Smoking Prevention Programs Research Articles

Prevalence of Smoking, and its Relationship with Depression, and Anxiety in a Sample of Iranian High School Students

Psychiatric disorders, like anxiety and depression, are risk factors for drug abuse and smoking behavior. The purpose of this survey was to determine the prevalence of smoking, depression and anxiety and their relationship among school age students. This cross-sectional survey was done on 1020 high school students (male and female) recruited randomly and DSM-IV interview was done by researchers. A psychiatry resident accompanied by 3 last year medical students interviewed with students and a questionnaire containing demographic , anxiety and depression questions was filled simultaneously. The obtained data were analyzed using SPSS16. 50% of the students were female and the remainder male. 277 students (27.2%) were in the first year, 242 (23.7%) in the second year and 501 (49.1%) in the third year of high school. 55 students (5.4%) were smoker and used cigarette , water pipe (hobble bobble) and pipe.183 students (18%) had anxiety and stress symptoms (mild, moderate , sever). The 29 smoker students (2.84%) had anxiety. 144 students (14.1%) had depression (mild, moderate, sever) and 23 smoker students (2.25%) had depression symptoms. There was no significant correlation between smoking and anxiety and depression symptoms among school age students. As conclusion, we hypothesized that smoking may increase the tendency to depression and anxiety in high school students. Although the above results didn't demonstrate any significant correlation between these three issues, school counselors and teachers need to be informed about the prevalence of problematic behaviors associated with smoking and it would be necessary to develop smoking prevention programs for adolescents, while taking the psychological factors such as depression and anxiety and school and family atmosphere into account.

Perception of Risks and Benefits of Smoking among Adolescents of Glacier International College

Background: Tobacco use is one of the important preventable causes of death and a leading public health problem all over the world. Multiple factors are involved in the initiation of smoking in adolescents and young adults. Adolescents may incorrectly believe that cigarette smoking is less risky than other behaviors, such as alcohol consumption and drug use, and they do not understand the short-term effect and addictive nature of smoking. Objectives: The main objective of the study was to find out the perceived physical risks, social risks, addiction risks and perceived benefits of smoking among adolescents. Method: A descriptive cross sectional study was conducted among 100 adolescents using stratified random sampling and self-administered questionnaire. In order to assess the perceived risks and benefits of smoking, questionnaire developed by Song et al. and Halpern-Felsher et al. was used. Results: Among 100 adolescents, 38 were female. The mean perceived risk was 60% and mean perceived benefit was 32%. There was a significant difference between age and perceived physical risks, social risks and benefits of smoking. Perceived benefits of smoking had a significant difference with educational level and smoking behavior of respondents as well. Conclusion: Adolescents perceive both risks and benefits of smoking. In order to discourage or prevent adolescents from initiating smoking, future intervention programs should focus on communicating not only the health risks but also the social and addiction risks as well as counteract the benefits associated with smoking. There is a felt need for smoking cessation program and necessity for school based smoking prevention programs.

신체활동이 고등학생의 흡연 경험 및 흡연 강도에 미치는 영향

Purpose: The purpose of this study was to investigate the influence of physical activity on smoking experience and smoking intensity in Korean high school students. Methods: This cross sectional study used secondary data from the 2013 Adolescent Health Behavior Online Survey. A total of 35,905 high school students were included in the study. Logistic regression was used for analysis of the influence of moderate and vigorous physical activity on smoking experience in a month and smoking intensity. Results: Adolescents with low (Adjusted OR: 1.242, 95% CI: 1.075~1.436) and moderate level (Adjusted OR: 1.094, 95% CI: 1.005~1.189) of moderate physical activity had more smoking experience than reference group, high level of physical activity. Also, smoking experience was more prevalent adolescents with low (Adjusted OR: 1.191, 95% CI: 1.064~1.333) and moderate level (Adjusted OR: 1.134, 95% CI: 1.039~1.237) of vigorous physical activity. Heavy smoking was more prevalent among adolescents who had low level of vigorous physical activity (Adjusted OR: 1.912, 95% CI: 1.347~2.712). Conclusion: Based on the results of this study, physical activity has significant influence on smoking experience and smoking intensity. Therefore, physical activity should be included smoking cessation and smoking prevention program for High School Students.

