Feasibility study of a peer-led, school-based, adolescent smoking prevention intervention (ASSIST) in culturally different middle income countries

在文化不同的中等收入国家开展由同伴主导、以学校为基础的青少年吸烟预防干预措施 (ASSIST) 的可行性研究

• 批准号: MR/T040416/1
• 负责人: Sharon Simpson
• 金额: $ 117.5万
• 依托单位: University of Glasgow
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT040416%2F1
• 关键词: Feasibility; study; peer; led; based

Tobacco is the world's main cause of avoidable poor health and early death. Around 80% of the world's smokers live in lower and middle-income countries. Our project focuses on three Asian middle-income countries with smoking rates that are high and predicted to increase or remain stable: China, Indonesia and the Philippines.Because most smoking begins in youth, it is crucial to prevent uptake in adolescence. This is challenging, but UK research showed an intervention called A Stop Smoking In Schools Trial (ASSIST) was effective. ASSIST is unusual, because it does not involve formal health education. It recruits 12-13 year olds who are influential among their school year group as 'peer supporters', to spread messages among their friendship networks via informal conversations about the risks of smoking and benefits of not smoking. Because ASSIST was shown to work, it was widely taken up in the UK.ASSIST is relatively low cost, and so may be suitable in lower and middle-income countries, but its informal peer-supporter model may make it less acceptable in countries with more formal or hierarchical school systems. Our project will therefore assess: (1) whether ASSIST can be successfully adapted and transferred to one or more of these three countries (which are themselves culturally diverse); and (2) how easy it would be to run a future large study (as happened in the UK) to test if it works to prevent smoking uptake in one or more of the countries.Our research team was formed during a smaller project, conducted in early 2019, when University of Glasgow researchers contacted international country partners to see if they were interested in this research area and to start talking to policymakers, school staff and students about the idea. This work suggested interest in the ASSIST model in each country, and our project will build on that momentum.To do this, in each country we will continue consultations on whether and how to adapt ASSIST so it is appropriate, both culturally and for contemporary adolescents, but still retains its key elements. A UK not-for-profit company with experience of training the trainers (who then train the peer supporters) will run train-the-trainer sessions in each country and support translation of required materials.Each country will recruit 10 secondary schools to take part in the study; six will be randomly selected as intervention schools (they will carry out ASSIST) and, for comparison, four as control schools (carrying on as normal, without ASSIST). In the intervention schools, ASSIST trainers will run sessions where the whole 12-13 year-old year-group completes a survey to say who they respect, think are good leaders and look up to. The 20% highest scoring students will be invited to become peer supporters and attend a two-day training session to improve their knowledge of smoking's harms and the benefits of not smoking, and develop skills and confidence in having conversations about smoking with friends. They will then act as peer supporters in their school for the next 10 weeks, with support from the trainers.In each country, researchers will run surveys among the whole year group in all 10 schools before ASSIST and 7-months after it is completed. These will include measures of smoking (so rates in intervention and control schools can be compared) and friendship networks (to help understand where peer supporters fit). Researchers will observe training sessions and conduct interviews and discussions with the trainers, and students, staff and parents in intervention schools to understand how ASSIST worked (or didn't work) in practice. They will also collect data on the costs of ASSIST.If research shows: ASSIST to be acceptable and feasible; that schools can support the research; and policymakers show interest in providing support for the intervention in one or more of the countries, the next step would be for a larger project with more schools to properly test if it works.

烟草是世界上可避免的健康状况不佳和过早死亡的主要原因。世界上大约80%的吸烟者生活在中低收入国家。我们的项目重点关注三个亚洲中等收入国家，这些国家的吸烟率很高，预计将增加或保持稳定：中国，印度尼西亚和菲律宾。由于大多数吸烟始于青年，因此预防青少年吸烟至关重要。这是具有挑战性的，但英国的研究表明，一项名为“在学校停止吸烟试验”（ASSIST）的干预措施是有效的。ASSIST是不寻常的，因为它不涉及正式的健康教育。它招募了12-13岁的学生作为“同龄人”，通过非正式的谈话在他们的友谊网络中传播关于吸烟的风险和不吸烟的好处的信息。由于ASSIST被证明是有效的，它在英国被广泛采用。ASSIST的成本相对较低，因此可能适合中低收入国家，但其非正式的同伴支持模式可能使其在更正式或等级学校系统的国家不太容易接受。因此，我们的项目将评估：（1）ASSIST是否可以成功地调整和转移到这三个国家中的一个或多个国家（本身就是文化上的差异）;以及（2）将来进行大型研究的容易程度（就像在英国发生的那样）来测试它是否能在一个或多个国家阻止吸烟。我们的研究团队是在一个较小的项目中成立的，该研究于2019年初进行，当时格拉斯哥大学的研究人员联系了国际国家合作伙伴，看看他们是否对这一研究领域感兴趣，并开始与政策制定者、学校工作人员和学生讨论这个想法。这项工作表明了每个国家对ASSIST模式的兴趣，我们的项目将在这一势头的基础上再接再厉，为此，我们将继续在每个国家就是否以及如何调整ASSIST进行磋商，使其在文化上和当代青少年中都是合适的，但仍保留其关键要素。一家英国非营利公司，具有培训培训师的经验（然后培训同伴支持者）将在每个国家举办培训员培训班，并支持翻译所需材料，每个国家将招募10所中学参加这项研究;将随机选择六所学校作为干预学校（他们将进行ASSIST），作为比较，四所作为对照学校（正常进行，没有ASSIST）。在干预学校，ASSIST培训师将举办课程，让整个12-13岁的年龄组完成一项调查，说出他们尊重谁，认为谁是好的领导者，并仰视谁。得分最高的20%的学生将被邀请成为同伴支持者，并参加为期两天的培训课程，以提高他们对吸烟的危害和不吸烟的好处的认识，并培养与朋友谈论吸烟的技能和信心。在接下来的10周里，他们将在培训师的支持下，在自己的学校充当同伴支持者。在每个国家，研究人员将在ASSIST之前和完成后7个月对所有10所学校的全年组进行调查。这些措施将包括吸烟的措施（因此干预学校和控制学校的比率可以比较）和友谊网络（以帮助了解同伴支持者的位置）。研究人员将观察培训课程，并与干预学校的培训师、学生、工作人员和家长进行访谈和讨论，以了解ASSIST在实践中是如何工作（或不工作）的。如果研究表明：ASSIST是可接受的和可行的;学校可以支持研究;决策者表示有兴趣为一个或多个国家的干预措施提供支持，下一步将是一个更大的项目，有更多的学校，以适当地测试它是否有效。