Smoking Prevention Interventions Research Articles

Long-term effectiveness of a combined student-parent and a student-only smoking prevention intervention among 7th grade school children in Berlin, Germany.

In Germany, the smoking prevalence among adolescents is among the highest in Europe. Our aim was to evaluate the long-term effectiveness of a combined student-parent and a student-only smoking prevention programme to reduce the smoking prevalence among 7th grade students in Berlin. Three-armed cluster-randomized controlled trial (RCT). Schools as cluster units were randomized into (i) student intervention, (ii) combined student-parent intervention or (iii) control group, with follow-up after 12 and 24months. High schools and integrated secondary schools in Berlin, Germany. Seventh grade students aged 11-16years. We included 47 schools, 161 classes and 2801 students [50.1% girls, mean age±standard deviation (SD)=13.0±0.6years]. The primary outcome was self-reported regular smoking (at least one cigarette per day) after 24months (point prevalence). Further self-reported outcomes were other smoking behaviours as well as parental rules and attitudes towards smoking. Comparisons were calculated as odds ratios (OR) with 95% confidence intervals (CI). At baseline, 2.3% of the students reported that they smoked regularly. After 24months, 7.8% and 7.0% were regular smokers in the student-only intervention and the student-parent intervention, respectively, compared with 10.1% in the control group. The OR for being a regular smoker was 0.81 (0.34-1.92) for the student-parent intervention versus control, 0.95 (CI=0.41-2.22) for the student-only intervention versus control and 0.85 (0.38-1.89) for student-parent intervention versus student-only intervention. A combined student-parent smoking prevention intervention delivered via secondary schools in Berlin, Germany did not result in a statistically significant reduction in regular smoking compared with a control group or a student-only intervention. The student-only intervention did not result in a significant reduction in regular smoking compared with the control group.

Does High Tobacco Consumption Cause Psychological Distress? A Mendelian Randomization Study.

Increasing evidence suggests that smoking influences mental health negatively. This study investigated whether high tobacco consumption is causally related to psychological distress in a Mendelian randomization design, using a variant in the nicotine acetylcholine receptor gene CHRNA3-known to influence individual tobacco consumption-as instrumental variable for tobacco consumption. Data from 90 108 participants in the Copenhagen General Population Study was used. Exposures included self-reported cigarettes/day and pack years and the CHRNA3 rs1051730 genotype as instrumental variable for tobacco consumption. Three dimensions of psychological distress were studied: Stress, fatigue, and hopelessness. Analyses with the CHRNA3 genotype were stratified by smoking status. Self-reported amount of smoking was associated with all three dimensions of psychological distress. For instance among participants smoking 30 cigarettes/day or more, the odds ratio (OR) for stress was 1.67 (95% confidence interval [CI] 1.47-1.89) compared to never-smokers. Corresponding ORs for fatigue and hopelessness were 2.18 (95% CI 1.92-2.47) and 3.08 (95% CI 2.62-3.62). Among current smokers, homozygotes and heterozygotes for the CHRNA3 genotype had higher tobacco consumption than noncarriers. Nevertheless, the CHRNA3 genotype was not associated with psychological distress neither in current nor in former or never-smokers. For instance among current smokers, the OR for stress was 1.02 (95% CI 0.91-1.15) among homozygotes compared to noncarriers of the CHRNA3 genotype. Though a strong association between tobacco consumption and psychological distress was found, there was no clear evidence that high tobacco consumption was causally related to psychological distress. Smoking is associated with several mental health outcomes and smoking cessation is associated with improved mental health. Causality in the association between smoking and mental health is difficult to establish using observational data. Using a genotype known to influence tobacco consumption as instrumental variable for amount of smoking, we found no clear evidence of a direct causal path between high tobacco consumption and psychological distress. Whatever causes the strong association between tobacco consumption and psychological distress, the co-occurrence is important to consider both in interventions for smoking prevention and cessation.

Impact and Acceptability of the Coach and Teacher Training Within a School-Based Sport-for-Health Smoking Prevention Intervention: SmokeFree Sports

ABSTRACTThis study evaluated the impact and acceptability of a three-hour bespoke training workshop for sports coaches and teachers to subsequently deliver a sport-for-health smoking prevention intervention in primary schools. Questionnaires were completed pre- and post-training by both teachers (N = 24) and coaches (N = 8), and post-intervention by teachers. Interviews were also conducted with coaches (N = 7) and teachers (N = 12). Both groups displayed a significant increase in intervention knowledge and delivery self-efficacy from pre- to post-training, which was maintained at post-intervention for teachers. Data suggest that a brief training workshop is acceptable to practitioners and fosters confidence to implement a sport-for-health smoking prevention program.

