title: Effectiveness of school-based smoking prevention curricula: systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess effectiveness of school-based smoking prevention curricula keeping children never-smokers.
  
  
  METHODS
  Systematic review, meta-analysis.
  
  
  METHODS
  MEDLINE (1966+), EMBASE (1974+), Cinahl, PsycINFO (1967+), ERIC (1982+), Cochrane CENTRAL, Health Star, Dissertation Abstracts, conference proceedings.
  
  
  RESULTS
  pooled analyses, fixed-effects models, adjusted ORs. Risk of bias assessed with Cochrane Risk of Bias tool.
  
  
  METHODS
  50 randomised controlled trials (RCTs) of school-based smoking curricula.
  
  
  METHODS
  Never-smokers age 5-18 (n=143,495); follow-up ≥6 months; all countries; no date/language limitations.
  
  
  METHODS
  Information, social influences, social competence, combined social influences/competence and multimodal curricula.
  
  
  METHODS
  Remaining a never-smoker at follow-up.
  
  
  RESULTS
  Pooling all curricula, trials with follow-up ≤1 year showed no statistically significant differences compared with controls (OR 0.91 (0.82 to 1.01)), though trials of combined social competence/social influences curricula had a significant effect on smoking prevention (7 trials, OR 0.59 (95% CI 0.41 to 0.85)). Pooling all trials with longest follow-up showed an overall significant effect in favour of the interventions (OR 0.88 (0.82 to 0.95)), as did the social competence (OR 0.65 (0.43 to 0.96)) and combined social competence/social influences curricula (OR 0.60 (0.43 to 0.83)). No effect for information, social influences or multimodal curricula. Principal findings were not sensitive to inclusion of booster sessions in curricula or to whether they were peer-led or adult-led. Differentiation into tobacco-only or multifocal curricula had a similar effect on the primary findings. Few trials assessed outcomes by gender: there were significant effects for females at both follow-up periods, but not for males.
  
  
  CONCLUSIONS
  RCTs of baseline never-smokers at longest follow-up found an overall significant effect with average 12% reduction in starting smoking compared with controls, but no effect for all trials pooled at ≤1 year. However, combined social competence/social influences curricula showed a significant effect at both follow-up periods.
  
  
  BACKGROUND
  Cochrane Tobacco Review Group CD001293.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada.
authors.forename: Roger E
authors.initials: RE
authors.lastname: Thomas
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: McLellan
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Rafael
authors.initials: R
authors.lastname: Perera
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003479:Curriculum; D006266:Health Education / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012574:Schools; D012737:Sex Factors; D000074606:Smoking Prevention; D066107:Social Skills
keywords: PREVENTIVE MEDICINE; PUBLIC HEALTH