Class 2000 Health Promotion Programme
12.6 Trier University Health Programme
Forthepast3years,aprogrammedesignedtopreventcigarettesmokinghasbeenimple- mentedinyear6studentsaged11–12yearsfromvarioussecondaryschoolsintheTrier region.Ineightteachingsessions,theprimeobjectiveistomotivatethestudentsnotto startsmokingatall.Atthesametime,socialandpersonaldeterminantsofearlysmoking initiationareidentiiedsothatconsequencescanbedrawnfortheprogrammecontent, whichisconstantlyreinedinthelightofnewdata.Theprogrammehasalreadybeen describedinvariouspublications [39,40,68,69] andisbasedonthemostup-to-date socialskillsapproachesdesignedprimarilytomodifyspeciicsocialbehaviouralpatterns ofchildrenandadolescentswithregardtosmoking.Theprogrammehasbeenintegrated intotheschoolcurriculumanditcomprisescomplementaryscientiicresearchaswellas parentalcollaborationandpublicrelationswork.Theteachingsessionshaverevealedthat studentswithsmokingexperiencearemorepreparedtotakerisksthannon-smokersofthe sameage.Theyalsohaveaconsiderablymorepositiveimageofsmokers. Alongsideencouragingresults,however,thisstudyalsorevealedafallinthenumberof non-smokers,althoughnoeducationalorscareprogrammewasusedforwhichsuchan effecthasbeendemonstrated.Itmaybethatthisrelectsadevelopmenteffectinasmuch asthedevelopmentaltasksfacingadolescentse.g.leavingtheparentalhome,peerorien- tationcoincidewithtrialconsumptionexploratorybehaviour [70,71] .Cluestothismay beearlysmokinginitiation,andtheconnectionsbetweensmokingbehaviourandaten- dencytowardsriskyforbiddenactivities [42] .12.7 Long-Term Studies
Withinthepast8years,threelarge-scalestudieshavebeenperformedtoinvestigatethe preventionofsmokinginitiationamongadolescents:adrugabusepreventiontrialina middle-class population [60] , a follow-up of smoking prevention effects in the North Kareliaproject [72] andtheHutchinsonSmokingPreventionProject [73] .Theirstof thesestudieswasarandomisedtrialinvolving56publicschools3,597predominantly white,12thgradestudentswhorepresented60.4oftheinitial7thgradesample.The schoolsreceivedthepreventionprogrammewithannualprovidertrainingworkshopsand ongoingconsultation,thepreventionprogrammewithvideotapedtrainingandnoconsul- tation,or“treatmentasusual”i.e.controls.Theinterventionconsistedof15classesin 7thgrade,10boostersessionsin8thgrade,and5boostersessionsin9thgrade.Thepro- grammetaughtgeneral“lifeskills”andskillsforresistingsocialinluencestousedrugs. The follow-up data were collected 6 years after baseline using school, telephone and mailedsurveys.Sixtobacco,alcoholandmarijuanauseself-reportscaleswererecorded. Reductionsindrugandpolydrugusewerefound,andthestrongesteffectswereproduced forindividualswhoreceivedareasonablycompleteversionoftheintervention,resulting in44fewerdrugusersand66fewerpolydrugtobacco,alcohol,marijuanausers [60] . It is concluded from this study that reductions in tobacco and drug use can be achievedbyteachingsocialresistanceandgenerallifeskills,includingatleast2yearsof boostersessions. Thesecondmajorstudydescribedtheresultsofa15-yearfollow-upofaschool-and community-basedsmokingpreventionprojectinNorthKarelia,Finland [72] .Fourinter- ventionschoolsfromthisdistrictandtwocontrolschoolsfromanotherprovincewere chosenfortheevaluation,beginningin1978with7thgradestudentsandrunningthrough 1980,witha15-yearfollow-up.InNorthKarelia,acommunity-basedsmokingcessation programmeforadultswasorganisedinaddition.Intheinterventionschools,healtheduca- torsandtrainedpeerleadersled10sessions3inthe7thgrade,5inthe8thgrade,and2in the9thgrade.In1993,thesubjectscompletedaquestionnaireathomeandatrainednurse carriedoutacardiovascularriskfactorsurveyinalocalhealthcentre.Cohortparticipation wasstill71after15years.Theprevalenceofallsmokersinthefourinterventionschools