School programs against smoking

Although we adjusted for the differences in these variables at baseline in our models, there may still have been residual confounding. For example, students with lower levels of knowledge may also have been different in other characteristics which could have led to the intervention being less effective in this group. Additionally, outcome measures were assessed using a self-reported questionnaire and participants might be inclined to underestimate their tobacco use.

Validation of our results with other instruments and biochemical tests would therefore be useful. Finally, this study only reported on the short-term impacts of the program; longer-term evaluation of the program is required to determine if the effectiveness of the intervention is sustainable in the longer term. Notwithstanding these limitations, this study is the first RCT to assess the effectiveness of school-based smoking prevention programs in Indonesia, using specifically developed interventions that included health- and Islamic-based concepts.

This study may have several implications for smoking prevention programs among Indonesian adolescents and those in other Muslim countries. The study also suggests that either an Islamic or Health-based program is suitable for students in Aceh and perhaps other Muslim societies. Combining the 2 programs does not however lead to greater effectiveness. Finally, we recommend further research to replicate this program intervention approach with a more rigorous study design that ensures better balance at baseline, populations with a higher prevalence of smoking, and longer term programs and evaluation so that the findings of this study and the long-term effectiveness of the programs can be established.

All authors participated in designing the study, implementing program interventions, conducting program evaluations, and the writing of the manuscript. Specifically, TT designed the concept of the study, was the main author of the manuscript, coordinated the program implementation, administration and testing of students, and completed data analysis; PRW participated in the development of the grant proposal, program protocol and manuscript preparation; JC contributed in program development and design and manuscript preparation; and RJW contributed in grant writing, data analysis and manuscript preparation.

The final manuscript was read and approved by all authors. National Center for Biotechnology Information , U. BMC Public Health. Published online Apr Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Teuku Tahlil: ua. Received Aug 29; Accepted Apr This article has been cited by other articles in PMC. Abstract Background School-based smoking prevention programs have been shown to increase knowledge of the negative effects of smoking and prevent tobacco smoking. Conclusions Both Health and Islamic school-based smoking prevention programs provided positive effects on health and Islamic related knowledge respectively among adolescents in Indonesia.

Background Tobacco smoking is a widespread phenomenon and an accepted cultural habit for many young Indonesians [ 1 ]. Methods Participants Participants were recruited using a combination of convenience and simple random sampling [ 10 ]. Randomization The eight selected schools were randomly assigned using block randomization to a control group 2 schools or one of the three smoking prevention interventions 2 schools for each intervention Figure 1.

Open in a separate window. Figure 1. Program development Prior to the development of the program, six face-to-face interviews and ten telephone interviews were conducted with junior high school teachers, former junior high school teachers, and staff from the Department of Education in Aceh Province, Indonesia. Program intervention and implementation 1. The health-based intervention The health-based intervention consisted of delivering health-based smoking prevention knowledge and skills to the students.

The Islamic-based intervention Students who participated in this program learned and practiced smoking prevention skills based on Islamic teaching. The combined intervention This intervention included components from the other two interventions and comprised eight two-hour classroom sessions. Primary outcomes The primary outcomes of the study were smoking knowledge, attitude, intentions, and behaviors, which were assessed using a questionnaire that was adapted from previous studies [ 10 , 12 , 24 ] and tailored towards the educational material to be delivered in the three intervention programs.

Development and testing of instrument The questionnaire was developed in English and translated into Indonesian. Health knowledge The health knowledge scale comprised 20 questions related to smoking prevalence in Indonesia, national regulation of tobacco control in Indonesia, and harmful effects of cigarette smoking. Islamic knowledge The Islamic knowledge scale comprised 20 questions on Islamic teaching and rulings on cigarette smoking.

Smoking attitude Attitude to smoking was evaluated using 25 statements derived and modified from previous studies [ 12 , 20 , 28 , 32 - 34 ].

Study procedure Pre and posttest questionnaires were administered one week before and one week after the program intervention, respectively [ 9 ]. Statistical analysis Sample size was determined according to results of a pilot study that allowed an estimate of the mean and standard deviation SD for health knowledge, which was the primary outcome of the study.

Results Subject characteristics A total of students participated in the study, with students completing the questionnaire at pretest one student absent and students at posttest. Table 1 Characteristics of participants. Effects of the interventions on knowledge 1.

