whilst considering the feasibility of delivering the programs. Involving stakeholders, original program developers, and community members in the cultural adaptation of evidence-based interventions is essential to properly adapt them to the local context, and to maintain the fidelity of program implementation.

Experiences of the First Year Implementation of a Nationwide School-Based Smoking Prevention Program in Korea.

Encouraged by the Framework Convention on Tobacco Control, Korea has implemented a nationwide School-based Smoking Prevention Program (SSPP) to reduce the prevalence of youth smoking. This qualitative study explored the school contexts of launching the SSPP in Seoul, Korea. Five focus groups were studied with 29 lead teachers in charge of the SSPP. Thematic analysis reveals three key findings. First, while infrastructure was insufficiently prepared due to the abrupt implementation, lead teachers agreed on the purpose of the SSPP. However, they perceived the program as myopic in only targeting smoking students and spending the mandatory budgets as a burdensome task. Second, the SSPP increased experience-based activities, influenced smoking family members, and created a smoke-free school environment. Third, to ensure more effective implementation, school principals should support inducing staff engagement. The teachers also maintained that the SSPP must be institutionalized as part of regular curricula with standardized books. For a more meaningful impact, the SSPP needs instructors and counselors to support smoking cessation programs that reflect school contexts. The teachers urged tobacco prevention measures at community, policy, and society levels. This study provides insights into a nationwide approach to initiating school-based smoking prevention program to achieve a tobacco-free generation.

School-based Smoking Prevention in Adolescents in Developing Countries: A Literature Review

BACKGROUND: The incidence of diseases due to tobacco consumption has increased, especially in developing countries, where around 90% of smokers start consuming tobacco before the age of 18 years. School-based smoking prevention programs can prevent smoking among adolescents. This program is often implemented in developing countries because it is considered cost-effective, and the results are promising. At present, the school-based smoking prevention program is expanding with many methods.
 AIM: This study aims to describe the various types of school-based smoking prevention interventions in developing countries.
 METHODS: This research applied a literature review approach with the process of collecting data through the Science Direct, ProQuest, EBSCO, and NCBI databases. Search literature was by keyword “smoking AND prevention AND school-based AND adolescent AND randomized controlled trials or randomized controlled trials.” Inclusion criteria used for data collection were studies on school-based smoking prevention interventions, full text, and journal publishing from 2015 to 2019, using English. The research conducted in developing countries and prevention interventions was not only for smoking in the traditional way but also in the form of other than the consumption of tobacco such as cigars, smokeless tobacco, and hookah or shisha. Exclusion criteria in this review were publication articles not in the form of original publications such as letters to editors, only abstracts, and books.
 RESULTS: The literature search results found 594 journals with details of 99 Science direct journals, ProQuest 385 journals, NCBI 85 journals, and 25 EBSCO journals. The entire database belongs to the inclusion criteria and only seven articles meet the requirements. The results of the analysis revealed that interventions conducted in school-based smoking prevention programs for adolescents in developing countries included the application of the anti-smoking curriculum, behavior change intervention (BCI), and peer education.
 CONCLUSION: Interventions considered useful for preventing smoking in adolescents are the anti-smoking curriculum, BCI, and peer education.

Implementation of a peer-led school based smoking prevention programme: a mixed methods process evaluation

BackgroundSmoking prevention programmes that reach adolescents before they experiment with tobacco may reduce the prevalence of tobacco use. ASSIST is a school-based, peer-led smoking prevention programme that encourages the diffusion of non-smoking norms among secondary school students (aged 12–13), and was shown in a randomised control trial (conducted 2001–2004) to reduce the prevalence of weekly smoking. This paper presents findings from a process evaluation of the implementation of ASSIST in Scotland in 2014–2017. It examines acceptability and fidelity of implementation and explores the context of message diffusion between peers.MethodsMixed method implementation study with students (n = 61), school staff (n = 41), trainers (n = 31) and policy and commissioning leads (n = 17), structured observations (n = 42) and student surveys (n = 2130).ResultsASSIST was delivered with a high degree of fidelity to the licensed manual with all elements of the programme implemented. Student survey findings indicated that the frequency of conversations about smoking increased over the ASSIST delivery period (18% at baseline, 26% at follow-up), but student recollection of conversations about smoking with peer supporters was low (9%). The delivery context of ASSIST was important when considering perceptions of message diffusion. In the study schools, survey findings showed that 0.9% (n = 19) of participants were regular smokers (at least once a week), with nine out of ten (89.9%, n = 1880) saying they had never smoked. This very low prevalence may have affected when and with whom conversations took place. Study participants indicated that there were wider benefits of taking part in ASSIST for: peer supporters (i.e. personal and communication skills); schools (an externally delivered health promotion programme that required minimal resource from schools); and communities (via communication about the risks of smoking to wider social networks).ConclusionsASSIST in Scotland was delivered with a high degree of fidelity to the licensed programme and was acceptable from the perspective of schools, students and trainers. Targeting ASSIST in deprived areas with higher youth smoking prevalence or in other countries where youth smoking rates are rising or higher than in Scotland may be particularly relevant for the future delivery.

