Development and evaluation of an intervention providing insight into the tobacco industry to prevent smoking uptake: a mixed-methods study
Development and evaluation of an intervention providing insight into the tobacco industry to prevent smoking uptake: a mixed-methods study
复制标题
制定和评估一项干预措施，深入了解烟草业以防止吸烟：一项混合方法研究
DOI：
10.3310/phr04090
复制
发表时间：
2016
影响因子：
--
通讯作者：
M. Bains
中科院分区：
文献类型：
--
作者：
L. Szatkowski;John A. Taylor;Amy Taylor;S. Lewis;J. Britton;A. McNeill;L. Bauld;Qi Wu;S. Parrott;Laura L. Jones;M. Bains
背景
在很小的时候就开始吸烟的吸烟者戒烟的可能性更小，更有可能死于他们的习惯。来自美国Truth®运动的证据表明，针对烟草行业做法和道德的干预措施可能有效地防止吸烟。
目标
在一项探索性研究中，开发、试验并提供烟雾风暴行动的可接受性和有效性的初步证据，烟雾风暴行动是一项基于Truth®运动前提的学校干预措施，旨在防止吸烟。
设计
混合方法、非随机对照研究。组件1交付给7年级的学生，并进行学生焦点小组和教师访谈，以完善的教训，并制定组件2和3。修订后的7年级课程和随附的家庭小册子仅在一所学校的一年后分发给7年级新生;两所学校的8年级学生都接受了强化课程。
地点和对象
7-8年级（11-13岁）的学生在两所英国学校。
干预
由三部分组成的干预措施，包括：（1）7年级的三节50分钟课堂课程，学生充当特工，通过视频、测验、讨论和演示来揭露行业实践;（2）随附的家庭小册子，其中包含旨在激发家长和学生之间关于吸烟的讨论的活动;及（3）为八年级学生而设的一小时互动课堂辅助课程，让学生从一位业界行政人员、一间市场推广公司及一位健康活动家的角度，学习烟草市场推广策略。
主要观察指标
比值比，以比较自我报告的患病率曾经吸烟和吸烟的易感性，在8年的学生在研究学校的助推器会议交付后，与当地对照学校的学生。关于干预措施可接受性的定性数据。
结果
曾经吸烟和易感性的合并患病率从第7年的18.2%增加到第8年的33.8%。调整混杂因素后，干预学校8年级学生吸烟或易感从不吸烟的几率与对照组相比无显著差异[调整后比值比（aOR）1.28，95%置信区间（CI）0.83至1.97; p = 0.263]，曾经吸烟的几率无显著差异（aOR 0.82，95%CI 0.42至1.58; p = 0.549）。学生们大多喜欢干预，并获得了新的知识，似乎加强了他们对吸烟的厌恶。教师们喜欢这种资源的“现成”性质，尽管他们强调了学生在理解所呈现信息的程度上的学术能力差异。家庭部分的使用率很低，但确实参与其中的父母对此表示积极欢迎。
限制
对数困难意味着学生在7年级和8年级的反应不能联系起来;然而，干预和对照学校之间的基线吸烟行为差异不大，并对随访时测量的混杂因素进行了调整。
结论
烟雾风暴行动是一个可以接受的资源，提供预防吸烟教育，但它似乎没有减少吸烟和易感性。
今后工作
缺乏潜在有效性的强烈信号，再加上在招募和与学校合作方面的后勤困难，表明没有必要对干预措施进行充分的聚类随机试验。
Background
Smokers who start smoking at an early age are less likely to quit and more likely to die from their habit. Evidence from the US Truth® campaign suggests that interventions focusing on tobacco industry practices and ethics may be effective in preventing smoking uptake.
Objectives
In an exploratory study, to develop, pilot and provide preliminary evidence of the acceptability and effectiveness of Operation Smoke Storm, a school-based intervention based on the premise of the Truth® campaign, to prevent smoking uptake.
Design
Mixed-methods, non-randomised controlled study. Component 1 was delivered to Year 7 students, and student focus groups and teacher interviews were conducted to refine the lessons and to develop components 2 and 3. The revised Year 7 lessons and accompanying family booklet were delivered to new Year 7 students 1 year later in one school only; Year 8 students in both schools received the booster session.
Setting and participants
Students in Years 7–8 (aged 11–13 years) in two UK schools.
Intervention
A three-component intervention comprising (1) three 50-minute classroom-based sessions in Year 7 in which students acted as secret agents to uncover industry practices through videos, quizzes, discussions and presentations; (2) an accompanying family booklet containing activities designed to stimulate discussions about smoking between parents and students; and (3) a 1-hour interactive classroom-based booster session for Year 8 students, in which students learnt about tobacco marketing strategies from the perspectives of an industry executive, a marketing company and a health campaigner.
Main outcome measures
Odds ratios to compare the self-reported prevalence of ever smoking and susceptibility to smoking in Year 8 students after the delivery of the booster session in study schools compared with students in local control schools. Qualitative data on acceptability of the intervention.
Results
The combined prevalence of ever smoking and susceptibility increased from 18.2% in Year 7 to 33.8% in Year 8. After adjusting for confounders there was no significant difference in the odds of a Year 8 student in an intervention school being an ever smoker or susceptible never smoker compared with controls [adjusted odds ratio (aOR) 1.28, 95% confidence interval (CI) 0.83 to 1.97; p = 0.263] and no significant difference in the odds of ever smoking (aOR 0.82, 95% CI 0.42 to 1.58; p = 0.549). Students mostly enjoyed the intervention and acquired new knowledge that appeared to strengthen their aversion to smoking. Teachers liked the ‘off-the-shelf’ nature of the resource, although they highlighted differences by academic ability in the extent to which students understood the messages being presented. Use of the family component was low but it was received positively by those parents who did engage with it.
Limitations
Logistical difficulties meant that students’ responses in Year 7 and Year 8 could not be linked; however, baseline smoking behaviours differed little between intervention and control schools, and analyses were adjusted for confounders measured at follow-up.
Conclusions
Operation Smoke Storm is an acceptable resource for delivering smoking-prevention education but it does not appear to have reduced smoking and susceptibility.
Future work
The lack of a strong signal for potential effectiveness, considered alongside logistical difficulties in recruiting and working with schools, suggests that a fully powered cluster randomised trial of the intervention is not warranted.
DOI：
10.1056/nejm199109263251318
发表时间：
1991-09
期刊：
The New England journal of medicine
影响因子：
--
作者：
E. Taioli;Wynder El
通讯作者：
E. Taioli;Wynder El