title: Family-Based Interventions in Preventing Children and Adolescents from Using Tobacco: A Systematic Review and Meta-Analysis.
abstract: Tobacco is the main preventable cause of death and disease worldwide. Adolescent smoking is increasing in many countries with poorer countries following the earlier experiences of affluent countries. Preventing adolescents from starting smoking is crucial to decreasing tobacco-related illness.
  
  
  
  To assess effectiveness of family-based interventions alone and combined with school-based interventions to prevent children and adolescents from initiating tobacco use.
  
  
  
  Fourteen bibliographic databases and the Internet, journals hand-searched, and experts consulted.
  
  
  
  Randomized controlled trials (RCTs) with children or adolescents and families, interventions to prevent starting tobacco use, and follow-up ≥6 months.
  
  
  
  Abstracts/titles independently assessed and data independently entered by 2 authors. Risk of bias was assessed with the Cochrane Risk-of-Bias tool.
  
  
  
  Twenty-seven RCTs were included. Nine trials of never-smokers compared with a control provided data for meta-analysis. Family intervention trials had significantly fewer students who started smoking. Meta-analysis of 2 RCTs of combined family and school interventions compared with school only, showed additional significant benefit. The common feature of effective high-intensity interventions was encouraging authoritative parenting.
  
  
  
  Only 14 RCTs provided data for meta-analysis (approximately a third of participants). Of the 13 RCTs that did not provide data for meta-analysis 8 compared a family intervention with no intervention and 1 reported significant effects, and 5 compared a family combined with school intervention with a school intervention only and none reported additional significant effects.
  
  
  
  There is moderate-quality evidence that family-based interventions prevent children and adolescents from starting to smoke.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: rthomas@ucalgary.ca.
authors.forename: Roger E
authors.initials: RE
authors.lastname: Thomas
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia.
authors.forename: Philip R A
authors.initials: PRA
authors.lastname: Baker
authors.affiliation: Independent Consultant, Calgary, Alberta, Canada.
authors.forename: Bennett C
authors.initials: BC
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D020407:Internet; D016487:Parenting; D012574:Schools; D000074606:Smoking Prevention; D014026:Nicotiana
keywords: adolescent; adolescent behavior; child; family; health promotion; parent-child relations; parents; primary prevention; tobacco use