A Smoking Prevention Program Delivered by Medical Students to Secondary Schools in Brazil Called "Education Against Tobacco": Randomized Controlled Trial.

BackgroundSmoking is the largest preventable cause of mortality in Brazil. Education Against Tobacco (EAT) is a network of more than 3500 medical students and physicians across 14 countries who volunteer for school-based smoking prevention programs. EAT educates 50,000 adolescents per year in the classroom setting. A recent quasi-experimental study conducted in Germany showed that EAT had significant short-term smoking cessation effects among adolescents aged 11 to 15 years.ObjectiveThe aim is to measure the long-term effectiveness of the most recent version of the EAT curriculum in Brazil.MethodsA randomized controlled trial was conducted among 2348 adolescents aged 12 to 21 years (grades 7-11) at public secondary schools in Brazil. The prospective experimental design included measurements at baseline and at 6 and 12 months postintervention. The study groups comprised randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes in the same schools (no intervention). Data were collected on smoking status, gender, social aspects, and predictors of smoking. The primary endpoint was the difference in the change in smoking prevalence between the intervention group and the control group at 12-month follow-up.ResultsFrom baseline to 12 months, the smoking prevalence increased from 11.0% to 20.9% in the control group and from 14.1% to 15.6% in the intervention group. This difference was statistically significant (P<.01). The effects were smaller for females (control 12.4% to 18.8% vs intervention 13.1% to 14.6%) than for males (control 9.1% to 23.6% vs intervention 15.3% to 16.8%). Increased quitting rates and prevented onset were responsible for the intervention effects. The differences in change in smoking prevalence from baseline to 12 months between the intervention and control groups were increased in students with low school performance.ConclusionsTo our knowledge, this is the first randomized trial on school-based tobacco prevention in Brazil that shows significant long-term favorable effects. The EAT program encourages quitting and prevents smoking onset, especially among males and students with low educational background.Trial RegistrationClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021International Registered Report Identifier (IRRID)RR2-10.2196/resprot.7134

A randomized controlled efficacy trial of a smoking prevention programme with Grade 8 students in high schools

The study undertook a Level 3 efficacy trial of a smoking prevention programme in Grade 8 high-school classrooms. A smoking prevention programme, ‘Dead Cool’, was tested in a randomized controlled trial. 17 Grade 8 classes were randomly assigned to intervention or control arms of the trial. The intervention was a cooperative learning-based intervention of five, 40 min lessons delivered by teachers, but designed by Cancer Focus NI. The primary outcome was smoking as measured by carbon monoxide (CO) in exhaled breath. Measurements of CO were undertaken pre-test, immediately post-test and three months after the intervention. Multi-level modelling indicated the programme prevented smoking initiation in Grade 8 students. Implications for research and design of school-based smoking prevention programmes are discussed.

"GiochiAMO": a school-based smoking and alcohol prevention program for children - a pilot randomized field trial. Part 2.