Table 2 Pre-test comparisons of smoking knowledge, attitude, intentions and behaviors. Table 3 Impact of the health and Islamic-based interventions and their interactions on knowledge and attitude. Effects of the interventions on intentions to smoke 1. Table 4 Impact of the health and Islamic-based interventions and their interactions on smoking intentions and behaviors. Effects of the interventions on smoking behavior 1.

Conclusions This study may have several implications for smoking prevention programs among Indonesian adolescents and those in other Muslim countries. Competing interests All authors have no competing interest. Health Educ Res. Geneva: World Health Organization; Banda Aceh: Serambi Indonesia; Atlanta: U. Multinational Monitor. Bridge-It: a system for predicting implementation fidelity for school-based tobacco prevention programs.

Prev Sci. School-based smoking prevention programs for adolescents in South Korea: a systematic review. The impacts of a school-wide no smoking strategy and classroom-based smoking prevention curriculum on the smoking behavior of junior high school students.

Addict Behav. Short-term effects of project EX a classroom-based smoking prevention and cessation intervention program. Smoking prevention for ethnically diverse adolescents: 2-year outcomes of a multicultural, school-based smoking prevention curriculum in Southern California. Prev Med. Stay away from tobacco: a pilot trial of a school-based adolescent smoking prevention program in Beijing, China. Nicotine Tob Res. A systematic review of school-based smoking prevention trials with long-term follow-up.

J Adolesc Health. School-based programmes for preventing smoking. Cochrane Database Syst Rev. School-based smoking prevention programs with the promise of long-term effects. Tob Induc Dis.

Adolescent risk behaviors and religion: findings from a national study. J Adolesc. Religion-based tobacco control interventions: how should WHO proceed? Info cards for our no-cost, ad-free app, SmokerStop, are given to students to pass out around their local community.

The medical students hang the first two posters of the Smokerface Poster campaign in the classroom to enhance the future effects of smoking and then say goodbye. Image 2: Poster of the Smokerface campaign, which is hanged up in the classroom at the end of the visit. School-based prevention. To enable a better overiew, the program presented in schools should consist of the following two segments: An interactive assembly with age-based intervention 45 min.

An interactive station setup in the classroom 80 min. Classroom: Interactive Station Setup 80 min. Brief descriptions of the stations: 1 Different Tobacco Products and Extraction of Tobacco Smoke This station is set up by a window or outside. Image 1: Info card recommending the Smokerstop app. Want to learn more? Read our publications! J Med Internet Res , 18 6 :e Plastic and reconstructive surgery , 5 The British journal of dermatology , 1 Journal of medical Internet research , 17 7 :e Edited by Baumeister RF.

Annals of Epidemiology , 18 5 Journal of the European Academy of Dermatology and Venereology , 25 9 BMJ open , 4 7 :e Health Psychology Review , — Ajzen I: Theory of planned behavior. American journal of epidemiology , 4 General personal and social skills. Programs should help students develop necessary assertiveness, communication, goal-setting, and problem-solving skills that may enable them to avoid both tobacco use and other health risk behaviors.

School-based programs should systematically address these psychosocial factors at developmentally appropriate ages. Local school districts and schools should review these concepts in accordance with student needs and educational policies to determine in which grades students should receive particular instruction. Recommendation 3: Provide tobacco-use prevention education in kindergarten through 12th grade.

This instruction should be especially intensive in junior high or middle school and should be reinforced in high school. Education to prevent tobacco use should be provided to students in each grade, from kindergarten through 12th grade 4. Because tobacco use often begins in grades six through eight, more intensive instructional programs should be provided for these grade levels Particularly important is the year of entry into junior high or middle school when new students are exposed to older students who use tobacco at higher rates.

Thereafter, annual prevention education should be provided. Without continued reinforcement throughout high school, successes in preventing tobacco use dissipate over time 52, Studies indicate that increases in the intensity and duration of education to prevent tobacco use result in concomitant increases in effectiveness Most evidence demonstrating the effectiveness of school-based prevention of tobacco use is derived from studies of schools in which classroom curricula focused exclusively on tobacco use.

Other evidence suggests that tobacco-use prevention also can be effective when appropriately embedded within broader curricula for preventing drug and alcohol use 57 or within comprehensive curricula for school health education The effectiveness of school-based efforts to prevent tobacco use appears to be enhanced by the addition of targeted communitywide programs that address the role of families, community organizations, tobacco-related policies, antitobacco advertising, and other elements of adolescents' social environment 8.