Mediating factors of a school-based multi-component smoking prevention intervention: the LdP cluster randomized controlled trial.

The aim of this study was to investigate factors mediating the effects of Luoghi di Prevenzione (LdP) smoking prevention intervention based on social competence and social influence approaches, and characterized by peer-led school-based interventions, out-of-school workshops, school lessons, and by enforcing the school anti-smoking policy. Students aged 14-15 years in 13 secondary schools in Reggio Emilia, Italy (989 students) were randomly assigned to the LdP intervention or a control condition. The baseline and follow-up surveys were carried out before and 18 months after the intervention, respectively.The outcomes were cigarette daily and frequent smoking and smoking at school. Multilevel multiple mediation analyses were carried out in order to study effect mediation. The mediators were normative perception, positive and negative beliefs, refusal skills for smoking, social acceptability perception, risk perception, smoking knowledge and awareness about dangers of second-hand smoking.The intervention effects were explained by the social influence component through the mediator refusal skills for smoking. The programme also showed to significantly increase risk perception and smoking knowledge, even though these mediators had no effect on smoking. Moreover, LdP intervention directly reduced smoking in school areas. Future interventions should maintain and strengthen the LdP social influence component and the part regarding the school anti-smoking policy.

Interventions for waterpipe tobacco smoking prevention and cessation: a systematic review.

Waterpipe tobacco smoking is growing in popularity despite adverse health effects among users. We systematically reviewed the literature, searching MEDLINE, EMBASE and Web of Science, for interventions targeting prevention and cessation of waterpipe tobacco smoking. We assessed the evidence quality using the Cochrane (randomised studies), GRADE (non-randomised studies) and CASP (qualitative studies) frameworks. Data were synthesised narratively due to heterogeneity. We included four individual-level, five group-level, and six legislative interventions. Of five randomised controlled studies, two showed significantly higher quit rates in intervention groups (bupropion/behavioural support versus placebo in Pakistan; 6 month abstinence relative risk (RR): 2.3, 95% CI 1.4–3.8); group behavioural support versus no intervention in Egypt, 12 month abstinence RR 3.3, 95% CI 1.4–8.9). Non-randomised studies showed mixed results for cessation, behavioural, and knowledge outcomes. One high quality modelling study from Lebanon calculated that a 10% increase in waterpipe tobacco taxation would reduce waterpipe tobacco demand by 14.5% (price elasticity of demand −1.45). In conclusion, there is a lack of evidence of effectiveness for most waterpipe interventions. While few show promising results, higher quality interventions are needed. Meanwhile, tobacco policies should place waterpipe on par with cigarettes.

Nicotine receptor partial agonists for smoking cessation.

Nicotine receptor partial agonists for smoking cessation.

Operation Smoke Storm: effectiveness of a school-based smoking prevention intervention providing insight into the tobacco industry