wasbetween28and32,whilethatinthecontrolschoolswas36and41.After15 years,cumulativeexposuretotobaccointheinterventiongroupwas22lowerthaninthe 13 15 16 17 21 28 Age [years] Intervention females Intervention males Control females Control males 200 400 Smoked Cigarette Packs 600 800 1000 1200 Fig. 12.3 Cumulativelifetime cigarettesmoking,inpacks, amongmaleandfemale studentsintheintervention andcontrolschoolsinthe NorthKareliaYouthProject [72] .Atotalof640subjects 71oftheoriginalcohort participatedintheinal survey.Analysesofvariance: schoolgroup,p=0.027;sex, p=0.000;schoolandsex interaction,p=0.28Parts
» Tobacco Plants and Their Origin Use of Tobacco for Religious Purposes
» The Appropriation of Tobacco by Europeans
» Development of the Cigarette
» Objections to Smoking on Health Grounds
» Women Won Over by the Cigarette
» The Medical Use of Tobacco in the Nineteenth Century
» Tobacco Research in the Twentieth Century
» Tobacco Consumption in the Twentieth Century
» Cigarette Smoking in the USA Since 1965
» Cigarette-Related Mortality in Different Countries
» Smokers and Other Risk Factors
» Smoking Behaviour and Educational Level in the EU
» Non-Disclosure of Findings by the Tobacco Industry
» The Cigarette as a Vehicle for Nicotine Release
» Modifications of Nicotine Release
» Maintaining Nicotine Dependence Nicotine and Dependence
» Marketing of Cigarettes with a “Reduced” Health Risk
» Compensatory Behaviour by Smokers
» Optimising Nicotine Release Nicotine and Dependence
» Importance of Absorption Rate
» Ammonium and pH Manipulation
» Cigarettes with Reduced Tar Yield
» Agonists and Antagonists of the nAChR and its Subtypes
» Effects of Nicotine on Receptors in Different Organs
» Metabolic and Hormonal Effects of Nicotine
» Central Nervous System Effects of Nicotine
» Types of Dependence Nicotine Dependence
» Molecular Biological Aspects of Dependence
» Genetic Aspects Nicotine Dependence
» Withdrawal Symptoms Nicotine Dependence
» Immunological Reactions Caused by Cigarette Smoking
» Association Between Smoking and Lung Cancer
» Tobacco-Specific Carcinogens Genetic Factors That Increase the Risk for Bronchial Carcinoma
» The Cytochrome P450 and GST System and Carcinogenesis
» Peptide Receptors, Genetic Factors That Increase the Risk for Bronchial Carcinoma
» Exogenous Factors and Lung Cancer
» Pathophysiology of COPD Cigarette Smoking and COPD
» Genetic Factors Important Risk Factors for COPD
» Occupational and Environmental Factors
» Caveats Concerning the Informative Value of Studies
» Cigarette Smoking and Bronchial Asthma in Adults
» Bronchial Asthma in Children
» Other Lung Diseases Influenced by Cigarette Smoking
» Coronary Artery Disease and Myocardial Infarction
» Changes in Endothelial Function and Microcirculation
» Microcirculation and O Systemic Vascular Changes
» Arteriosclerotic and Inflammatory Vascular Reactions
» Genetic Factors Blood Coagulation and Fibrinolysis
» Nicotine and Ischaemic Heart Disease
» Cognitive Impairment Central Nervous System
» Influence on Cognitive Performance
» Intellectual Impairment in Childhood
» Smoker Personality Profiles and Genetic Inheritance of Smoking
» Peculiarities of the Smoker’s Personality
» Reasons for Increased Cigarette Consumption
» Comorbidity Between Depression and Smoking
» Extent of Cigarette Consumption
» Effects of Smoking in Forms of Dementia
» Smoking and Parkinson’s Disease
» Diabetic Retinopathy Ocular Diseases
» Graves’ Ophthalmopathy Ocular Diseases
» Macular Degeneration Ocular Diseases
» Ocular Tumours Ocular Diseases
» Retinal Detachment Ocular Diseases
» Lipid and Cholesterol Metabolism
» Insulin Resistance Diabetic Nephropathy
» Oesophageal Cancer Gastrointestinal Tract
» Gastrointestinal Ulcers Gastrointestinal Tract
» Cancers of the Gastrointestinal Tract
