Development and Feasibility Test of a Theory- and Evidence-Based Multicomponent Intervention to Reduce Student Smoking at Danish Vocational Schools

Andersen, Susan; Holt, Ditte Heering; Vinther, Johan L.; Danielsen, Dina; Jakobsen, Gitte S.; Holmberg, Teresa; Jensen, Marie Pil; Pisinger, Charlotta; Krølner, Rikke

doi:10.3390/youth3020047

Cited by 3 publications

(1 citation statement)

References 56 publications

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“…Prior analyses of Focus indicate that the school tobacco policy drives the reduction of smoking in the participating schools while the other components may support the implementation but cannot stand alone. For example, the students may experience the class competition as enjoyable, 51 which may motivate them to adhere to the school tobacco policy but cannot stand alone. Studies among younger adolescents that have examined smoke-free class competition programmes show no long-term effects on smoking outcomes 52 ; nevertheless, it has not been investigated as an add-on to implementing a strict school tobacco policy.…”

Section: Discussionmentioning

confidence: 99%

Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial

Kjeld,

Thygesen,

Danielsen

et al. 2024

BMJ Open

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ObjectivesPublic health interventions are designed to improve specific health-related outcomes; however, they may also produce negative side effects, such as substitution use, psychological or social harms. Knowledge about the unintended effects of school-based smoking preventive interventions is sparse. Hence, this study examined these potential unintended effects of the smoking-reducing intervention, Focus, among students in the vocational education and training setting.DesignCluster randomised controlled trial stratified by school type with 5 months follow-up.Setting and participantsAcross Denmark, eight schools were randomised to the intervention group (n=844 students, response proportion 76%) and six schools to the control group (n=815 students, response proportion 75%). This study focused solely on students who smoked at baseline (N=491).InterventionsThe intervention was developed systematically based on theory and a thoroughly mixed-methods needs assessment. Intervention components included a comprehensive school tobacco policy (smoke-free school hours) supported by a 3-day course for school staff and launched by an edutainment session for students; class-based lessons and a quit-and-win competition; and individual telephone smoking cessation support.OutcomesAlternative tobacco and nicotine products (regular use of smokeless tobacco, hookah and e-cigarettes), regular cannabis use, boredom and loneliness at school, stress and perceived stigmatisation among smokers.ResultsWe found no statistically significant unintended effects of the intervention. Nonetheless, insignificant findings indicated that students in the intervention group were less likely to be bored during school hours (OR 0.59, 95% CI 0.32 to 1.10) and experience stress (OR 0.62, 95% CI 0.35 to 1.10), but more likely to report feeling stigmatised compared with the control group (OR 1.55, 95% CI 0.71 to 3.40).ConclusionsOverall, findings suggested no unintended effects of the Focus trial with respect to substitution use, psychological, nor group or social harms. Future research is encouraged to report potential harmful outcomes of smoking preventive interventions, and interventions should be aware of the possible stigmatisation of smokers.Trial registration numberISRCTN16455577.

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Section: Discussionmentioning

confidence: 99%

Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial

Kjeld,

Thygesen,

Danielsen

et al. 2024

BMJ Open

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The Impact of Implementation Fidelity of a School-Based Multi-Component Smoking Prevention Intervention on Vocational Students’ Smoking Behavior: A Cluster-Randomized Controlled Trial

Jensen,

Krølner,

Thygesen

et al. 2024

Prev Sci

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Preventing young people’s cigarette smoking is a major public health priority, and smoking is especially prevalent in vocational schools. Well-enforced comprehensive school tobacco policies accompanied by preventive efforts show potential to reduce smoking, but the implementation process is crucial to achieve the intended effect. We investigate whether and how implementation fidelity of a multi-component smoking prevention intervention impacted student smoking outcomes after 4–5 months among students in Danish vocational education and training (national age range 15–65 years, mean 25.6) and preparatory basic education (national age range 15–25 years, mean 17.6) institutions using questionnaire data from a cluster-RCT. The intervention included a smoke-free school hours policy, educational curriculum, and class competition. We calculated an overall implementation fidelity measure combining staff-reported school-level delivery (fidelity) and student-reported receipt (participation, responsiveness), and used multilevel regression models to analyze associations with smoking outcomes (smoking daily, regularly, and during school hours). We supplemented the analysis with restricted cubic spline regression. Additionally, we stratified the analyses by school types and analyzed associations between implementation fidelity of the separate intervention components and smoking outcomes. High implementation was associated with lower odds of regular smoking (OR: 0.37, 95% CI: 0.18–0.78) and smoking during school hours, but not daily smoking, and these associations varied between the school settings. When analyzed separately, implementation fidelity of the components did not affect the outcomes significantly. Our findings underline the need to support the implementation process of school tobacco policy interventions to ensure the intended effects of reducing students’ smoking.

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When smoking is the smallest problem: A qualitative study of smoking prevention in Danish vocational schools

Rusiti,

Kjeld,

Andersen

et al. 2024

Health Education Journal

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Objective: In Denmark, more students smoke in vocational schools than in upper secondary schools. Smoking-prevention initiatives may reduce the prevalence of smoking but may also introduce unforeseen challenges. This study examined the significance of smoking and dilemmas related to smokefree school hours (SFSH) among established smokers in Danish vocational schools. Design: Qualitative research design. Setting: Data collection took place in a vocational education and training (VET) school in Denmark. The subject area was care, health and pedagogy (CHP). Method: Participant observation and focus groups were conducted with students and teachers. Two classes were observed for 2 weeks in total. The data analysed consisted of participant observation field notes ( n = 10 school days), transcripts from student focus groups ( n = 6; aged 18–56) and transcripts from teacher focus groups ( n = 11). Results: Two dilemmas were described as faced by established smokers in relation to the implementation of smokefree school hours: (1) The school is entitled to make rules versus the right to decide for oneself; and (2) life and schoolwork are challenging and demanding versus school work is more important than smoking. Conclusion: The findings illustrate how smoking, as an ingrained everyday practice for established smokers, represents a means of coping with difficult school demands and everyday challenges, particularly for vulnerable students, and how regulations such as SFSH create dilemmas for those students. These dilemmas are important to consider when designing and implementing smoking-prevention initiatives to prevent potential negative side effects and an unintended increase in social inequality in smoking.

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Development and Feasibility Test of a Theory- and Evidence-Based Multicomponent Intervention to Reduce Student Smoking at Danish Vocational Schools

Cited by 3 publications

References 56 publications

Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial

Do school-based smoking preventive interventions have unintended effects? Post hoc analysis of the Focus cluster randomised controlled trial

The Impact of Implementation Fidelity of a School-Based Multi-Component Smoking Prevention Intervention on Vocational Students’ Smoking Behavior: A Cluster-Randomized Controlled Trial

When smoking is the smallest problem: A qualitative study of smoking prevention in Danish vocational schools

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