BackgroundAssessment of the US Truth campaign showed that mass media campaigns informing children about tobacco industry practices are effective in preventing smoking uptake. The aim of this study was to assess the potential effectiveness of a school-based intervention, based on the premise of Truth, in reducing ever smoking and susceptibility to smoking among children in the UK. MethodsData come from a pilot study intended to test the acceptability of the intervention and ease of delivery, and to provide preliminary evidence of effectiveness before further assessment in a randomised trial. 445 students in two schools in the East Midlands, UK, completed anonymous questionnaires in Year 7 (ie, aged 11–12 years) and Year 8 (12–13), before and after receiving the Operation Smoke Storm intervention. This intervention consisted of three teacher-led sessions that combined interactive paper-based and audio-visual components in Year 7 and one booster session in Year 8. We used multilevel logistic regression (students nested within schools), adjusted for confounders, to compare the odds of smoking and susceptibility at follow-up in students who received Operation Smoke Storm with 1692 students in eight local schools who were asked identical questions about smoking behaviour as part of another survey but who did not receive the intervention. The study was approved by the University of Nottingham Medical School Research Ethics Committee (reference C13122012 CHS EPH Smoking). FindingsPrevalence of ever smoking or susceptibility to smoking was similar in intervention and control schools in Year 7. In Year 8, 34 students (7·6%) who received Operation Smoke Storm reported ever smoking and 111 (24·9%) reported susceptibility to smoking; 175 students (10·3%) who did not receive Operation Smoke Storm reported ever smoking and 329 (19·4%) reported susceptibility. There was no significant difference in the odds of a combined outcome of ever smoking or susceptibility to smoking in students who received the intervention compared with controls (adjusted odds ratio 1·28, 95% CI 0·83–1·97; p=0·263), and no difference in odds of ever smoking (0·82, 0·42–1·58; p=0·549). InterpretationOperation Smoke Storm does not seem to have reduced smoking and susceptibility to smoking among students aged 12–13 years in two UK schools. Qualitative analysis is ongoing to explore students’ and teachers’ perceptions of Operation Smoke Storm and potential reasons to explain the apparent lack of effectiveness. FundingThe National Institute for Health Research Public Health Research Programme (NIHR PHRP) (project number 11/3010/02). The funder had no role in the writing of the abstract or the decision to submit.

Perspectives in Implementing a Pragmatic Pediatric Primary Care-Based Intervention Trial.

The 2013 U.S. Preventive Services Task Force (USPSTF) concluded that behavioral interventions are effective in reducing initiation of smoking in youth, recommending primary care clinicians provide education or brief counseling to prevent initiation, and that there are promising trends toward behavioral interventions improving cessation in this population. Our primary care-based intervention RCT conducted between 2000 and 2004, Air It Out, informed these USPSTF recommendations. Our trial was designed to determine whether a pediatric primary care practice-based smoking prevention and cessation intervention would be effective in increasing abstinence rates among adolescents under usual clinic conditions, to inform clinical practice. Therefore, the trial was designed to be largely a pragmatic trial. In this paper, we describe where each of the Air It Out study components falls along the pragmatic-explanatory continuum regarding participant eligibility criteria, intervention and comparison condition design, follow-up and outcomes, compliance and adherence assessments, and analysis. Such an assessment assists researchers by providing a framework to guide decisions regarding study design and implementation. We then share a few principles and lessons learned in developing and implementing the primary care-based intervention trial, focusing on study setting selection, engaging providers who will be delivering the intervention and the target population who will be receiving it in designing the trial and interventions to be tested, and the need to carefully plan recruitment and retention procedures. The hope is to increase the number of well-designed studies that can be included in the evidence reviews to guide future USPSTF recommendation statements.

A longitudinal study on determinants of the intention to start smoking among Non-smoking boys and girls of high and low socioeconomic status.

BackgroundThis study identifies differences in socio-cognitive factors as they relate to the intention to smoke among boys and girls living in high socioeconomic status (HSES) and low socioeconomic status (LSES) neighborhoods.MethodsA total of 1,643 children (aged 10–12 years) completed a web-based questionnaire assessing their intention, attitude, social influences, and self-efficacy toward smoking at baseline and at one year follow-up. Logistic regression analyses were conducted to examine the relations between intention and predictor variables (i.e. attitude, social influence, and self-efficacy). Three-way interaction terms were added to the first analysis to examine potential interactions of gender, socioeconomic status and predictor variables. A 3-way interaction effect was present, and therefore subgroup analyses for HSES and LSES boys and girls were warranted.ResultsThe results indicated that positive attitudes toward smoking were related to the intention to smoke among HSES boys, whereas HSES girls had higher intentions to smoke if they perceived fewer disadvantages of smoking (OR: 0.42; 95 % CI: 0.22–0.82). The intention to smoke among LSES boys was predicted by perceived social norms (OR: 0.49; 95 % CI: 0.25–0.93); in LSES girls, the smoking behavior of people in their environment was most strongly related to their smoking intention (OR: 5.55; 95 % CI: 2.81–10.93).ConclusionsTo prevent youth smoking, HSES boys and girls may benefit from interventions that address attitudes. Boys from an LSES neighborhood may profit from smoking prevention interventions that target social norms, while LSES girls may benefit from strategies aimed at resisting the influence of smokers in their environment.Trial registrationThe ‘Fun without Smokes’ study is approved by the Medical Ethics Committee of the Atrium-Orbis-Zuyd Hospital (NL32093.096.11/MEC 11-T-25) and registered in the Dutch Trial Register (NTR3116).

