Mass media interventions to reduce youth smoking prevalence. Cigarette smoking and drug use in schoolchildren: III--evaluation of a smoking prevention education programme. The television, school, and family smoking prevention and cessation project. VIII. Student outcomes and mediating variables. Interventions with retailers to reduce cigarette sales to minors: a randomised controlled trial. Evaluation of a Health Promoting Schools program to reduce smoking in Australian secondary schools. Influence of education and advertising on the uptake of smoking by children. [Effectiveness of a programme of intensive tobacco counselling by nursing professionals]. Cluster randomised controlled trial of expert system based on the transtheoretical ("stages of change") model for smoking prevention and cessation in schools. Effectiveness of a computer-tailored smoking cessation program: a randomized trial.
Mass media interventions for reduction of youth cigarette smoking have been recommended based on a broad array of evidence, although few randomized community trials have been reported.
                Four matched pairs of independent media markets were identified; one member of each pair was randomized to receive the intervention. School surveys were conducted in all markets, in 2001 before (n=19,966) and in 2005 after (n=23,246) the interventions were completed.
                Grade 7-12 students from public schools in these eight medium-sized metropolitan areas participated in the summative evaluations; Grades 4-12 students were targeted to receive mass media interventions in four of these markets.
                Four simultaneous campaigns consisting of specially developed messages based on behavioral theory and targeted to defined age groups of racially and ethnically diverse young people were placed in popular TV, cable, and radio programming using purchased time for 4 years.
                Prevalence of youth smoking and psychosocial mediators of smoking.
                No significant impacts of these interventions on smoking behaviors or mediators were found for the overall samples. A positive effect was found for one mediator in subgroups. Among Hispanic participants a marginally favorable effect on smoking prevalence and significant effects on mediators were found. General awareness of smoking prevention TV messages was slightly higher over time in the intervention areas.
                Mass media interventions alone were unable to induce an incremental difference in youth smoking prevalence, probably because of a relatively strong tobacco control environment that included a substantial national smoking prevention media campaign.
                Copyright 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved. A one year randomized controlled trial was used to evaluate the effectiveness of a smoking prevention programme designed by health educationalists for 10-12 year old primary schoolchildren. The study was carried out in the Hunter Region of New South Wales, Australia, using a sample of over 6000 children which would be large enough to detect, with high probability, differences of about 5% in smoking prevalence between the treatment and control groups. We report the results from the children surveyed in 1979 and 1980, before and after the programme was implemented. It was found that there were no significant differences in smoking behaviour between treatment and control groups. The changes that the programme did bring about were very small compared with the overall increases in smoking prevalence which occurred during the study period. The programme's effectiveness varied with both the age and sex of the children. It was most successful among older girls, aged 11-12 years, for whom smoking prevalence rates increased from 10.7% in 1979 to 22.6% in 1980 in the treatment group compared with 6.2% to 26.8% in the control group. It was least successful for younger boys, aged 10-11 years, for whom smoking increased from 9.4% to 14.5% in the treatment group compared with 10.3% to 11.8% in the control group. Attitudes changed in parallel with changes in smoking behaviour. Changes in knowledge differed only slightly between treatment and control groups. Inadequate implementation of the programme by some teachers may have been associated with adverse effects on the children's behaviour, attitudes and knowledge. This paper presents the student outcomes of a large-scale, social-influences-based, school and media-based tobacco use prevention and cessation project in Southern California.
                The study provided an experimental comparison of classroom delivery with television delivery and the combination of the two in a 2 x 2 plus 1 design. Schools were randomly assigned to conditions. Control groups included "treatment as usual" and an "attention control" with the same outcome expectancies as the treatment conditions. Students were surveyed twice in grade 7 and once in each of grades 8 and 9. The interventions occurred during grade 7.
                We observed significant effects on mediating variables such as knowledge and prevalence estimates, and coping effort. The knowledge and prevalence estimates effects decayed partially but remained significant up to a 2-year follow-up. The coping effort effect did not persist at follow-ups. There were significant main effects of both classroom training and TV programming on knowledge and prevalence estimates and significant interactions of classroom and TV programming on knowledge (negative), disapproval of parental smoking, and coping effort. There were no consistent program effects on refusal/self-efficacy, smoking intentions, or behavior.
