Fifteen‐month follow‐up results of a school‐based life‐skills approach to smoking prevention

Health Education Research, Apr 2004

The life‐skills approach to smoking prevention was tested in this study. In total, 1024 pupils (mean age 11.4 years, SD = 0.90) from Austria, Denmark, Luxembourg and Germany were recruited as an experimental group, and a sample of 834 matched pupils served as a control group. While the pupils from the control group received no specific intervention, the pupils in the experimental group participated in an intervention programme which was based on the life‐skills approach and consisted of 21 sessions. The aims of the programme were to promote fundamental social competencies and coping skills. In addition, specific information on cigarette smoking was given and skills for resisting social influences to smoke were rehearsed. The programme was conducted by trained school teachers during a course of 4 months. Anonymous questionnaires were administrated (1) before the programme was implemented and (2) 15 months after the programme had started. Teachers as well as pupils showed a high level of satisfaction with the programme idea and the materials. With regard to the outcome variables, the programme had no differential effect on current smoking (4‐week prevalence). The programme showed a weak effect (P < 0.1) on lifetime smoking prevalence and experimental smoking. There was also an effect of the programme on smoking knowledge, on the social competences of the pupils as well as on the classroom climate. No effects were found on susceptibility to smoking among never‐smokers, attitudes towards smoking and the perceived positive consequences of smoking. The results indicate that prevention programmes that are run for only a few months can have a positive impact on variables considered to be protective with regard to smoking uptake.

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Fifteen‐month follow‐up results of a school‐based life‐skills approach to smoking prevention

Health Education Research Fifteen-month follow-up results of a school-based life-skills approach to smoking prevention1 Reiner Hanewinkel 0 Department of Child and Adolescent Psychiatry, University of Hamburg , 20246 Hamburg , Germany 1 Institute for Therapy and Health Research, IFT-Nord , 24105 Kiel The life-skills approach to smoking prevention was tested in this study. In total, 1024 pupils (mean age 11.4 years, SD = 0.90) from Austria, Denmark, Luxembourg and Germany were recruited as an experimental group, and a sample of 834 matched pupils served as a control group. While the pupils from the control group received no speci®c intervention, the pupils in the experimental group participated in an intervention programme which was based on the life-skills approach and consisted of 21 sessions. The aims of the programme were to promote fundamental social competencies and coping skills. In addition, speci®c information on cigarette smoking was given and skills for resisting social in¯uences to smoke were rehearsed. The programme was conducted by trained school teachers during a course of 4 months. Anonymous questionnaires were administrated (1) before the programme was implemented and (2) 15 months after the programme had started. Teachers as well as pupils showed a high level of satisfaction with the programme idea and the materials. With regard to the outcome variables, the programme had no differential effect on current smoking (4-week prevalence). The programme showed a weak effect (P < 0.1) on lifetime smoking prevalence and experimental smoking. There was also an effect of the programme on smoking knowledge, on the social competences of the pupils as well as on the classroom climate. No effects were found on susceptibility to smoking among never-smokers, attitudes towards smoking and the perceived positive consequences of smoking. The results indicate that prevention programmes that are run for only a few months can have a positive impact on variables considered to be protective with regard to smoking uptake. - 1,3 and Martin Aûhauer 2 Introduction Smoking remains the leading preventable cause of premature disease and death worldwide (WHO, 1997) . It is estimated that in the next 20±30 years, 10 million people per year will die from tobaccorelated diseases such as cancer, cardiovascular disease, chronic obstructive pulmonary disease and others (Satcher, 2001) . Epidemiological studies indicate that smoking prevalence among youth underwent a sustained and substantial decline in the 1970s and 1980s, but during the 1990s smoking prevalence increased among adolescents in the US (Ferrence et al., 2000) and also in Europe (WHO, 2000) . In addition, little progress has been made over the years in improving cessation rates among smokers and relapse is still the rule rather than the exception in treatment studies. Thus, effective primary prevention programmes for youth smoking are urgently required. Over the past decades several different educational models for smoking prevention have been established and evaluated (US Department of Health and Human Services, 2000) . The earliest evaluated programmes designed to prevent children and adolescents from beginning to smoke were based on an information de®cit model (US Department of Health and Human Services, 1994) . The assumption of this approach is that adolescents would refrain from smoking if they were supplied with adequate information regarding the harmful effects of smoking. Factual information concerning the nature, pharmacology and harmful consequences of tobacco is given based on the belief that once individuals are aware of the hazards of using tobacco, they will develop antitobacco attitudes, and make a rational and logical decision not to use tobacco. Reviews and metaanalysis indicate that this approach leads to an increase in knowledge, but neither affects the attitudes towards smoking nor the actual behavior (Hansen, 1992; Bruvold, 1993; Tobler and Stratton, 1997; Tobler et al., 2000) . Recognizing the limitations of this approach, other educational interventions have been developed in order to prevent youth smoking (Durlak, 1995) . The underlying assumption of the affective education model is that reduced levels of perceived self-esteem, and poor attitudes towards family, school and community cause smoking initiation. Therefore, a broad range of educational strategies were established in order to clarify values, build up self-esteem and develop skills for decision making. Several evaluations of this prevention approach show that it is not more effective in in¯uencing adolescents attitudes and behaviors than programmes which are based on the information de®cit model (Lynch and Bonnie, 1994; Vartiainen et al., 1994) . Beginning in the 1970s, new approaches to smoking prevention have been developed, which mostly use psychological inoculation techniques and behavioral rehearsal to strengthen attitudes and skills that aid in r (...truncated)


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Hanewinkel, Reiner, Aßhauer, Martin. Fifteen‐month follow‐up results of a school‐based life‐skills approach to smoking prevention, Health Education Research, 2004, pp. 125-137, Volume 19, Issue 2, DOI: 10.1093/her/cyg018