Exploring an effective tobacco prevention programme for Indian adolescents

ObjectivesTobacco use is among the most significant public health issues faced by the world today. It is estimated that approximately 5500 adolescents start using tobacco every day in India, adding to the four million youths aged <15 years who are already regular users. School-based smoking prevention programmes have been shown to increase knowledge about the negative effects of tobacco and prevent tobacco use, but the majority of evidence on effectiveness comes from Western countries. This study investigated the impact of a school-based short-term educational intervention regarding tobacco use on adolescents' knowledge, attitudes, intentions and behaviours (KAIB) in Bangalore, India. Study designAn intervention trial was conducted among 720 adolescents aged 15–16 years in Bangalore, India. MethodsEducational interventions were imparted to all study subjects in a phased manner, along with two interactive sessions held six months apart. The impact of the programme was measured using questionnaires administered before the first intervention (pre-intervention) and after the second intervention (post-intervention). ResultsMean (±standard deviation) pre-intervention KAIB scores of the subjects were 5.9 ± 1.87 (knowledge), 23.6 ± 3.15 (attitude) and 18.9 ± 3.27 (practice), which improved to 7.8 ± 2.01, 26.7 ± 2.43 and 12.3 ± 2.52, respectively, postintervention. The differences in mean KAIB scores were significant (P < 0.0001, df = 1400), suggesting that the intervention had a major positive impact. ConclusionSchool-based short-term educational intervention programmes are effective for preventing and reducing tobacco use among Indian adolescents.

Preliminary results of Project EX in Spain: A classroom-based smoking prevention and cessation program

Preliminary results of Project EX in Spain: A classroom-based smoking prevention and cessation program

Smoking uptake among Saudi adolescents: tobacco epidemic indicators and preventive actions needed.

The aim of this cross-sectional school-based study was to assess smoking prevalence, indicators for the smoking epidemic and determinants of smoking among Saudi adolescents. The study included 695 male adolescents from 11 to 16 years of age who filled out self-report questionnaires based on the European Smoking Framework Approach questionnaire, which uses the I-Change model to assess attitude, social influence and the self-efficacy of the participants. Smokers were 275 (39.6%) adolescents. Smokers tended to receive more daily pocket money, live in more affluent families and show lower academic performance. Non-smokers were inclined to believe that smoking may help people to feel relaxed and confident, encountered less social influences to smoke than smokers, but reported low self-efficacy not to smoke when with smoker friends and when offered a cigarette. Smokers reported the lowest self-efficacy not to smoke in all situations assessed. The results suggest the smoking epidemic among male Saudi adolescents may still be in the early stages, providing ample opportunity for preventive actions aimed at halting the further progress of this epidemic. Secondly, smoking prevention programs in Saudi Arabia need to reinforce non-smoking attitudes, address how to resist pressure to smoke, and how to develop high self-efficacy towards non-smoking in various situations.

Long-Term Health and Medical Cost Impact of Smoking Prevention in Adolescence

PurposeTo estimate smoking progression probabilities from adolescence to young adulthood and to estimate long-term health and medical cost impacts of preventing smoking in today's adolescents. MethodsUsing data from the National Longitudinal Study of Adolescent Health (Add Health), we first estimated smoking progression probabilities from adolescence to young adulthood. Then, using the predicted probabilities, we estimated the number of adolescents who were prevented from becoming adult daily smokers as a result of a hypothetical 1 percentage point reduction in the prevalence of ever smoking in today's adolescents. We further estimated lifetime medical costs saved and quality-adjusted life years (QALYs) gained as a result of preventing adolescents from becoming adult daily smokers. All costs were in 2010 dollars. ResultsCompared with never smokers, those who had tried smoking at baseline had higher probabilities of becoming current or former daily smokers at follow-up regardless of baseline grade or sex. A hypothetical 1 percentage point reduction in the prevalence of ever smoking in 24.5 million students in 7th–12th grades today could prevent 35,962 individuals from becoming a former daily smoker and 44,318 individuals from becoming a current daily smoker at ages 24–32 years. As a result, lifetime medical care costs are estimated to decrease by $1.2 billion and lifetime QALYs is estimated to increase by 98,590. ConclusionsEffective smoking prevention programs for adolescents go beyond reducing smoking prevalence in adolescence; they also reduce daily smokers in young adulthood, increase QALYs, and reduce medical costs substantially in later life. This finding indicates the importance of continued investment in effective youth smoking prevention programs.

Smoking and trajectories of dysmenorrhoea among young Australian women

ObjectiveTo investigate the association of cigarette smoking at baseline and trajectories of dysmenorrhoea in a large sample of Australian women.DesignA prospective cohort study.SettingAustralian (population-based survey).ParticipantsA total of 9067 young women,...