Young people who begin to smoke at an early age are at a higher risk of becoming occasional or regular smokers and establishing a premature dependence. It is fundamental to act as soon as possible, from very early childhood, to prevent harmful behaviors for health such as smoking and drinking alcohol. Young people must be encouraged to adopt healthy lifestyles. The aim of the study is two-fold. First, increasing the knowledge about the negative health effects of cigarette smoking and alcohol consumption among children aged 9-10 years; and second, to introduce and reinforce life skills in order to learn how to tackle social influences that encourage children to smoke and to drink alcohol. A pilot randomized field trial was conducted in May-June 2017. Four primary school classes in Rome were randomized to either the intervention or the control group. Both groups participated in an oral presentation about the risks and consequences of smoking and alcohol consumption, and the concept of life skills. The intervention group participated in two gaming sessions, each lasting 1.5 hours. Children were involved in six games aiming to deliver and reinforce knowledge about the target themes of the study. A 21 multi-response questions questionnaire was handed out to both groups at the beginning and at the end of the study. Eleven questions were about smoking; five questions about alcohol; five questions about life skills. Each question item included one correct answer. For each domain, a score was computed (total; smoking; alcohol; life skills). 67 children participated in the study (34 in the intervention and 33 in the control group). Univariate analyses showed significant differences among the intervention group before and after the intervention for total score (p<0.001), smoke score (p<0.001), and life skills score (p=0.003). No significant differences among the intervention group before and after the intervention were reported for alcohol score (p=0.076). Regarding the control group univariate analysis showed significant differences in total score (p=0,001) and life skills score (p=0.005). Multivariate analysis revealed that enrollment in the intervention was the only variable that had a significant positive influence on smoking knowledge score (beta=1.070, p=0.05). This pilot study shows that the intervention was effective among the intervention group for all the scores: total score, smoke score and life skills score, but ineffective for alcohol. Overall, the combination of a presentation and games was effective in increasing life skills knowledge.

Fourteen years of ‘Smokefree Class’, a school-based smoking prevention programme in Catalonia that adapts to new forms of consumption.

Fourteen years of ‘Smokefree Class’, a school-based smoking prevention programme in Catalonia that adapts to new forms of consumption.

Facilitators and barriers to the delivery of school-based smoking prevention interventions for children and young people: a protocol for a systematic review of qualitative studies

BackgroundDespite a decline in child and adult smoking prevalence, young people who smoke (even occasionally) can rapidly become addicted to nicotine, with most adult smokers initiating smoking before they are 18. Schools have long been a popular setting to deliver youth smoking prevention interventions, but evidence of the effectiveness of school-based prevention programmes is mixed, and outcomes vary by the type of programme delivered. Existing systematic reviews that explore the factors contributing to the success or failure of school-based smoking prevention programmes often exclude qualitative studies, due to a focus on intervention effectiveness which qualitative research cannot answer. Instead, qualitative research is focussed on the experiences and perceptions of those involved in the programmes. This systematic review will address this gap by updating a 2009 review to examine qualitative studies. The aim is to generate deeper insight to help target resources which have the potential to save lives by preventing smoking initiation among children and young people.MethodsThis systematic review will be searching the following databases: the Cochrane Library, MEDLINE, EMBASE, PsycINFO, HMIC, ERIC, ASSIA, Web of Science and CINAHL. In order to identify additional references, we will consult the reference lists of a sample of systematic reviews and search relevant organizational websites in order to identify appropriate grey literature. The search strategy will include key words and database-specific subject headings relating to smoking, children and young people, health promotion and school. Authors will independently screen, assess data quality and extract data for synthesis. Study findings will be synthesised thematically using ‘best-fit framework syntheses’. This allows for an existing set of themes to be used as a starting point to map or code included studies. These themes are then adapted as coding takes place to accommodate new emerging themes.DiscussionThis review will focus on qualitative studies that seek to examine the barriers and facilitators to the delivery of school-based smoking prevention programmes in order to inform the design of future theory-based interventions in schools to prevent children and young people from smoking.Systematic review registrationPROSPERO CRD42014015483

Effect of school based smoking prevention program in Korea

Effect of school based smoking prevention program in Korea

Process evaluation and challenges of implementation of a school-based waterpipe tobacco smoking prevention program for teens in Lebanon.