One-Year Effects of Project EX in Spain: A Classroom-Based Smoking Prevention and Cessation Intervention Program.

BackgroundTobacco use prevalence rates are high among Spanish adolescents. Programming to counteract tobacco use is needed.Methods and FindingsThe current study provides a one-year follow-up outcome evaluation of Project EX, an eight-session classroom-based curriculum. The intervention was tested using a randomized controlled trial with 1,546 Spanish students, involving three program and three control schools. Compared to the control condition, the program condition revealed a greater reduction in nicotine dependence (p < .05) and CO ppm levels (p < .001), and lower consumption of cigarettes at last month (p = .03).ConclusionsLong-term outcomes of the Project EX classroom-based program are promising for adolescent prevention and possibly cessation in Spain.

Multilevel meta network analysis with application to studying network dynamics of network interventions

In this paper, I introduce new methods for multilevel meta network analysis. The new methods can combine results from multiple network models, assess the effects of predictors at network or higher levels and account for both within- and cross-network correlations of the parameters in the network models. To demonstrate the new methods, I studied network dynamics of a smoking prevention intervention that was implemented in 76 classes of six middle schools in China. The results show that as compared to random intervention (i.e., that targets random students), smokers’ popularity was significantly reduced in the classes with network interventions (i.e., those target central students or students with their friends together). The findings highlight the importance of examining network outcomes in evaluating social and health interventions, the role of social selection in managing social influence, and the potential of using network methods to design more effective interventions.

A Web-based, computer-tailored smoking prevention program to prevent children from starting to smoke after transferring to secondary school: randomized controlled trial.

BackgroundSmoking prevalence rates among Dutch children increase rapidly after they transit to secondary school, in particular among children with a low socioeconomic status (SES). Web-based, computer-tailored programs supplemented with prompt messages may be able to empower children to prevent them from starting to smoke when they transit to secondary school.ObjectiveThe main aim of this study is to evaluate whether computer-tailored feedback messages, with and without prompt messages, are effective in decreasing children’s smoking intentions and smoking behavior after 12 and 25 months of follow-up.MethodsData were gathered at baseline (T0), and after 12 months (T1) and 25 months (T2) of follow-up of a smoking prevention intervention program called Fun without Smokes. A total of 162 schools were randomly allocated to a no-intervention control group, an intervention prompt group, or an intervention no-prompt group. A total of 3213 children aged 10 to 12 years old participated in the study and completed a Web-based questionnaire assessing their smoking intention, smoking behavior, and sociocognitive factors, such as attitude, social influence, and self-efficacy, related to smoking. After completion, children in the intervention groups received computer-tailored feedback messages in their own email inbox and those messages could be accessed on the intervention website. Children in the prompt group received prompt messages, via email and short message service (SMS) text messaging, to stimulate them to reuse the intervention website with nonsmoking content. Multilevel logistic regression analyses were performed using multiple imputations to assess the program effects on smoking intention and smoking behavior at T1 and T2.ResultsA total of 3213 children participated in the Fun without Smokes study at T0. Between T0 and T1 a total of 1067 children out of the original 3213 (33.21%) dropped out of the study. Between T0 and T2 the number of children that did not participate in the final measurement was 1730 out of the original 3213 (53.84%). No significant program effects were observed for any of the intervention groups compared to the control group at T1 for the intention to engage in smoking—prompt, OR 0.67 (95% CI 0.30-1.50), no-prompt, OR 0.76 (95% CI 0.34-1.67)—or for smoking behavior—prompt, OR 1.13 (95% CI 0.13-9.98), no-prompt, OR 0.50 (95% CI 0.04-5.59). Similar nonsignificant program effects were found at T2 for the intention to start smoking—prompt, OR 0.78 (95% CI 0.26-2.32), no-prompt, OR 1.31 (95% CI 0.45-3.82)—and smoking behavior—prompt, OR 0.53 (95% CI 0.12-2.47), no-prompt, OR 1.01 (95% CI 0.24-4.21).ConclusionsThis study showed that the Web-based, computer-tailored feedback messages with and without prompt messages were not effective in modifying children’s smoking intentions and smoking behavior as compared to no information. Future smoking prevention interventions are recommended to start closer to the age of actual smoking uptake. Furthermore, future studies on Web-based, computer-tailored smoking prevention programs should focus on assessing and controlling exposure to the educational content and the response to the prompt messages.Trial RegistrationNetherlands Trial Register NTR3116; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3116 (Archived by WebCite at http://www.webcitation.org/6O0wQYuPI).

