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Community Interventions for Preventing Smoking in Young People (Review) Cochrane Database of Systematic Reviews Community interventions for preventing smoking in young people (Review) Carson KV, Brinn MP, Labiszewski NA, Esterman AJ, Chang AB, Smith BJ Carson KV, Brinn MP, Labiszewski NA, Esterman AJ, Chang AB, Smith BJ. Community interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001291. DOI: 10.1002/14651858.CD001291.pub2. www.cochranelibrary.com Community interventions for preventing smoking in young people (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 3 BACKGROUND .................................... 5 OBJECTIVES ..................................... 5 METHODS ...................................... 5 RESULTS....................................... 8 Figure1. ..................................... 9 Figure2. ..................................... 13 DISCUSSION ..................................... 17 AUTHORS’CONCLUSIONS . 19 ACKNOWLEDGEMENTS . 20 REFERENCES ..................................... 20 CHARACTERISTICSOFSTUDIES . 27 DATAANDANALYSES. 98 Analysis 1.1. Comparison 1 Reported tobacco use, Outcome 1 Smoking - Daily. 100 Analysis 1.2. Comparison 1 Reported tobacco use, Outcome 2 Smoking-weekly. 101 Analysis 1.3. Comparison 1 Reported tobacco use, Outcome 3 Smoking - monthly. 102 Analysis 1.4. Comparison 1 Reported tobacco use, Outcome 4 Smoking - ever smoked. 103 Analysis 1.5. Comparison 1 Reported tobacco use, Outcome 5 Smokeless tobacco use. 104 Analysis 2.1. Comparison 2 Reported tobacco Use, Subgroup by length of follow-up, Outcome 1 Smoking - daily. 105 Analysis 2.2. Comparison 2 Reported tobacco Use, Subgroup by length of follow-up, Outcome 2 Smoking - weekly. 106 Analysis 2.3. Comparison 2 Reported tobacco Use, Subgroup by length of follow-up, Outcome 3 Smoking - monthly. 107 Analysis 2.4. Comparison 2 Reported tobacco Use, Subgroup by length of follow-up, Outcome 4 Smoking - ever smoked..................................... 108 Analysis 2.5. Comparison 2 Reported tobacco Use, Subgroup by length of follow-up, Outcome 5 Smokeless tobacco use. ..................................... 109 Analysis 3.1. Comparison 3 Reported behaviours, Outcome 1 Behaviours - rules on smoking. 110 Analysis 3.2. Comparison 3 Reported behaviours, Outcome 2 Behaviours - intentions to smoke. 110 Analysis 4.1. Comparison 4 Reported perceptions, Outcome 1 Perceptions - peer smoking. 111 Analysis 5.1. Comparison 5 Length of follow-up 12-months or less, Outcome 1 Attitudes - advantages/positives. 112 Analysis 5.2. Comparison 5 Length of follow-up 12-months or less, Outcome 2 Attitudes - toward smoking (total). 112 Analysis 5.3. Comparison 5 Length of follow-up 12-months or less, Outcome 3 Attitudes - disadvantages/negatives. 113 Analysis 5.4. Comparison 5 Length of follow-up 12-months or less, Outcome 4 Attitudes - perceived peer attitudes. 113 Analysis 5.5. Comparison 5 Length of follow-up 12-months or less, Outcome 5 Attitudes - okay for young people to smoke. .................................... 114 Analysis 5.6. Comparison 5 Length of follow-up 12-months or less, Outcome 6 Behaviours - intentions to smoke. 114 Analysis 5.7. Comparison 5 Length of follow-up 12-months or less, Outcome 7 Behaviours - rules on smoking. 115 Analysis 5.8. Comparison 5 Length of follow-up 12-months or less, Outcome 8 Knowledge - total. 116 Analysis 5.9. Comparison 5 Length of follow-up 12-months or less, Outcome 9 Knowledge - first use harmful/mild okay...................................... 116 Analysis 6.1. Comparison 6 Length of follow-up 13-months or more, Outcome 1 Attitudes - toward smoking (total). 117 Analysis 6.2. Comparison 6 Length of follow-up 13-months or more, Outcome 2 Attitudes - perceived peer attitudes. 117 Analysis 6.3. Comparison 6 Length of follow-up 13-months or more, Outcome 3 Behaviours - rules on smoking. 118 Analysis 6.4. Comparison 6 Length of follow-up 13-months or more, Outcome 4 Perception - peer smoking. 118 ADDITIONALTABLES. 118 APPENDICES ..................................... 139 FEEDBACK...................................... 140 WHAT’SNEW..................................... 141 HISTORY....................................... 141 Community interventions for preventing smoking in young people (Review) i Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. CONTRIBUTIONSOFAUTHORS . 142 DECLARATIONSOFINTEREST . 142 SOURCESOFSUPPORT . 142 INDEXTERMS .................................... 143 Community interventions for preventing smoking in young people (Review) ii Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Community interventions for preventing smoking in young people Kristin V Carson1, Malcolm P Brinn1, Nadina A Labiszewski1, Adrian J Esterman2, Anne B Chang3, Brian J Smith4 1Clinical Practice Unit, The Queen Elizabeth Hospital, Adelaide, Australia. 2University of South Australia, Adelaide, Australia. 3Menzies School of Health Research, Charles Darwin University, Casuarina, Australia. 4Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia Contact address: Kristin V Carson, Clinical Practice Unit, The Queen Elizabeth Hospital, 4A Main Building, 28 Woodville Road Woodville South, Adelaide, South Australia, 5011, Australia. [email protected]. Editorial group: Cochrane Tobacco Addiction Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 7, 2011. Review content assessed as up-to-date: 17 February 2011. Citation: Carson KV, Brinn MP, Labiszewski NA, Esterman AJ, Chang AB, Smith BJ. Community interventions for pre- venting smoking in young people. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001291. DOI: 10.1002/14651858.CD001291.pub2. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ABSTRACT Background Cigarette smoking is one of the leading causes of preventable death in the world. Decisions to smoke are often made within a broad social context and therefore community interventions using coordinated, multi-component programmes may be effective in influencing the smoking behaviour of young people. Objectives To determine the effectiveness of multi-component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. Search methods The Tobacco Addiction group’s specialised register, Medline and other health, psychology and public policy electronic databases were searched, the bibliographies of identified studies were checked and raw data was requested from study authors. Searches were updated in August 2010. Selection criteria Randomized and non randomized controlled trials that assessed the effectiveness of multi-component community interventions com- pared to no intervention or to single component or school-based programmes only. Reported outcomes had to include smoking be- haviour in young people under the age of 25 years. Data collection and analysis Information relating to the characteristics and the content of community interventions, participants, outcomes and methods of the study was extracted by one reviewer and checked by a second. Studies were combined in a meta-analysis where possible and reported in narrative synthesis in text and table. Community interventions for preventing smoking in young people (Review) 1 Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Main results Twenty-five studies were included in the review and sixty-eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short-term smoking prevalence (twelve months or less), while nine studies detected significant long-term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. Authors’ conclusions There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws. PLAIN LANGUAGE SUMMARY Can community interventions deter young people from starting to smoke? Some evidence is available to suggest that multi-component community interventions are effective in influencing smoking behaviour and preventing the uptake of smoking in young people. These interventions use co-ordinated, widespread, multi-component programmes to try and influence young people’s behaviour. Community members are often involved in determining and/or implementing these programmes. These include education of tobacco retailers about age restrictions, programmes for prevention of smoking-related diseases, mass media, school and family-based programmes.
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