» Pancreatic Cancer Gastrointestinal Tract
» Toxic Substances and Inducers
» Kidney Cancer Urinary Tract Diseases
» Bladder Cancer Urinary Tract Diseases
» Prostatic Hyperplasia and Prostatic Cancer
» Fertility Disorders Urinary Tract Diseases
» Vitamin D and Oestrogen Metabolism
» Osteoporosis Disorders of Mineral Metabolism and Bone
» Hip Fractures Disorders of Mineral Metabolism and Bone
» Skin Changes Skin and Mucosa
» Skin Tumours Skin and Mucosa
» Breast Cancer Skin and Mucosa
» Effects of Smoking on the Placenta
» Malformations Possibly Caused by Smoking
» Smoking and Sudden Infant Death Syndrome SIDS
» Effects of Nicotine on the Foetus
» Medical Care Costs Attributable to Smoking During Pregnancy
» ETS in the Workplace and at Home
» Fibrinogen Cholesterol Endothelium and Platelets
» Markers of Inflammation Changes at the Molecular and Cellular Level
» Passive Smoking During and After Pregnancy
» Coronary Heart Disease Cardiovascular Disease
» Stroke and Subarachnoid Haemorrhage
» Respiratory Tract in Children and Teenagers
» Bronchial Carcinoma Respiratory Tract
» Indications and Diagnostic Considerations
» Self-Help Interventions by the Smoker
» Physician Advice for Smoking Cessation
» Group Behaviour Therapy Programmes
» Mass Media Communication Strategies
» E-Learning, Email and Internet for Smoking Cessation
» Evaluation of Nicotine Products
» Nicotine Chewing Gum Nicotine
» Nicotine Sublingual Tablet Nicotine Nasal Spray
» Treatment and Dosage Nicotine
» Nicotine Chewing Gum Adverse Events Associated with NRT
» Nicotine Patch Adverse Events Associated with NRT
» Nicotine Nasal Spray Adverse Events Associated with NRT
» Nicotine Inhaler Adverse Events Associated with NRT
» Nicotine Sublingual Tablet Adverse Events Associated with NRT
» Nicotine Lozenge Adverse Events Associated with NRT
» Drug Interactions During Smoking Cessation
» Contraindications for the Use of Nicotine Products
» Nicotine Formulations as OTC Products
» Contraindications and Drug Interactions
» Tranquillisers and Buspirone Other Pharmacotherapies
» Various Antidepressants Other Pharmacotherapies
» Opioid Antagonists Other Pharmacotherapies
» Silver Acetate Other Pharmacotherapies
» Therapeutic Monitoring in Smoking Cessation
» Ischaemic Heart Disease Special Therapeutic Situations
» Pregnancy Special Therapeutic Situations
» Weight Gain Special Therapeutic Situations
» Alcohol Consumption Special Therapeutic Situations
» Organic Depression Organic Depression and Schizophrenia
» Schizophrenic Patients Organic Depression and Schizophrenia
» Interactions Between Cigarette Smoking and Administration of Psychopharmaceuticals
» Pre-operative Smoking Cessation Special Therapeutic Situations
» Social Influence Inoculation Strategy
» Life Skills Strategy Prevention Programmes for Schools
» Class 2000 Health Promotion Programme
» Trier University Health Programme Long-Term Studies
» Role of Teachers in Primary Prevention
» Prevention by Restricting Sales of Tobacco Products to Minors
» Role of the Mass Media in Sales of Tobacco Products to Adolescents
» Role of Government and Community in Primary Prevention
» Effect of Tobacco Industry Advertising Messages
» Tobacco Advertising and Adolescent Smoking Initiation
» Advertising with “Light” Cigarettes
» Smoking Bans in Public Buildings and Public Spaces
» Tobacco Industry, Governmental and Non-governmental Organisations
» Politicians and Their Attitude to Smoking
» Scientists and the Tobacco Industry
» Governmental Control of Toxic Tobacco Constituents
» Bans on Advertising in Various Countries
» Tobacco Industry: Playing Down the Risks of Smoking and Passive Smoking
» Smoking and Non-smoking: Weighing the Benefits
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