Smoking cessation during pregnancy and relapse after childbirth in Canada.

This analysis was undertaken to determine the rates and determinants of smoking cessation during pregnancy and smoking relapse after childbirth in Canada. We used data from the Maternity Experiences Survey, a cross-sectional study of mothers who gave birth to a singleton baby in Canada in 2006. A total of 1586 mothers who smoked occasionally or daily before pregnancy were included in the analysis. The rate of smoking cessation during pregnancy was 53.0% (95% CI 50.3% to 55.7%). Higher pre-pregnancy smoking frequency, Inuit origin, being aged ≥ 35 years, lower education, not attending prenatal classes, lack of social support, stress before or during pregnancy, and living with a smoker were independently associated with higher risk of continued smoking, while First Nations (off-reserve) origin was associated with a lower risk. Among those who had quit smoking, 47.1% (95% CI 43.5% to 50.6%) relapsed postpartum. Living with a smoker, not having breastfed, and having stopped breastfeeding were independently associated with a higher risk of relapse. This study highlights the need to tailor smoking cessation and prevention interventions for some high-risk groups of women.

Active and passive smoking in relation to lung cancer incidence in the Women's Health Initiative Observational Study prospective cohort

BackgroundLung cancer is the leading cause of worldwide cancer deaths. While smoking is its leading risk factor, few prospective cohort studies have reported on the association of lung cancer with both active and passive smoking. This study aimed to determine the relationship between lung cancer incidence with both active and passive smoking (childhood, adult at home, and at work). Patients and methodsThe Women's Health Initiative Observational Study (WHI-OS) was a prospective cohort study conducted at 40 US centers that enrolled postmenopausal women from 1993 to 1999. Among 93 676 multiethnic participants aged 50–79, 76 304 women with complete smoking and covariate data comprised the analytic cohort. Lung cancer incidence was calculated by Cox proportional hazards models, stratified by smoking status. ResultsOver 10.5 mean follow-up years, 901 lung cancer cases were identified. Compared with never smokers (NS), lung cancer incidence was much higher in current [hazard ratio (HR) 13.44, 95% confidence interval (CI) 10.80–16.75] and former smokers (FS; HR 4.20, 95% CI 3.48–5.08) in a dose-dependent manner. Current and FS had significantly increased risk for all lung cancer subtypes, particularly small-cell and squamous cell carcinoma. Among NS, any passive smoking exposure did not significantly increase lung cancer risk (HR 0.88, 95% CI 0.52–1.49). However, risk tended to be increased in NS with adult home passive smoking exposure ≥30 years, compared with NS with no adult home exposure (HR 1.61, 95% CI 1.00–2.58). ConclusionsIn this prospective cohort of postmenopausal women, active smoking significantly increased risk of all lung cancer subtypes; current smokers had significantly increased risk compared with FS. Among NS, prolonged passive adult home exposure tended to increase lung cancer risk. These data support continued need for smoking prevention and cessation interventions, passive smoking research, and further study of lung cancer risk factors in addition to smoking. ClinicalTrials.govNCT00000611.

The prevalence of and factors associated with current smoking among College of Health Sciences students, Mekelle University in northern Ethiopia.

BackgroundTobacco smoking is one of the greatest causes of preventable morbidity and mortality globally, and is responsible for many causes of untimely deaths. This survey was aimed to determine prevalence and factors associated with current smoking among the students of College of Health Sciences, Mekelle University, Ethiopia.MethodsA cross-sectional study was employed using a structured self-administered questionnaire among College of Health Sciences students in March 2013. A stratified random sampling method was employed to select study participants. Data were entered and analysed using of Statistical Package for Social Sciences (SPSS) version 20.0.ResultsOf the 193 students, 57 (29.5%) of the students were current smokers. Most of the current smokers (89.4%) smoked between 1–10 sticks of cigarette per day. The two main reasons cited for smoking cigarettes were peer pressure (43.9%) and to relieve stress (36.8%). Being female (adjusted OR [AOR] = 0.49; 95% CI: 0.25, 0.95) and Tigre by ethnicity (AOR = 0.32; 95% CI: 0.14, 0.74) were significantly less associated with current smoking. On the other hand, being second year students (AOR = 3.84; 95% CI: 1.41, 10.46), khat chewing (AOR = 8.36; 95% CI: 2.60, 26.85) and taking illicit drugs (AOR = 10.59; 95% CI: 2.77, 40.51) were positively associated with current smoking cigarettes.ConclusionsThe current smoking prevalence among students in College of Health Sciences, Mekelle University is high and therefore, effective smoking prevention and cessation intervention programs are required to reduce smoking among university students.

