Longitudinal effects of the European smoking prevention framework approach (ESFA) project in Spanish adolescents
European Journal of Public Health
Longitudinal effects of the European smoking prevention framework approach (ESFA) project in Spanish adolescents
Carles Ariza 1 2
Manel Nebot 1 2
Zoa Toma´ s 2
Emmanuel Gime´ nez 2
Sara Valmayor 2
Visitacio´ n Tarilonte 0
Hein De Vries 3
0 Personal Services Division, Barcelona Council , Barcelona , Spain
1 CIBER in Epidemiology and Public Health (CIBERESP) , Spain
2 Evaluation and Intervention Methods Service, Age`ncia de Salut P u ́blica de Barcelona, Public Health Agency , Barcelona
3 Health Education Department, Maastricht University , Maastricht , The Netherlands Service, Age`ncia de Salut Pu ́ blica de Barcelona (Public Health Agency, Barcelona) , Pl. Lesseps 1, 08023 Barcelona, Spain, tel:
Background: To describe the effects of a Spanish smoking prevention programme in the context of an European project on regular smoking, in a sample of Barcelona adolescents. Method: A quasiexperimental design was conducted. An experimental group (EG) (1080 pupils) was exposed to programme and compared with a control group (CG) (872 students). The intervention included a schoolbased programme (16 sessions in 3 years), reinforcement of a smoke-free school policy, smoking cessation for teachers, brochures for parents and other community-based activities involving youth clubs and tobacco sales. Results: At 12 months, 4.5% of boys and 5.6% of girls were new smokers in the EG versus 6.7% and 11.7% in the CG (P < 0.001). At 36 months, 18.6% of boys and 31.2% of girls in the EG were regular smokers versus 21.6% of boys and 38.3% of girls in the CG (P < 0.001). The main factors associated with progression to regular smoking at 36 months were to be girl, to attend to a public school and to belong to the CG. Conclusion: These results endorse the effectiveness of multi-modal smoking prevention programmes, which include strategies with adults who influence adolescents.
Introduction
ver the past 20 years several school-based programmes
Oused social influences or Life Skills Training approaches.1
Social influences programmes aim to increase awareness of
external factors that lead to smoking onset by modifying
smoking acceptability and building smoking resistance skills.2
Life Skills Training enhances personal and social competence
such as self-management and refusal skills training.3
Several studies have concluded that social influences
programmes alone are ineffective in long-term prevention of
smoking onset.4–6 Pentz7 demonstrated that a comprehensive
community intervention, combining school-based
programmes with the participation of parents and community
leaders and smoke-free school policies are more effective than
advertising and parent and community organisation alone.
Between 1998 and 2001, Barcelona and five European
countries participated in the European Smoking Prevention
Framework Approach (ESFA) project. This included a ‘global
prevention’ approach: a school-based programme as part of
a comprehensive approach to change smoking behaviour of
parents and teachers, to create non-smoking policies in schools
and other youth settings.8 According to this, this article wants
to add scientific evidence that school-based interventions,
reinforced by other community actions can change the
smoking behaviour among adolescents.
This study was conducted in Barcelona where the PASE
(Substance Abuse Prevention in the School) programme, based
on a social influences model, was designed and evaluated in
1990, showing some reduction in smoking behaviour.9,10
Other follow-up studies have since been conducted in
Barcelona which examined the main determinants in
progression to regular smoking.11–15 These findings were used to
develop this new school-based intervention and, in the context
of the ESFA project, the PASE programme was renewed with
complementary activities (new PASE).
The study describes the effects of a smoking prevention
programme (new PASE) on regular smoking in the context of
a smoking multi-modal intervention in a sample of Barcelona
adolescents. Follow-up outcomes up to 36 months are
available.
Methods
Design
The ESFA project included an evaluative study, where an
experimental group (EG) exposed to an intervention was
compared with a control group (CG). In Barcelona, a
quasiexperimental design was conducted. One of the 10 districts of
the city (10th district) was selected as the EG. All the secondary
schools of the district were invited to participate, and 16 of 24
accepted. In total, 46 classes of 1st year of compulsory secondary
education (students aged 12–13 years old) participated in the
project. The CG was composed of 37 schools (and 37 classes,
one class by school), as a representative sample of the other
districts. These CG schools were randomly selected after
stratifying by type of school, school size, socio-economic status
(SES) of the neighbourhood where students lived and the
previous implementation of the former PASE programme. The
stratification resulted in nine strat (...truncated)