Prevention of smoking in adolescents with lower education: a school based intervention study.
OBJECTIVE
To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students.


METHODS
Group randomised controlled trial.


METHODS
26 Dutch schools that provided junior secondary education.


METHODS
1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years.


METHODS
Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition.


METHODS
Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis.


RESULTS
In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant.


CONCLUSIONS
In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect.
Crone
M R
MR
TNO Prevention and Health, Leiden, The Netherlands. mrcrone@pg.tno.nl
Reijneveld
S A
SA
Willemsen
M C
MC
van Leerdam
F J M
FJ
Spruijt
R D
RD
Sing
R A Hira
RA
D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009426:Netherlands; D016017:Odds Ratio; D010379:Peer Group; D012572:School Health Services; D000074606:Smoking Prevention; D013223:Statistics as Topic