Abstract 5054: Smoking prevention intervention with school classes at a university hospital by thoracic surgeon und pulmonologist

Abstract Purpose: Smoking prevention in schoolchildren with the aim to inform and prevent smoking initiation has been widely studied and has shown variable results. Interventions provided by physicians in a hospital setting have been rarely reported. Here we show the feasibility and gain of knowledge of our smoking prevention project in a hospital setting. Methods: Interventions performed from November 2009 - February 2013 were evaluated. Overall 470 children participated in our preventive intervention. A 7-item questionnaire was provided to the school classes (Grades 6 to 10) before and after a two-hour smoking prevention intervention consisting of anatomical models, oral presentations, videos, patient interviews and hands-on lung function tests. The goal was to show the anatomical and physiological basics as well as age-based information about the harms of smoking. During the intervention the children have been motivated to be actively involved. Class selection has been performed for groups of children in a highly vulnerable phase of age before smoking initiation. Results: The baseline questionnaire was completed by 457 children, the one after intervention by 426. The knowledge about which organs are affected by smoking increased from 6.8-99.6% to 65.5-99.5% (p&amp;lt;0.01). While only 59.5% knew that only a minority of people is able to quit smoking successfully, 94.1% answered the question correctly after intervention (p&amp;lt;0.001). Prior to the intervention only 78.1% believed that minor tobacco consumption is not damaging which increased to 89.4% after the teaching session (p&amp;lt;0.05). Smoking hookah was believed to be less harmful than cigarettes by 30.2% of children decreasing to 7.7% after the intervention (p&amp;lt;0.001). Conclusion: Information on health effects provided by lung specialists in the hospital leads to a statistically significant increase in knowledge as assessed by a short questionnaire. The intervention is feasible and well received. This kind of interventions might help to prevent schoolchildren from smoking in a highly vulnerable phase of age. Citation Format: Sandra Tomaszek, Macé M. Schuurmans, Didier Schneiter, Walter Weder, Sven Hillinger. Smoking prevention intervention with school classes at a university hospital by thoracic surgeon und pulmonologist. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5054. doi:10.1158/1538-7445.AM2014-5054

Challenges to obtaining parental permission for child participation in a school-based waterpipe tobacco smoking prevention intervention in Qatar.

BackgroundInvolving children in research studies requires obtaining parental permission. A school-based intervention to delay/prevent waterpipe use for 7th and 8th graders in Qatar was developed, and parental permission requested. Fifty three percent (2308/4314) of the parents returned permission forms; of those 19.5% of the total (840/4314) granted permission. This paper describes the challenges to obtaining parental permission. No research to date has described such challenges in the Arab world.MethodsA random sample of 40 schools in Doha, Qatar was selected for inclusion in the original intervention. Permission forms were distributed to parents for approval of their child’s participation. The permission forms requested that parents indicate their reasons for non-permission if they declined. These were categorized into themes. In order to understand reasons for non-permission, interviews with parents were conducted. Phone numbers of parents were requested from the school administration; 12 of the 40 schools (30%) agreed to provide the contact information. A random sample of 28 parents from 12 schools was interviewed to reach data saturation. Thematic analysis was used to analyze their responses.ResultsReasons for non-permission documented in both the forms and interviews included: poor timing; lack of interest; the child not wanting to participate; and the child living in a smoke-free environment. Interviews provided information on important topics to include in the consent forms, parents’ decision-making processes regarding their child’s participation, and considerations for communicating with parents. Many parents also indicated that this was the first time they had been asked to give an informed consent for their child’s participation in a study.ConclusionsResults indicate that more attention needs to be given to the informed parental consent process. Researchers should consider enhancing both the methods of communicating information as well the specific information provided. Before embarking on recruitment of children for studies, formative research on the parental consent process is suggested.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6939-15-70) contains supplementary material, which is available to authorized users.