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 2157: Causal effects of delaying smoking initiation on subsequent lung cancer risk

Abstract Background: Methods that report relative risks when describing the association between age at smoking initiation and lung cancer adjust for variables unknown or unpredictable at the time of initiation (smoking duration, pack-years etc.). Such methods do not provide valid estimates of the causal effect of smoking initiation. Also, relative risks are not informative for assessing the effects of youth smoking prevention programs or describing the impact of individuals' decisions to start smoking. Applying a causal modelling framework, we estimate absolute lung cancer risk - a metric more relevant to public health than relative risk - given variables fixed at the age of smoking initiation and averaging over subsequent smoking behaviors. Methods: We used the Environment And Genetics in Lung cancer Etiology (EAGLE) study (1942 lung cancer cases, 2116 controls), a population-based case-control study in Lombardy, Italy. We classified risk factors as fixed at smoking initiation (gender, childhood exposure to tobacco smoke [CETS], lung cancer family history [FH], birth cohort) and as causally related to the initiation age (pack-years, cigarettes per day, quitting, nicotine dependency). Using the sampling fractions for controls selection, we reconstructed the original study cohort and estimated absolute lung cancer risks overall and conditionally on fixed factors. We predicted lung cancer rates for different ages at smoking initiation as number of cases per 100,000 person-years (PY) using a binomial linear model and estimated corresponding risk differences (RD) and 95% confidence intervals (CI). Instead of adjusting for the effects of smoking behaviors that happen after initiation, we averaged over them. We show how assumptions about factors unknown at smoking initiation affect the estimates. Results: Delaying smoking initiation from age 16 to age 20 reduces estimated lung cancer rate in men from 149 to 78 cases per 100,000 PY with a RD=71 (95% CI 25 to 120), but there is apparently no corresponding effect in women (RD= -1 [95% CI -50 to 48] from 26 to 27 cases per 100,000 PY). The effect of delaying initiation is larger for those without CETS (RD=113 [95% CI 52 to 174] cases per 100,000 PY from 156 to 43) than those with CETS (RD=45 [95% CI -2 to 92] cases per 100,000 PY from 92 to 47). For those with FH RD was 214 (95% CI -106 to 534) cases per 100,000 PY from 282 to 68, and for those without FH it was 44 (95% CI 3 to 85) cases per 100,000 PY from 85 to 41). RDs were greater for early birth cohorts. There was heterogeneity among individuals with same initiation age but different subsequent smoking behaviors. Conclusion: We estimated absolute lung cancer risk from a case-control study using information fixed at the initiation age and averaging over subsequent smoking behaviors. Our estimates show substantial impact of delaying initiation in men, even if the person eventually smokes. Extrapolation to current youths and young adults requires integration of data on contemporary smoking patterns. Citation Format: Orestis A. Panagiotou, Fangyi Gu, Carolyn Reyes-Guzman, Maria-Teresa Landi, Michele Bloch, Neil E. Caporaso, Sholom Wacholder. Causal effects of delaying smoking initiation on subsequent lung cancer risk. [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 2157. doi:10.1158/1538-7445.AM2014-2157

Smoking Habit among Male Medical and Dental Students of B.P.Koirala Institute of Health Sciences, Nepal

Smoking and health are intimately related and thus, smoking among future health care personnel is an important issue. As future physicians and dentists who will witness the continued burden of smoking-related diseases among their patients, represent a primary target for smoking prevention programs. To explore the magnitude of smoking problem and assess the major causes aggravating the burden of smoking among medical and dental students. METHODS; A cross sectional study was conducted between June and July 2009 among 345 medical and dental students. Pre-tested self-administered questionnaire containing questions regarding smoking and its various correlates were used to collect the data. Chi square test was used for testing hypothesis. Prevalence of smoking was estimated as 38.4%, among whom majority started smoking during 15 to 19 years of life. Peer pressure was the major cause behind smoking (29.5%). Nearly one third of the participants used to consume alcohol along with smoking. Presence of parental smoking and use of other drugs were significantly associated with smoking among the students. Tobacco smoking is a significant health problem among the male medical and dental students. Medical and dental students were approached as they are the treatment providers for smoking and disease related to it in the future. The results in our study are discouraging and reveal that the medical knowledge regarding ill effects of smoking has not been able to check its use.

Age at smoking initiation and subsequent smoking among Korean adolescent smokers.