INTRODUCTIONWaterpipe tobacco smoking is increasing globally particularly among youth. In Lebanon, the high prevalence of waterpipe tobacco smoking among younger age groups calls for immediate intervention particularly given its negative health effects. To date, such interventions have rarely been implemented or evaluated.METHODSThis manuscript describes the process evaluation of a school-based intervention to prevent/delay waterpipe tobacco smoking among 6th and 7th graders (n=844) in Lebanon. Process evaluation documents whether an intervention is implemented as planned, and guides understanding of the relationship between the intervention activities and outcomes. The intervention was carried out over 5 months during 2011-2012 on school premises and during school hours, using a participatory approach. The ten intervention sessions included knowledge, skills and a social promise. The process evaluation assessed fidelity, dose delivered, dose received, reach, satisfaction, and the influence of context. Tools included observation and satisfaction forms, attendance log sheets, focus group discussions, and daily journal entries.RESULTSThe majority of participants (87.2%) attended at least 75% of the sessions. Results indicate high fidelity of implementation; 72.3% of the activities were rated by facilitators to be fully implemented - with high participant satisfaction; 89.5% of children chose a happy face to express their rating of the session. Facilitators rated children’s participation as ‘positive and active’ in 77.9% of the sessions.CONCLUSIONSMain challenges to implementation were contextual at the country and school level, and related to local pro social norms around waterpipe tobacco smoking. The experience of this intervention confirms the critical importance of context in program implementation.

School-Based Smoking Prevention Programs for Middle School Students in Nowshahr- Iran: a Randomized Controlled Trial

Background: Smoking among youths is a main public health concern, and detecting predictors of smoking is essential for designing preventive programs. Any interventional program should plan with highlighting on behavioral change models and based on operative interventional program. So, this study aimed to investigate school-based smoking prevention programs for middle school students in Nowshahr, Iran.Materials and Methods: A quasi-experimental study was performed with 280 male students aged 15-17 years selected by multistage sampling. For this purpose, 6 middle schools were randomly recruited from male students in Nowshahr- Iran. Then, 140 students were randomly chosen for each the experimental and the control groups. After pretest, educational program based on Health Belief Model were performed in experimental group. Also, post-test was applied four months after interventional program in both experimental and control group.Results: Based on the results, the prevalence of smoking was higher at age 14 old in both experimental (38.7%) and control (30 %) groups. About 35% of participants in the experimental group and 33.6% in control group had smoker father. Additionally, 10% in experimental group and 7.8% in control group had smoker mother. Most main cause for smoking in 57.9% of the experimental group and 52.63% of the control group was reducing anxiety. Results also shown that there was a significant difference between students in the experimental and control groups after performing educational program in the mean scores of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and preventive behaviors of smoking (P < 0.05).Conclusion: By performing educational program, it was found that the prevalence of cigarette smoking was decreased in the intervention group. So, with a better understanding of factors affecting on this complex behavior (cigarette smoking), it can be a valuable phase to decrease rate of costs and improve adolescents' health outcomes.

Effects of a randomized controlled trial to assess the six-months effects of a school based smoking prevention program in Saudi Arabia

ObjectiveTo examine the efficacy of a smoking prevention program which aimed to address smoking related cognitions and smoking behavior among Saudi adolescents age 13 to 15. MethodA randomized controlled trial was used. Respondents in the experimental group (N=698) received five in-school sessions, while those in the control group (N=683) received no smoking prevention information (usual curriculum). Post-intervention data was collected six months after baseline. Logistic regression analysis was applied to assess effects on smoking initiation, and linear regression analysis was applied to assess changes in beliefs and analysis of covariance (ANCOVA) was used to assess intervention effects. All analyses were adjusted for the nested structure of students within schools. ResultsAt post-intervention respondents from the experimental group reported in comparison with those from the control group a significantly more negative attitude towards smoking, stronger social norms against smoking, higher self-efficacy towards non-smoking, more action planning to remain a non-smoker, and lower intentions to smoke in the future. Smoking initiation was 3.2% in the experimental group and 8.8% in the control group (p<0.01). ConclusionThe prevention program reinforced non-smoking cognitions and non-smoking behavior. Therefore it is recommended to implement the program at a national level in Saudi-Arabia. Future studies are recommended to assess long term program effects and the conditions favoring national implementation of the program.

The Role of Substance-Specific Skills and Cognitions in the Effectiveness of a School-Based Prevention Program on Smoking Incidence

"Eigenständig werden 5+6" (Becoming independent 5+6) is a German school-based smoking prevention program that draws on social competence and social influence approaches. It was investigated whether the program's effect on smoking onset is mediated by substance-specific skills and cognitions such as knowledge, attitudes/risk perception, normative expectations, resistance skills, and refusal self-efficacy. Multiple mediation analyses revealed a statistically significant total indirect effect that accounted for 30.8% of the total effect. When considered separately, significant indirect effects could be found for normative expectations concerning peer smoking and the resistance skill of saying 'no'. Between these two mediators, the percentage of total effect mediated varied between 9.8% and 10.3%. Results of the current study emphasize the importance of substance-specific skills and cognitions in the effectiveness of school-based programs combining social competence and social influence curricula in preventing adolescent smoking onset.