Because tobacco use is one of several interrelated health risk behaviors addressed by schools, CDC recommends that tobacco-use-prevention programs be integrated as part of comprehensive school health education within the broader school health program Adequate curriculum implementation and overall program effectiveness are enhanced when teachers are trained to deliver the program as planned 59, Teachers should be trained to recognize the importance of carefully and completely implementing the selected program.

Teachers also should become familiar with the underlying theory and conceptual framework of the program as well as with the content of these guidelines. The training should include a review of the program content and a modeling of program activities by skilled trainers. Teachers should be given opportunity to practice implementing program activities.

Studies indicate that in-person training and review of curriculum-specific activities contribute to greater compliance with prescribed program components 4,5,61, Some programs may elect to include peer leaders as part of the instructional strategy. By modeling social skills 63 and leading role rehearsals 64 , peer leaders can help counteract social pressures on youth to use tobacco. These students must receive training to ensure accurate presentation of skills and information. Although peer-leader programs can offer an important adjunct to teacher-led instruction, such programs require additional time and effort to initiate and maintain.

Recommendation 5: Involve parents or families in support of school-based programs to prevent tobacco use. Parents or families can play an important role in providing social and environmental support for nonsmoking. Schools can capitalize on this influence by involving parents or families in program planning, in soliciting community support for programs, and in reinforcing educational messages at home. Homework assignments involving parents or families increase the likelihood that smoking is discussed at home and motivate adult smokers to consider cessation Recommendation 6: Support cessation efforts among students and all school staff who use tobacco.

Potential practices to help children and adolescents quit using tobacco include self-help, peer support, and community cessation programs. In practice, however, these alternatives are rarely available within a school system or community. Although the options are often limited, schools must support student efforts to quit using tobacco, especially when tobacco use is disallowed by school policy. Effective cessation programs for adolescents focus on immediate consequences of tobacco use, have specific attainable goals, and use contracts that include rewards.

These programs provide social support and teach avoidance, stress management, and refusal skills Further, students need opportunities to practice skills and strategies that will help them remain nonusers 66,67, Cessation programs with these characteristics may already be available in the community through the local health department or voluntary health agency e.

Schools should identify available resources in the community and provide referral and follow-up services to students. If cessation programs for youth are not available, such programs might be jointly sponsored by the school and the local health department, voluntary health agency, other community health providers, or interested organizations e.

More is known about successful cessation strategies for adults. School staff members are more likely than students to find existing cessation options in the community. Most adults who quit tobacco use do so without formal assistance. Nevertheless, cessation programs that include a combination of behavioral approaches e. For all school staff, health promotion activities and employee assistance programs that include cessation programs might help reduce burnout, lower staff absenteeism, decrease health insurance premiums, and increase commitment to overall school health goals Local school boards and administrators can use the following evaluation questions to assess whether their programs are consistent with CDC's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction.

Personnel in federal, state, and local education and health agencies also can use these questions to. The following questions can serve as a guide for assessing program effectiveness:. Do schools have a comprehensive policy on tobacco use, and is it implemented and enforced as written?

Does the tobacco education program foster the necessary knowledge, attitudes, and skills to prevent tobacco use? Is education to prevent tobacco use provided, as planned, in kindergarten through 12th grade, with special emphasis during junior high or middle school? Is in-service training provided, as planned, for educators responsible for implementing tobacco-use prevention? Are parents or families, teachers, students, school health personnel, school administrators, and appropriate community representatives involved in planning, implementing, and assessing programs and policies to prevent tobacco use?

Does the tobacco-use prevention program encourage and support cessation efforts by students and all school staff who use tobacco? In , the first Surgeon General's report on smoking and health warned that tobacco use causes serious health problems.

Thirty years later, in , the Surgeon General reports that tobacco use still presents a key threat to the well-being of children. School health programs to prevent tobacco use could become one of the most effective national strategies to reduce the burden of physical, emotional, and monetary expense incurred by tobacco use.

To achieve maximum effectiveness, school health programs to prevent tobacco use must be carefully planned and systematically implemented. Research and experience acquired since the first Surgeon General's report on smoking and health have helped in understanding how to produce school policies on tobacco use and how to plan school-based programs to prevent tobacco use so that they are most effective.

Carefully planned school programs can be effective in reducing tobacco use among students if school and community leaders make the commitment to implement and sustain such programs.

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