title: Reducing smoking in adolescents: cost-effectiveness results from the cluster randomized ASSIST (A Stop Smoking In Schools Trial).
abstract: BACKGROUND
  School-based smoking prevention programmes can be effective, but evidence on cost-effectiveness is lacking. We conducted a cost-effectiveness analysis of a school-based "peer-led" intervention.
  
  
  METHODS
  We evaluated the ASSIST (A Stop Smoking In Schools Trial) programme in a cluster randomized controlled trial. The ASSIST programme trained students to act as peer supporters during informal interactions to encourage their peers not to smoke. Fifty-nine secondary schools in England and Wales were randomized to receive the ASSIST programme or usual smoking education. Ten thousand seven hundred and thirty students aged 12-13 years attended participating schools. Previous work has demonstrated that the ASSIST programme achieved a 2.1% (95% CI = 0%-4.2%) reduction in smoking prevalence. We evaluated the public sector cost, prevalence of weekly smoking, and cost per additional student not smoking at 24 months.
  
  
  RESULTS
  The ASSIST programme cost of £32 (95% CI = £29.70-£33.80) per student. The incremental cost per student not smoking at 2 years was £1,500 (95% CI = £669-£9,947). Students in intervention schools were less likely to believe that they would be a smoker at age 16 years (odds ratio [OR] = 0.80; 95% CI = 0.66-0.96).
  
  
  CONCLUSIONS
  A peer-led intervention reduced smoking among adolescents at a modest cost. The intervention is cost-effective under realistic assumptions regarding the extent to which reductions in adolescent smoking lead to lower smoking prevalence and/or earlier smoking cessation in adulthood. The annual cost of extending the intervention to Year 8 students in all U.K. schools would be in the region of £38 million and could result in 20,400 fewer adolescent smokers.
authors.affiliation: School of Social and Community Medicine , University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. william.hollingworth@bristol.ac.uk
authors.forename: William
authors.initials: W
authors.lastname: Hollingworth
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: James
authors.initials: J
authors.lastname: Hawkins
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Hughes
authors.forename: Laurence A R
authors.initials: LA
authors.lastname: Moore
authors.forename: Jo C
authors.initials: JC
authors.lastname: Holliday
authors.forename: Suzanne
authors.initials: S
authors.lastname: Audrey
authors.forename: Fenella
authors.initials: F
authors.lastname: Starkey
authors.forename: Rona
authors.initials: R
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D005500:Follow-Up Studies; D006293:Health Promotion / Q000191:economics / Q000379:methods; D006379:Helping Behavior; D006801:Humans; D016017:Odds Ratio; D010379:Peer Group; D015995:Prevalence; D015397:Program Evaluation / Q000379:methods*; D012572:School Health Services / Q000191:economics*; D012574:Schools / Q000458:organization & administration*; D012680:Sensitivity and Specificity; D012907:Smoking / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D016540:Smoking Cessation / Q000191:economics / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D013334:Students / Q000523:psychology; D014852:Wales / Q000453:epidemiology