Class 2000 Health Promotion Programme

12.6 Trier University Health Programme

For฀the฀past฀3฀years,฀a฀programme฀designed฀to฀prevent฀cigarette฀smoking฀has฀been฀imple- mented฀in฀year฀6฀students฀aged฀11–12฀years฀from฀various฀secondary฀schools฀in฀the฀Trier฀ region.฀In฀eight฀teaching฀sessions,฀the฀prime฀objective฀is฀to฀motivate฀the฀students฀not฀to฀ start฀smoking฀at฀all.฀At฀the฀same฀time,฀social฀and฀personal฀determinants฀of฀early฀smoking฀ initiation฀are฀identiied฀so฀that฀consequences฀can฀be฀drawn฀for฀the฀programme฀content,฀ which฀is฀constantly฀reined฀in฀the฀light฀of฀new฀data.฀The฀programme฀has฀already฀been฀ described฀in฀various฀publications฀ [39,฀40,฀68,฀69] ฀and฀is฀based฀on฀the฀most฀up-to-date฀ social฀skills฀approaches฀designed฀primarily฀to฀modify฀speciic฀social฀behavioural฀patterns฀ of฀children฀and฀adolescents฀with฀regard฀to฀smoking.฀The฀programme฀has฀been฀integrated฀ into฀the฀school฀curriculum฀and฀it฀comprises฀complementary฀scientiic฀research฀as฀well฀as฀ parental฀collaboration฀and฀public฀relations฀work.฀The฀teaching฀sessions฀have฀revealed฀that฀ students฀with฀smoking฀experience฀are฀more฀prepared฀to฀take฀risks฀than฀non-smokers฀of฀the฀ same฀age.฀They฀also฀have฀a฀considerably฀more฀positive฀image฀of฀smokers. Alongside฀encouraging฀results,฀however,฀this฀study฀also฀revealed฀a฀fall฀in฀the฀number฀of฀ non-smokers,฀although฀no฀educational฀or฀scare฀programme฀was฀used฀for฀which฀such฀an฀ effect฀has฀been฀demonstrated.฀It฀may฀be฀that฀this฀relects฀a฀development฀effect฀in฀as฀much฀ as฀the฀developmental฀tasks฀facing฀adolescents฀e.g.฀leaving฀the฀parental฀home,฀peer฀orien- tation฀coincide฀with฀trial฀consumption฀exploratory฀behaviour฀ [70,฀71] .฀Clues฀to฀this฀may฀ be฀early฀smoking฀initiation,฀and฀the฀connections฀between฀smoking฀behaviour฀and฀a฀ten- dency฀towards฀risky฀forbidden฀activities฀ [42] .

12.7 Long-Term Studies

Within฀the฀past฀8฀years,฀three฀large-scale฀studies฀have฀been฀performed฀to฀investigate฀the฀ prevention฀of฀smoking฀initiation฀among฀adolescents:฀a฀drug฀abuse฀prevention฀trial฀in฀a฀ middle-class฀ population฀ [60] ,฀ a฀ follow-up฀ of฀ smoking฀ prevention฀ effects฀ in฀ the฀ North฀ Karelia฀project฀ [72] ฀and฀the฀Hutchinson฀Smoking฀Prevention฀Project฀ [73] .฀The฀irst฀of฀ these฀studies฀was฀a฀randomised฀trial฀involving฀56฀public฀schools฀3,597฀predominantly฀ white,฀12th฀grade฀students฀who฀represented฀60.4฀of฀the฀initial฀7th฀grade฀sample.฀The฀ schools฀received฀the฀prevention฀programme฀with฀annual฀provider฀training฀workshops฀and฀ ongoing฀consultation,฀the฀prevention฀programme฀with฀videotaped฀training฀and฀no฀consul- tation,฀or฀“treatment฀as฀usual”฀i.e.฀controls.฀The฀intervention฀consisted฀of฀15฀classes฀in฀ 7th฀grade,฀10฀booster฀sessions฀in฀8th฀grade,฀and฀5฀booster฀sessions฀in฀9th฀grade.฀The฀pro- gramme฀taught฀general฀“life฀skills”฀and฀skills฀for฀resisting฀social฀inluences฀to฀use฀drugs.฀ The฀ follow-up฀ data฀ were฀ collected฀ 6฀ years฀ after฀ baseline฀ using฀ school,฀ telephone฀ and฀ mailed฀surveys.฀Six฀tobacco,฀alcohol฀and฀marijuana฀use฀self-report฀scales฀were฀recorded.฀ Reductions฀in฀drug฀and฀polydrug฀use฀were฀found,฀and฀the฀strongest฀effects฀were฀produced฀ for฀individuals฀who฀received฀a฀reasonably฀complete฀version฀of฀the฀intervention,฀resulting฀ in฀44฀fewer฀drug฀users฀and฀66฀fewer฀polydrug฀tobacco,฀alcohol,฀marijuana฀users฀ [60] .฀ It฀ is฀ concluded฀ from฀ this฀ study฀ that฀ reductions฀ in฀ tobacco฀ and฀ drug฀ use฀ can฀ be฀ achieved฀by฀teaching฀social฀resistance฀and฀general฀life฀skills,฀including฀at฀least฀2฀years฀of฀ booster฀sessions. The฀second฀major฀study฀described฀the฀results฀of฀a฀15-year฀follow-up฀of฀a฀school-฀and฀ community-based฀smoking฀prevention฀project฀in฀North฀Karelia,฀Finland฀ [72] .฀Four฀inter- vention฀schools฀from฀this฀district฀and฀two฀control฀schools฀from฀another฀province฀were฀ chosen฀for฀the฀evaluation,฀beginning฀in฀1978฀with฀7th฀grade฀students฀and฀running฀through฀ 1980,฀with฀a฀15-year฀follow-up.฀In฀North฀Karelia,฀a฀community-based฀smoking฀cessation฀ programme฀for฀adults฀was฀organised฀in฀addition.฀In฀the฀intervention฀schools,฀health฀educa- tors฀and฀trained฀peer฀leaders฀led฀10฀sessions฀3฀in฀the฀7th฀grade,฀5฀in฀the฀8th฀grade,฀and฀2฀in฀ the฀9th฀grade.฀In฀1993,฀the฀subjects฀completed฀a฀questionnaire฀at฀home฀and฀a฀trained฀nurse฀ carried฀out฀a฀cardiovascular฀risk฀factor฀survey฀in฀a฀local฀health฀centre.฀Cohort฀participation฀ was฀still฀71฀after฀15฀years.฀The฀prevalence฀of฀all฀smokers฀in฀the฀four฀intervention฀schools฀ was฀between฀28฀and฀32,฀while฀that฀in฀the฀control฀schools฀was฀36฀and฀41.฀After฀15฀ years,฀cumulative฀exposure฀to฀tobacco฀in฀the฀intervention฀group฀was฀22฀lower฀than฀in฀the฀ 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 ฀฀฀Cumulative฀lifetime฀ cigarette฀smoking,฀in฀packs,฀ among฀male฀and฀female฀ students฀in฀the฀intervention฀ and฀control฀schools฀in฀the฀ North฀Karelia฀Youth฀Project฀ [72] .฀A฀total฀of฀640฀subjects฀ 71฀of฀the฀original฀cohort฀ participated฀in฀the฀inal฀ survey.฀Analyses฀of฀variance:฀ school฀group,฀p฀=฀0.027;฀sex,฀ p฀=฀0.000;฀school฀and฀sex฀ interaction,฀p฀=฀0.28