Systematic review of school-based interventions to prevent smoking for girls.
BACKGROUND
The purpose of this review is to study the effect of school-based interventions on smoking prevention for girls.


METHODS
We performed a systematic review of articles published since 1992 on school-based tobacco-control interventions in controlled trials for smoking prevention among children. We searched the databases of PubMed, Embase, Web of Science, The Cochrane Databases, CINAHL, Social Science Abstracts, and PsycInfo. Two reviewers independently assessed trials for inclusion and quality and extracted data. A pooled random-effects estimate was estimated of the overall relative risk.


RESULTS
Thirty-seven trials were included, of which 16 trials with 24,210 girls were included in the pooled analysis. The overall pooled effect was a relative risk (RR) of 0.96 (95 % confidence interval (CI) 0.86-1.08; I (2)=75 %). One study in which a school-based intervention was combined with a mass media intervention showed more promising results compared to only school-based prevention, and four studies with girl-specific interventions, that could not be included in the pooled analysis, reported statistically significant benefits for attitudes and intentions about smoking and quit rates.


CONCLUSIONS
There was no evidence that school-based smoking prevention programs have a significant effect on preventing adolescent girls from smoking. Combining school-based programs with mass media interventions, and developing girl-specific interventions, deserve additional study as potentially more effective interventions compared to school-based-only intervention programs.


BACKGROUND
PROSPERO CRD42012002322.
Gender & Women's Health, Department of Primary and Community Care, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands. mjjdekleijn@me.com.
Miriam J J
MJ
de Kleijn
VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, North Hills, CA, 91343, USA. Melissa.Farmer@va.gov.
Melissa M
MM
Farmer
RAND Corporation, 1776 Main Street, 90401, Santa Monica, CA, USA. suttorp@rand.org.
Marika
M
Booth
RAND Corporation, 1776 Main Street, 90401, Santa Monica, CA, USA. amotala@rand.org.
Aneesa
A
Motala
RAND Corporation, 1776 Main Street, 90401, Santa Monica, CA, USA. asmith@rand.org.
Alexandria
A
Smith
Veterans Affairs New York Harbor Healthcare System, 423 East 23rd Street, 10010, New York, NY, USA. Scott.Sherman@nyumc.org.|New York University Langone Medical Center, 227 East 30th Room 642, 10016, New York, NY, USA. Scott.Sherman@nyumc.org.
Scott
S
Sherman
Department of Primary and Community Care, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands. pim.assendelft@radboudumc.nl.
Willem J J
WJ
Assendelft
RAND Corporation, 1776 Main Street, 90401, Santa Monica, CA, USA. shekelle@rand.org.|Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, 90073, Los Angeles, CA, USA. shekelle@rand.org.
Paul
P
Shekelle
D000293:Adolescent; D000294:Adolescent Behavior; D005260:Female; D006801:Humans; D015397:Program Evaluation; D012572:School Health Services; D012574:Schools; D000074606:Smoking Prevention