                Previous reports demonstrated successful development and pilot testing of program components and measures and high acceptance of the program by students and parents. The lack of behavioral effects may have been the result of imperfect program implementation or low base rates of intentions and behavior. We aimed to determine the relative effectiveness of an education intervention and a threat-of-enforcement intervention in reducing sales of cigarettes to under-age youth by randomly allocating 300 retailers in a nonmetropolitan region of New South Wales to: a control group with no intervention; a minimal-intervention group, which received an educational letter; and a maximal-intervention group, which received a threat of enforcement followed by a visit from a public health officer. Retailers were checked for compliance at pretest and post-test, six months apart, by twelve 18-year-olds who were judged by independent raters to look younger. The retailers were surveyed by telephone at both times for knowledge, attitudes and self-reported sales practices. Neither intervention achieved significant improvements for the two key behavioural outcomes: requiring proof of age and display of a warning sign. Neither was there an intervention effect on knowledge about the law. The greatest improvement in the proportion of retailers who believed that the legal age should be 18 or over was in the minimal-intervention group, and both intervention groups were less likely than the control group at post-test to think that it was acceptable to sell to a person who was nearly 18. There was poor overall compliance with the revised legislation at pre-test. The finding of a pretest-to-post-test improvement but no differential intervention effect highlights the methodological difficulties of such research. The interventions may, however, have been partly successful in modifying the attitudes of retailers. This randomized controlled trial evaluated the effectiveness of a multicomponent Health Promoting Schools (HPS) intervention program in improving self-reported smoking outcomes among a cohort of adolescents in 22 public secondary schools in the Hunter Region of New South Wales, Australia. Pre-test surveys were completed by students in the first 2 years of secondary school, with a 2-year post-test survey. Multivariate analyses examined intervention effect for the main outcome, post-test smoking behavior, controlling for pre-test smoking status, school and other confounders. The sample comprised the cohort of 1852 students who completed both surveys. The results demonstrated that the HPS program failed to improve smoking behavior over the 2 years (equal increase of 10% in both groups). The program was successful in improving smoking knowledge, but not attitudes, in intervention versus control group (P < 0.001). Independent predictors of post-test smoking included: pre-test smoking [odds ratio (OR) = 5.44; 95% confidence interval (CI) = 3.20-9.28], being female (OR = 0.55; CI = 0.35-0.87), having more close friends who smoked (OR = 1.42; CI = 1.33-1.52), peer group having no clear opinion about smoking (OR = 3.23; CI = 1.27-8.27), having more positive and less negative attitudes towards smoking, and being less involved in school activities. We discuss methodological issues in multicomponent community-based interventions, and highlight the strengths and limitations of this study. How effective are peer-led programmes in preventing the uptake of smoking by children? In 1981, we conducted a randomized controlled trial of a school-based educational programme for the prevention of smoking in children who were in their seventh year at school. In this article, the reported results of two years of follow-up confirm an earlier report that both teacher-led and peer-led programmes resulted in a reduction, to about the same degree, in the uptake of smoking by girls, while only the teacher-led programme appeared to be effective in boys. In girls, both the teacher-led and peer-led programmes maintained their effects over the two years of follow-up with adjusted differences in prevalence rates of the uptake of smoking relative to the control group of -6.6% (95% CL, -17.3%, 4.0%) and -8.1% (95% CL, -18.9%, 2.7%), respectively, after two years. In boys, the effect of the teacher-led programme was reduced substantially by the second year with a difference in the prevalence rate of -2.8% (95% CL, -11.2%, 5.6%); for the peer-led programme the difference in the prevalence rate was +6.4% (95% CL, -3.6%, 16.4%). Other variables which had a significant effect on the smoking behaviour were the perceived response to cigarette advertising, parental and sibling smoking status, the perceived parental sanctions on smoking behaviour, selected peer influences and the intention to smoke. The children's perceived responses to cigarette advertising showed the strongest and most consistent evidence of an effect on the uptake of smoking by children who initially were non-smokers. After adjustment for the effects of other variables there was an excess of 15.0% (95% CL, 2.1%, 27.9%) in the prevalence rate of smoking after two years for girls who thought that they were influenced by advertising compared with those who did not. The corresponding difference for boys was 15.3% (95% CL, 4.0%, 26.6%). As smoking-prevention programmes only may delay the onset of smoking in children, it is important that legislative measures be introduced to reduce the effects of cigarette advertising. To determine the effectiveness of a systematic intensive tobacco counselling programme conducted by nursing professionals.
