Prevention of smoking in adolescents with lower education: a school based intervention study

• Published in: Journal of epidemiology and community health (1979) Vol. 57; no. 9; pp. 675 - 680
• Main Authors: Crone, M R, Reijneveld, S A, Willemsen, M C, van Leerdam, F J M, Spruijt, R D, Sing, R A Hira
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.09.2003; BMJ Publishing Group; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adolescent; Adolescent Behavior; Adolescents; Agreements; Anti smoking movements; Bias; Child; Cigarette smoking; Community health care; Competition; Control groups; Drug prevention; Education; Evidence Based Public Health Policy and Practice; Female; Follow-Up Studies; Group pressure; Health Education - methods; Health Knowledge, Attitudes, Practice; Health services; High school students; Humans; Industrialized nations; Intervention; Male; Netherlands; Odds Ratio; Peer Group; Peer pressure; Peer relationships; prevention; Registration; Researchers; School Health Services; Schools; Secondary education; Skill development; Smoking; Smoking cessation; Smoking Prevention; Social influence; socioeconomic status; Statistics as Topic; Students; Teenagers; Tobacco smoking; Netherlands
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.57.9.675

Objective: To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students. Design: Group randomised controlled trial. Setting: 26 Dutch schools that provided junior secondary education. Subjects: 1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years. Intervention: Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition. Main outcome measures: Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis. Results: In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant. Conclusions: In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect.