Evaluation of the effectiveness of a smoking prevention program based on the ‘Life Skills Training’ approach

Health Education Research, Aug 2013

Our objective was to verify the effectiveness of a program based on the Life Skills Training approach with a greater extent than usual, not applied by teachers and a very high degree of reliability regarding the implementation of the expected content. Twenty-eight secondary schools in Granada (Spain) were randomly assigned to the intervention or control group. The students in the intervention group received 21 one-hour sessions in the first year and 12 one-hour sessions in the second year, whereas those in the control group received no health education or preventive sessions. Students completed questionnaires before and after the first year of sessions, before and after the second year, and at 1 year after the program. All five questionnaires were completed by 77% of the 1048 students initially enrolled in the study. The results suggest that the program had no preventive effects either immediately or at 1 year after its application. Application of the Life Skills Training approach does not appear to prevent the onset of smoking but may prove effective for avoiding escalation of the consumption levels of tobacco or other problematic drugs.

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Evaluation of the effectiveness of a smoking prevention program based on the ‘Life Skills Training’ approach

Evaluation of the effectiveness of a smoking prevention program based on the 'Life Skills Training' approach Mar´ıa Luna-Adame 1 2 Toma´s Jes u´s Carrasco-Gime´nez 1 2 Mar´ıa del Mar Rueda-Garc´ıa 0 1 0 Departamento de Estad ́ıstica e Investigacio ́n Operativa, Universidad de Granada , 18071-Granada , Spain 1 The Author 2013. Published by Oxford University Press. All rights reserved. Downloaded from https://academic.oup.com/her/article-abstract/28/4/673/700954 by guest on 09 2 Departamento de Personalidad, Evaluacio ́n y Tratamiento Psicolo ́gico, Universidad de Granada , 18071-Granada , Spain Our objective was to verify the effectiveness of a program based on the Life Skills Training approach with a greater extent than usual, not applied by teachers and a very high degree of reliability regarding the implementation of the expected content. Twenty-eight secondary schools in Granada (Spain) were randomly assigned to the intervention or control group. The students in the intervention group received 21 one-hour sessions in the first year and 12 one-hour sessions in the second year, whereas those in the control group received no health education or preventive sessions. Students completed questionnaires before and after the first year of sessions, before and after the second year, and at 1 year after the program. All five questionnaires were completed by 77% of the 1048 students initially enrolled in the study. The results suggest that the program had no preventive effects either immediately or at 1 year after its application. Application of the Life Skills Training approach does not appear to prevent the onset of smoking but may prove effective for avoiding escalation of the consumption levels of tobacco or other problematic drugs. Introduction Tobacco consumption continues to be a major cause of disease and death [ 1 ]. Over the past 40 years, the application of prevention programs has been the main strategy for reducing the rate of consumption among children and adolescents [ 2 ]. In the 1970s and 1980s, most of these programs adopted the so-called Social Influences Approach, which focuses on endowing young people with skills that allow them to resist the pressure to smoke from their peers and the media [ 3 ]. The poor results obtained by most of these programs led to the emergence of a new approach, called Life Skills Training, based on providing adolescents with a wide range of skills to successfully meet the challenges they face [ 4 ]. The effectiveness of school-based tobacco prevention programs is currently under debate [ 5 ]. Various studies found little or no evidence of the effectiveness of the life skills approach [ 6–8 ], whereas others attributed the poor preventive outcomes to an inadequate duration of the program, which was usually 5–10 sessions [ 9 ], or to the poor implementation of the program, most frequently by teachers after a brief training period [ 10, 11 ]. It has also been questioned whether teachers are the best agents for applying preventive programs, given the reluctance by some members of the profession, some of whom are smokers, to play this role and the consequent negative effects on the reliability of the program implementation [ 11–13 ]. The aim of this study was to examine the possible adverse influence of these factors on the effectiveness of a preventive program based on life training skills by running a 2-year program to be implemented by well-trained non-teachers with a rigorous control over adherence to the implementation protocol. Methods Sample selection Twenty-eight secondary schools were randomly selected from among all public and state-funded private schools in the city of Granada (Spain). Toward the end of the academic year before the start of the preventive program, data were gathered on the tobacco consumption of all pupils in the third year of secondary education (equivalent to ninth grade in the United States) at the selected schools, as detailed below (see ‘Tobacco consumption assessment’). Each school was assigned a ‘tobacco consumption rate’, i.e. the sum of the mean percentages of sporadic, monthly, weekly and daily smokers among its ninth-grade students, and the 28 schools were ranked according to their rate. The ‘alternate ranks’ [ 14 ] procedure was then applied to assign schools to the intervention or control group, randomly assigning the school with the highest tobacco consumption rate to one of these groups and then assigning the remaining schools according to their ranking, using the formula ABBAABBA. In the next academic year, all seventh-grade classes in each selected school participated in the study. Approval for the study was obtained from the review board of the Ministry of Education of the Autonomous Government of Andalusia. The primary guardians were informed of the objectives of the research and none refused the participation of their child (a passive consent procedure was used) (Fig. 1). Participants The sample co (...truncated)


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Luna-Adame, María, Carrasco-Giménez, Tomás Jesús, Rueda-García, María del Mar. Evaluation of the effectiveness of a smoking prevention program based on the ‘Life Skills Training’ approach, Health Education Research, 2013, pp. 673-682, Volume 28, Issue 4, DOI: 10.1093/her/cyt061