Objectives:The aim of this study was to investigate the relationship between age at cigarette smoking initiation and smoking level among adolescent current smokers.Methods:In 2007, students from one or two classes of the 10th or 11th grade were randomly selected using the probability proportional to size sampling method. In total, 743 current smokers were included. Multiple logistic regression was used to determine the association between age at smoking initiation and smoking level as either frequent, daily, or heavy smokers.Results:The adjusted odds ratios for each smoking level were significantly higher for younger ages of smoking initiation than those for older ages of initiation were (p for trend <0.001). Compared with the students who started smoking in grades 10 to 11, the adjusted odds ratios for frequent, daily, and heavy smokers increased from 2.24 (95% confidence interval [CI], 1.30 to 3.87) to 3.90 (95% CI, 2.02 to 7.56), from 1.56 (95% CI, 0.92 to 2.62) to 3.17 (95% CI, 1.70 to 5.92), and from 2.56 (95% CI, 1.21 to 5.42) to 5.67 (95% CI, 2.61 to 12.30) with younger ages of smoking initiation.Conclusions:Smoking frequency and amount were closely associated with age at smoking initiation. Therefore, smoking prevention programs should be initiated from the young adolescent period.

초등학생을 위한 단계별 흡연예방 프로그램의 효과

본 연구는 정규교과과정으로 활용될 수 있도록 개발된 사회인지학습이론 기반 흡연예방 교육프로그램의 효과를 측정하고자 수행되었다. 프로그램 적용대상은 D 광역시 소재 4개 초등학교의 1학년, 3학년, 5학년 학생으로 실험군과 대조군이 1학년은 54명과 50명, 3학년은 57명과 54명, 5학년은 101명과 99명이었다. 프로그램 실시는 1학년은 2시수, 3학년은 4시수, 5학년은 6시수가 2013년 11월 1일부터 12월 19일까지 이루어졌다. 프로그램의 효과측정을 위해 흡연 지식 및 태도, 자아개념 도구를 사용하였으며, 수집자료의 분석에는 Chi-square test와 t-test를 사용하였다. 연구결과 프로그램 실시 전후 흡연지식에서는 모든 학년에서 통계적으로 유의한 차이가 있었으나 흡연태도와 자아개념에서는 차이가 없었다. 초등학생 대항 흡연예방 프로그램은 정규교과과정에 연계되어 단계별로 적용되어야 하며 단기 효과보다는 장기 효과를 목표로 하여야 할 것이다. 【The subjects of this study were 415 children in the first to third grade selected from 4 primary schools. Among them, 212 children belong to the experimental group, and 203 children were in the control group. The program was provided respectively to first, third and fifth grade children for 2, 4 and 6 teaching-hours from 2013.1.1 to 2013.12.19. To measure the effects of the program, the knowledge and attitudes on/toward smoking, self-concept were used as the research tools. Before and after program-implementation, there were significant differences in knowledge of smoking, but no differences in attitudes and self-concept. A smoking prevention program for primary school children should be applied step-by-step in conjunction with the regular education curriculum. In addition, the program should aim for long-term effects rather than short-term effects.】

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.

THREE-YEAR FOLLOW-UP ON THE EFFECTS OF A SMOKING PREVENTION PROGRAM FOR ELEMENTARY SCHOOL CHILDREN WITH A QUASI-EXPERIMENTAL DESIGN IN JAPAN

We performed the follow-up tests for three years for junior high school students by the quasi-experimental design to investigate the medium-term effect of smoking prevention education in the elementary school. The intervention group consisted of 106 school students of three elementary schools and received a smoking prevention program in the elementary school. Moreover, the follow-up tests were conducted at each grade of junior high school, and the booster program was mailed. The comparison group consisted of 193 school students of another three elementary schools without the program. The intervention effects were recognized on knowledge up to the second grade of junior high school for boys and up to the third grade for girls, on awareness of the importance of not smoking at the second grade, and on the intention of smoking at the age of 20 for girls up to the first grade. On the other hand, the intervention effects were not recognized on smoking experience for boys and girls. However, increase of the rate of smoking experience was not significant in the intervention group, while it was significant in the comparison group. The effect of the program for three years was judged to be moderate.

Education Against Tobacco (EAT): a quasi-experimental prospective evaluation of a programme for preventing smoking in secondary schools delivered by medical students: a study protocol

IntroductionA survey conducted by the German Federal Centre for Health Education in 2012 showed that 35.2% of all young adults (18–25 years) and 12.0% of all adolescents (12–17 years) in...

Tobacco Smoking Status and Perception of Health among a Sample of Jordanian Students

Limited data are available from Jordan examining patterns of tobacco use among adolescents, or how use is related to health perceptions. This study aims to estimate the prevalence of tobacco use and to assess the relationship between use and health-related perceptions. A cross-sectional survey was conducted among a sample of 11–18 year old school students from a major governorate in Jordan. Using a multistage random sampling 1050 students were selected. Students were categorized as non-smokers, cigarette-only smokers, waterpipe-only smokers, or dual smokers. Rates of waterpipe-only and cigarette-only smoking were 7% and 3%, respectively, and were similar for boys and girls. In contrast, the rate of dual use was much higher than for single product use and was double in girls compared to boys (34% vs. 17%). Dual-smokers were significantly more likely to think that it is safe to smoke as long as the person intends to quit within two years compared to non-smokers, and had lower self-rated health status than other groups. This is the first study among Arab adolescents to document high rates of dual tobacco use, especially pronounced among girls. The study findings have significant implications for designing tobacco smoking prevention programs for school health settings.

