School based interventions to prevent the uptake of smoking among children

As I noted at the end of last week NICE are consulting on evidence papers around school based efforts to prevent young people from smoking. You can download the papers from here, but I thought it might be helpful to provide a summary of what they found, which you can find below.

One of the things I found interesting was that (in contrast to what NICE believe is effective in mass media campaigns) fear based approaches are seen as a barrier to providing prevention programmes in schools.

What helps and what hinders providing interventions in schools

The University of Bath have reviewed the literature on the facilitators and barriers to implementing school based programmes and interventions which aim to prevent the uptake of smoking amongst pupils.

They suggest that while the literature is of mixed quality and largely from the United States there are 6 themes that emerge.

Delivery context of the intervention

Facilitators	Barriers
timing to suit school assessment schedules; including multiple sessions; delivering school-based prevention as part of a wider tobacco control strategy; and involving other organisations in design and delivery	schools where staff are smokers

Characteristics of young people receiving the intervention

Facilitators	Barriers
	Where young people receiving the intervention are regular smokers; where they live with smokers; where community smoking rates are high; and where those receiving school-based prevention are older teenagers

Peer interventions

Facilitators	Barriers
peer-supporter nomination by fellow students; training for peer-supporters delivered by professionals away from school; flexibility in delivery; supporting peer interventions with other prevention materials; and good communication between external intervention development teams and the school	Teacher’s concern about ‘suitability’ of some peer supporters selected by fellow students; Peer norms and peer group structure can influence how much and when adolescents smoke, and can also influence the extent to which young people are receptive to prevention messages delivered by peers

Delivery mechanisms

Facilitators	Barriers
delivery of the intervention by trusted external professionals; delivery by non-smoking teachers; and involvement of parents	teacher’s reluctance to discuss parental smoking; and the use of outdated communication methods in delivery

Smokefree schools

Facilitators	Barriers
introduction and enforcement of smokefree school policies	allowing smoking on school grounds poor enforcement of smoking policy

Programme content

Facilitators	Barriers
content that is innovative; interactive; includes role play; includes new material; and is culturally sensitive	fear-based approaches; and content that is too complex

Which interventions are effective in preventing the uptake of smoking?

A separate paper from the West Midlands Health Technology Assessment Collaboration has tried to answer questions about the effectiveness of smoking prevention in schools.

They conclude that the literature:

has provided few insights into what works and for whom. Most variations in participants, intervention, comparators and outcomes do not appear to have much impact on effectiveness. Apart from quality issues, the main exceptions are weak evidence indicating that school-based interventions starting soon after entry into primary schools may be effective in reducing the uptake of smoking up to age of 14, and strong evidence that booster sessions enhance effectiveness of main programmes.

Are any school-based interventions more cost-effective in preventing children and young people from taking up smoking?

A third paper, also from the West Midlands Health Technology Assessment Collaboration, looks at cost-effectiveness and concludes:

All of the studies reviewed suggest that school-based smoking prevention programmes may be an efficient use of resources within the health care and education jurisdictions considered. However, the two studies that considered indirect benefits found that the majority of benefits accrued by such interventions were attributable to a reduction in productivity loss due to smoking-related morbidity and premature mortality.

The authors do, however, point out that the research may not be applicable to the UK and may have overestimated the long term impact of the interventions.

Filed under: NICE, tobacco