Replicating cluster subtypes for the prevention of adolescent smoking and alcohol use

IntroductionSubstance abuse interventions tailored to the individual level have produced effective outcomes for a wide variety of behaviors. One approach to enhancing tailoring involves using cluster analysis to identify prevention subtypes that represent different attitudes about substance use. This study applied this approach to better understand tailored interventions for smoking and alcohol prevention. MethodsAnalyses were performed on a sample of sixth graders from 20 New England middle schools involved in a 36-month tailored intervention study. Most adolescents reported being in the Acquisition Precontemplation (aPC) stage at baseline: not smoking or not drinking and not planning to start in the next six months. For smoking (N=4059) and alcohol (N=3973), each sample was randomly split into five subsamples. Cluster analysis was performed within each subsample based on three variables: Pros and Cons (from Decisional Balance Scales), and Situational Temptations. ResultsAcross all subsamples for both smoking and alcohol, the following four clusters were identified: (1) Most Protected (MP; low Pros, high Cons, low Temptations); (2) Ambivalent (AM; high Pros, average Cons and Temptations); (3) Risk Denial (RD; average Pros, low Cons, average Temptations); and (4) High Risk (HR; high Pros, low Cons, and very high Temptations). ConclusionsFinding the same four clusters within aPC for both smoking and alcohol, replicating the results across the five subsamples, and demonstrating hypothesized relations among the clusters with additional external validity analyses provide strong evidence of the robustness of these results. These clusters demonstrate evidence of validity and can provide a basis for tailoring interventions.

Berlin evaluates school tobacco prevention - BEST prevention: study design and methodology.

BackgroundThe hazardous health effects of smoking are established, but there remains a need to evaluate existing smoking prevention strategies and to increase their effectiveness in adolescents. Strategies focusing on parental attitudes and rule setting have been identified as a potentially effective approach. The present manuscript describes objectives, study design and methodology of the BEST Prevention study.Methods/designBEST Prevention is a three-armed cluster randomized-controlled trial among 7th grade (11–16 years) students in Berlin, Germany. Schools were enrolled between 2010 and 2011 and allocated using a centralized randomization list into 1) a student smoking prevention intervention (visit to an established interactive circuit), 2) the same intervention plus a parent intervention, and 3) a control group (visit to an established exercise and nutrition interactive circuit). Students were assessed at baseline, 12 and 24 months via self-report, as well as via carbon monoxide and cotinine in saliva at the 24 month follow-up. Statistical analyses uses multi-level regression models with cluster effects (school and class within school) based on the intention to treat population. Here we report descriptive baseline characteristics of recruited schools, and schools classes. Two schools from the control group dropped out after allocation. Hence, 47 secondary schools from all 12 districts of the city, including 161 school classes and 3023 students are participating in the study. Of those, 2801 students completed the baseline assessment.DiscussionThe present manuscript provides details on the study design and methodology of a large school-based smoking prevention trial in a metropolitan area in Germany. Findings from this study will yield important insight into the long-term effectiveness of specific smoking prevention strategies, also in disadvantaged population groups.Trial registrationNCT01306552 (January 2011).

Systematic review: internet-based program for youth smoking prevention and cessation.

To review the characteristics and effects Internet-based youth smoking prevention and cessation programs. Systematic review of published articles in peer-reviewed journals in the past 10 years, focused on Internet-based youth smoking prevention and cessation programs. Twelve articles were selected based on the following criteria: studies reporting the outcomes of Internet-based smoking cessation or prevention intervention programs for adolescents who are younger than 24 years. The components of youth Internet-based smoking intervention programs are analyzed based on study features (i.e., sample, design, theoretical basis, analysis, outcome measures) and program characteristics (i.e., focus, setting, frequency, duration, intensity, and different components) that make the programs effective. The most common components of effective Internet-based programs are identified as the following: the use of multimedia, tailored approaches, personalized feedback, and interactive features. The characteristics and effects of the programs vary, but most programs show positive results in youth smoking prevention and cessation in spite of the studies' limitations. The evidence from this review provides useful information of recent efforts related to Internet-based youth smoking prevention and cessation programs, which can have significant clinical implications in developing future innovative youth smoking prevention and intervention programs.