From the classroom to Facebook: a modern approach for smoking education in adolescents

Background Although studies show that a large majority of smokers initiate smoking while in early adulthood, poor efficacy of school smoking-prevention programs has been noted. With the explosive rise in internet use, the imperative need to use new forms of media for educational purposes has emerged more prominently than ever before. In this paper we briefly describe the design and testing of a smoking-related social media-integrated education intervention. Materials and methods We describe 5 simple steps towards a successful presentation that will lead to meaningful social media interactions: Steps 1-3 include the careful selection of the presenters and their education on general presentation techniques and classroom behaviors, as well as the topic in particular. During step 4, the presenters link up with the students using a social media platform, and provide “take-home” key points. Facebook is chosen as the most popular social networking website in which the vast majority of youth is daily active and already has accounts. Finally, in step 5, the presenters request the attendees to upload one of the take home messages as their Facebook status. The rationale is that the knowledge could, thus, reach a quite larger number of young people than the finite number of attendees. Results We implemented and tested the above algorithm during a tobacco control lecture curriculum to 225 high school students in Athens, Greece, in May 2012. After the lecture, a 3-day window was provided to the attendees to connect with the presenters in Facebook and post a smokingrelated sentence in their account status. Assessed 72hrs later, 32 students (14.2%) had posted a smoking-related sentence in their Facebook account, a “take-home message” that was spread to their 20,095 cumulative friends as a note on their wall via newsfeed. Conclusions

Does smoking within an individual's peer group affect intervention effectiveness? An evaluation of the Smoke-Free Class Competition among Swiss adolescents

ObjectiveThe aim of this study is to test whether participation in the Smoke-Free Class Competition (SFC), a classroom-based smoking prevention program, reduced smoking and increased smoking-related knowledge among those with and without smoking peers compared to control groups. MethodIncluding smoking peers as a moderator in multilevel models, a quasi-experimental design with a post-test at seven months was used to analyze data from 1035 students in Switzerland (2011; mean age 13.3, 53.2% female). ResultsCompleting the SFC decreased smoking prevalence (OR=0.7; CI=0.5–1.0; ns) and increased smoking-related knowledge (b=1.0; p<.01) compared to control classes. However, the former effect was only significant among those without smoking peers (OR=0.3; CI=0.2–0.5; p<.001). With smoking peers, smoking prevalence was even higher at post-test (OR=3.7; CI=1.7–8.2; p<.01) in the classes that completed SFC compared to controls. No effect was found in classes that started SFC but had to pull out. ConclusionsThe results indicate that SFC should be applied early in adolescence, when individuals are less likely to have classmates who smoke and are therefore less likely to have to pull out of the program. This is particularly important because SFC was only effective among those who completed the program and did not have smoking peers.

Lessons from a peer-led obesity prevention programme in English schools.

SummaryObesity in young people is a major public health concern. Energy balance, the interrelationship between diet and physical activity, is known to be a key determinant. Evidence supports the development of school-based approaches to obesity prevention. ASSIST (A Stop Smoking in Schools Trial) is an effective school-based, peer-led smoking prevention programme for 12–13-year-old students, based on diffusion of innovations theory. The AHEAD (Activity and Healthy Eating in ADolescence) study tested the feasibility of adapting ASSIST to an obesity prevention intervention. The AHEAD intervention was tested and refined during a pilot study in one school, followed by an exploratory trial in six schools. Quantitative (self-report behavioural questionnaires and evaluation forms) and qualitative (structured observations, focus groups and interviews) research methods were used to examine the implementation and acceptability of the intervention. The potential effectiveness of the intervention in increasing healthy eating was measured using self-report behavioural questionnaires. Activity monitors (accelerometers) were used to measure physical activity. Results show it was feasible to implement the AHEAD intervention, which was well received. However, implementation was resource and labour intensive and relatively expensive. Furthermore, there was no evidence of promise that the intervention would increase physical activity or healthy eating in adolescents. Although diet and physical activity are both relevant for obesity prevention, the focus on two behaviours appeared too complex for informal diffusion through peer networks. This identifies a tension, particularly for adolescent peer-led health promotion, between the desire not to isolate or oversimplify health behaviours and the need to present clear, succinct health promotion messages.