Systematic review of school-based interventions to prevent smoking for girls.

BackgroundThe purpose of this review is to study the effect of school-based interventions on smoking prevention for girls.MethodsWe performed a systematic review of articles published since 1992 on school-based tobacco-control interventions in controlled trials for smoking prevention among children. We searched the databases of PubMed, Embase, Web of Science, The Cochrane Databases, CINAHL, Social Science s, and PsycInfo. Two reviewers independently assessed trials for inclusion and quality and extracted data. A pooled random-effects estimate was estimated of the overall relative risk.ResultsThirty-seven trials were included, of which 16 trials with 24,210 girls were included in the pooled analysis. The overall pooled effect was a relative risk (RR) of 0.96 (95 % confidence interval (CI) 0.86-1.08; I2=75 %). One study in which a school-based intervention was combined with a mass media intervention showed more promising results compared to only school-based prevention, and four studies with girl-specific interventions, that could not be included in the pooled analysis, reported statistically significant benefits for attitudes and intentions about smoking and quit rates.ConclusionsThere was no evidence that school-based smoking prevention programs have a significant effect on preventing adolescent girls from smoking. Combining school-based programs with mass media interventions, and developing girl-specific interventions, deserve additional study as potentially more effective interventions compared to school-based-only intervention programs.Systematic review registrationPROSPERO CRD42012002322Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0082-7) contains supplementary material, which is available to authorized users.

Tobacco Use Prevention by Integrating Inside and Outside of School Based Programs: A Systematic Review Article.

Experience of tobacco use in early ages will increase probability of addiction to nicotine therefore, efficient tobacco control programs for teenagers are crucial. This study was conducted to recognize elements of successful integrated inside and outside of school based smoking prevention programs. MeSH terms and related keywords were used to search PubMed, Cochrane, Medline, EMBASE, ERIC, SID databases from inception to 29th October 2013. Trials with random and non-random designs, systematic reviews and cohort studies that assessed or reported application of integrated tobacco control programs were included. Quality of the retrieved publications was checked independently by the authors and any disagreement was resolved by consensus. Among the 745 identified publications, only 15 studies had the inclusion criteria with a considerable methodological heterogeneity. While, precise out-come of integrated out of school/school-based interventions were not percepti-ble but this study's findings implied that outside of school intervention could strengthen school-based tobacco prevention programs. No study was found to examine school-based interventions integrated with primary health care such as anti-tobacco consultations, high-risk students screening and their referral to special centers. Integration of outside and inside of school-based programs may boost probability of obtaining favorable outcomes and success rate in practice.

Risk and Protective Factors for Cigarette Use in Young Adolescents in a School Setting: What Could Be Done Better?

Smoking among Malaysian adolescents remains a public health concern despite concerted efforts in tobacco control. The aims of this study were to examine the prevalence and determinants of current-smoking status in young adolescents. This cross sectional study used the first round of the Malaysian Health and Adolescents Research Team’s prospective cohort study. It was conducted in three States of the Central and Northern regions of Peninsular Malaysia between March and May 2012. The study used the multistage stratified sampling design. A total of 1,342 adolescents of both sexes, aged 12-13 years, were sampled from randomly selected urban and rural national schools. Information on current smoking status and associated factors were collected by a self-administered, pre-tested, validated, structured questionnaire. Seven percent of the samples were current-smokers; the majority (62%) of them started smoking at the age of 11 years or below. The prevalence of current smoking was significantly higher in males (odds ratio [OR] = 2.37; 95% CI: 1.46, 3.84), those who were influenced by smoker friends (OR = 8.35; 95% CI: 4.90, 14.25), who were unaware of the health risks of smoking (OR =1.85; 95% CI: 1.02, 3.36) and who reported a lack of satisfaction about their overall life (OR =3.26; 95% CI: 1.73, 6.12). The study findings provide valuable information to strengthen the existing school-based smoking prevention program through integration of social competence and social influence curricula. The program should empower the young adolescents to refuse tobacco offers, to overcome social influences and to resist peer pressure to avoid starting smoking. Particular focuses to include mental health service to prevent both emotional and behavioural problems are needed.