                Randomised clinical trial with control.
                Primary care nursing and medical consultations.
                Smokers requesting help in our centre's medical clinics during the recruitment period, up to the sample size required (125). Inclusion criteria were: aged between 18 and 70, people who smoked during the preceding month any number of cigarettes a day, and a score over 7 on the Richmond test.
                The patients recruited were randomised, according to the clinic from which they came, to the group that received brief counselling from the doctor (control group) or to the group that received brief counselling plus nursing follow-up (intervention group). Follow-up visits were programmed in this latter group for up to 3 months after giving up smoking.
                Abstinence at 12 and 24 months.
                The effectiveness of the intervention considered as the rate of abstinence at 12 months was 13.8% (95% CI, 6.5-24.7) in the control group and 6.7% (95% CI, 1.8-16.2) in the intervention group, with no significant differences between the two.
                In smokers seen in primary care, the effectiveness of a programme of intensive tobacco counselling by nursing staff is no more effective than the doctor's brief, one-off counselling. Brief counselling has a better cost-effectiveness relationship than intensive counselling. To examine whether a year long programme based on the transtheoretical model of behaviour change, incorporating three sessions using an expert system computer program and three class lessons, could reduce the prevalence of teenage smoking.
                Cluster randomised trial comparing the intervention to a control group exposed only to health education as part of the English national curriculum.
                52 schools in the West Midlands region. Participants: 8352 students in year 9 (age 13-14 years) at those schools.
                Prevalence of teenage smoking 12 months after the start of the intervention.
                Of the 8352 students recruited, 7444 (89.1%) were followed up at 12 months. The intention to treat odds ratio for smoking in the intervention group relative to control was 1.08 (95% confidence interval 0.89 to 1.33). Sensitivity analysis for loss to follow up and adjustment for potential confounders did not alter these findings.
                The smoking prevention and cessation intervention based on the transtheoretical model, as delivered in this trial, is ineffective in schoolchildren aged 13-14. From a public health perspective, prevention of cancer and cardiovascular diseases requires effective smoking cessation programs that can be used on a large scale.
                To test the effectiveness of a new computer-tailored smoking cessation program vs no intervention.
                Randomized controlled trial, in the French-speaking part of Switzerland, September 20, 1998, to December 31, 1999. Potential participants were randomly selected from a general population register and recruited by mail. Daily cigarette smokers who wished to participate (N = 2934) were randomized to either the program or no intervention. A mean of 1.5 times per 6 months, participants in the active arm received by mail a computer-tailored counseling letter based on their answers to a questionnaire and stage-matched booklets. The counseling letters were tailored to the participants' stage of change (categorized as precontemplation [no intention of quitting smoking in the next 6 months], contemplation [seriously considers quitting in the next 6 months], or preparation [has decided to quit in the next 30 days]), level of tobacco dependence, self-efficacy, and personal characteristics. The outcome measure was self-reported abstinence (no puff of tobacco smoke in the past 4 weeks) 7 months after entry into the program.
                Abstinence was 2.6 times greater in the intervention group than in the control group (5.8% vs 2.2%, P<.001). The program was effective in "precontemplators" who were not motivated to quit smoking at baseline (intervention vs control, 3.8% vs 0.8%; P =.001) and was effective regardless of perceived difficulty in quitting smoking at baseline.
                The program was effective in increasing smoking cessation rates. Because it can reach a large number of smokers, this program can substantially contribute to disease prevention at a population level.
There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign. Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme. Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney). The intensity and duration of mass media campaigns may influence effectiveness, but length of follow-up and concurrent secular trends and events can make this difficult to quantify. No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender.