Effects of a settings-based intervention to promote student wellbeing and reduce smoking in vocational schools: A non-randomized controlled study.
School dropout and health risk behavior such as cigarette smoking represent major problems among students attending upper secondary vocational education. Modifications to the social environment may promote educational attainment as well as health and wellbeing of young people. However, there is a need for more evidence-based intervention programs.



The aim of this study was to assess the effectiveness of an intervention targeting the socio-environmental setting at vocational schools on student wellbeing and smoking.



We conducted a non-randomized controlled trial of 5794 students (mean age 21 years; 81% male) in 10 (four intervention and six comparison) large vocational schools in Denmark. The intervention involved changes in everyday school practices focusing on four themes: (i) introduction activities, (ii) daily class meetings, (iii) scheduled breaks and (iv) pleasant non-smoking environment. Outcomes were student wellbeing (four subscales: school connectedness, student support, teacher relatedness, positive valuing of the profession) and daily smoking measured at 10-week follow-up.



We found statistically significant between-group difference in school connectedness, but not in student support, teacher relatedness and valuing the profession. The intervention had no effect on daily smoking. However, we found a statistically significant interaction between baseline smoking status and condition. This interaction suggested that baseline occasional smokers in the intervention group had significantly reduced odds ratio (OR) of becoming a daily smoker compared to baseline occasional smokers in the control group (8% versus 16%; OR = 0.44).



The positive effects on school connectedness and in preventing occasional smokers becoming daily smokers indicate that it is possible to tackle school-related wellbeing and smoking in a high risk population through settings-based interventions.
Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark. Electronic address: sua@niph.dk.
Susan
S
Andersen
Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark. Electronic address: mhj@niph.dk.
Morten Hulvej
MH
Rod
Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark. Electronic address: ake@niph.dk.
Annette Kjær
AK
Ersbøll
Institute of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700 Esbjerg, Denmark. Electronic address: cstock@health.sdu.dk.
Christiane
C
Stock
The Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. Electronic address: christof@cancer.dk.
Christoffer
C
Johansen
Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark. Electronic address: tho@niph.dk.
Teresa
T
Holmberg
Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark. Electronic address: lizi@niph.dk.
Line
L
Zinckernagel
Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark. Electronic address: liin@niph.dk.
Liselotte
L
Ingholt
Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark. Electronic address: bbso@niph.dk.
Betina Bang
BB
Sørensen
Centre for Intervention Research in Health Promotion and Disease, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark. Electronic address: jst@niph.dk.
Janne Schurmann
JS
Tolstrup
D000293:Adolescent; D000328:Adult; D003718:Denmark; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D016014:Linear Models; D008297:Male; D015397:Program Evaluation / Q000379:methods; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D012572:School Health Services / Q000592:standards*; D000074606:Smoking Prevention; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires; D014829:Vocational Education / Q000458:organization & administration
Denmark; Health promotion; Multi-level modelling; Smoking; Social environment; Vocational education; Wellbeing