Effects of a school-based prevention programme on smoking in early adolescence: a 6-month follow-up of the 'Eigenstandig werden' cluster randomised trial.
OBJECTIVE
To test the effects of a school-based prevention programme on students' smoking-related behaviour, attitudes and knowledge 6 months after implementation over 2 school-years has ended.


METHODS
Two-arm prospective cluster randomised controlled trial with a follow-up survey 6 months after end of programme implementation, that is, 26 months after baseline.


METHODS
45 public secondary schools from four federal states in Germany (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein).


METHODS
A total of 3444 students from 172 classes with a mean age of 10.37 years (SD=0.59) and 47.9% girls at baseline. Analysis sample with follow-up up data merged to baseline data comprises 2513 datasets (73%).


METHODS
'Eigenständig werden 5+6', a school-based prevention programme for grades 5 and 6 to enhance substance-specific and general life skills, consisting of 14 units (à 90 min) and two workshops (4-6 h) being taught over a time period of 2 school-years by trained teachers.


METHODS
Lifetime and current smoking, incidence of smoking in baseline never smokers, smoking-related knowledge, attitudes, perceived norms of smoking and self-efficacy to refuse cigarette offers were assessed in students.


RESULTS
6 months after the end of programme implementation, students of intervention classes showed significantly lower rates for lifetime smoking (adjusted OR=0.63; 95% CI 0.41 to 0.96; p=0.026) and incidence of smoking (adjusted OR=0.66; 95% CI 0.43 to 1.00; p=0.047), a higher increase of smoking-related knowledge (adjusted β=9.38; 95% CI 6.73 to 12.04; p<0.001) and a greater change in attitudes towards a more critical perception of risks and disadvantages of smoking (adjusted β=0.10; 95% CI 0.03 to 0.16; p=0.002). No group differences were found for current smoking, perceived norms of smoking and self-efficacy to refuse cigarette offers.


CONCLUSIONS
Participation in the school-based prevention programme 'Eigenständig werden 5+6' may have small effects on smoking behaviour and attitudes and a moderate effect on smoking-related knowledge.


BACKGROUND
Current Controlled Trials ISRCTN99442407.
Institute for Therapy and Health Research (IFT-Nord), Kiel, Germany.
Barbara
B
Isensee
Julia
J
Hansen
Karin
K
Maruska
Reiner
R
Hanewinkel
D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D005260:Female; D005858:Germany; D006266:Health Education / Q000379:methods / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation / Q000379:methods / Q000706:statistics & numerical data; D012572:School Health Services / Q000706:statistics & numerical data*; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology; D000074606:Smoking Prevention; D013334:Students
Public Health; cluster randomized controlled trial; efficacy; school based prevention; smoking