Effects of a school-based prevention programme on smoking in early adolescence: a 6-month follow-up of the 'Eigenstandig werden' cluster randomised trial

Abstract

Objectives: To test the effects of a school-based prevention programme on students' smoking-related behaviour, attitudes and knowledge 6 months after implementation over 2 school-years has ended.

Design: Two-arm prospective cluster randomised controlled trial with a follow-up survey 6 months after end of programme implementation, that is, 26 months after baseline.

Setting: 45 public secondary schools from four federal states in Germany (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein).

Participants: A total of 3444 students from 172 classes with a mean age of 10.37 years (SD=0.59) and 47.9% girls at baseline. Analysis sample with follow-up up data merged to baseline data comprises 2513 datasets (73%).

Intervention: 'Eigenständig werden 5+6', a school-based prevention programme for grades 5 and 6 to enhance substance-specific and general life skills, consisting of 14 units (à 90 min) and two workshops (4-6 h) being taught over a time period of 2 school-years by trained teachers.

Outcome measures: Lifetime and current smoking, incidence of smoking in baseline never smokers, smoking-related knowledge, attitudes, perceived norms of smoking and self-efficacy to refuse cigarette offers were assessed in students.

Results: 6 months after the end of programme implementation, students of intervention classes showed significantly lower rates for lifetime smoking (adjusted OR=0.63; 95% CI 0.41 to 0.96; p=0.026) and incidence of smoking (adjusted OR=0.66; 95% CI 0.43 to 1.00; p=0.047), a higher increase of smoking-related knowledge (adjusted β=9.38; 95% CI 6.73 to 12.04; p<0.001) and a greater change in attitudes towards a more critical perception of risks and disadvantages of smoking (adjusted β=0.10; 95% CI 0.03 to 0.16; p=0.002). No group differences were found for current smoking, perceived norms of smoking and self-efficacy to refuse cigarette offers.

Conclusions: Participation in the school-based prevention programme 'Eigenständig werden 5+6' may have small effects on smoking behaviour and attitudes and a moderate effect on smoking-related knowledge.

Trial registration: Current Controlled Trials ISRCTN99442407.

Keywords: Public Health; cluster randomized controlled trial; efficacy; school based prevention; smoking.

Figure 1

Participation flow chart.

Figure 2

Percentage of lifetime smoking, current smoking at baseline and 6-month follow-up, percentage of smoking incidence at 6-month follow-up among baseline never-smokers and multilevel mixed effects logistic regressions; logistic regressions were adjusted for age, gender, type of school, socioeconomic status, migration background, peer/parent/sibling smoking, sensation seeking, rebelliousness, earlier participation in a prevention programme.