Are Health Education Interventions Effective in Preventing Smoking in Adolescents?

This dissertation examines the effectiveness of health education interventions in preventing smoking among adolescents. It explores various strategies, theories, and models used in health education, including peer-led approaches and participatory video production programs. The research aims to provide insights into the effectiveness of these interventions and their impact on smoking prevention.

REVIEW QUESTION: ARE HEALTH EDUCATION INTERVENTION EFFECTIVE IN PREVENTING SMOKING IN
ADOLESCENTS?
WORD COUNTS: 8000 WORDS EXCLUDING TITLE PAGE, APPENDICES AND REFERENCES
ACKNOWLEDGEMENTS
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I give thanks and glory to the Almighty God who made this dream come true.
I would like to express my utmost thankfulness to my husband and children in supporting my vision.
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ABSTRACT
The dissertation is mainly focused on consider the concept regarding health intervention as well as
education that always support for identifying prevention of smoking among Adolescents . This
dissertation draws on different interventions using various means of health education from various
journal articles on the prevention of smoking among adolescents. This is because Health education
entail long-term, well reasoned, carefully organized and evaluated programme (Whitehead, 2019). For
health education to result in positive outcomes, Whitehead and Russell, (2004), The research is mainly
focused on the pinpoint various strategies in term of goal and objective. It help for specific negotiating
goals and always tried to take follow-up on regular process through multiple evaluation event or
program. These plans may consider the effective health educational event or programme are
structurally prepared and evaluates. Furthermore, it will be organised the various model as well as
theories, which providing the guidance towards specific aim, objective and generated result or outcome.
Apart from that it can be restricted the single process regarding behaviour changes and information
gathering or providing activities.
The intervention that could prevent smoking in adolescents has to be multiple because of the
multifactorial nature of the health issue and health education has been shown to be effective to a
certain extent.
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TABLE OF CONTENTS
Acknowledgement.............................................................................................................................2
Abstract.............................................................................................................................................3
Introduction.......................................................................................................................................5
Chapter One:
Background........................................................................................................................................6
Chapter Two:
Methodology ...................................................................................................................................11
Chapter Three:
Critical Appraisal................................................................................................................................16
Chapter Four:
Discussions and Recommendation......................................................................................................21
Chapter Five:
Conclusion........................................................................................................................................27
Appendices
CASP.................................................................................................................................................29
References..........................................................................................................................................39
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INTRODUCTION
This research is mainly exploring the concept of health intervention and education that are providing
prevention activities towards the smoking among multiple adolescents. Health education intends to
provide individuals with the expertise require to live and maintain positive healthy behaviours. It mixes
self and combined intervention plans to acquire more knowledge and skills according to the
requirements. Sometimes, it also appropriate for decision making and also linked with the health
condition of adolescent. However, these involvements are complex and combine different complex
elements. The consequences of these interventions arise from both the interventions themselves and
the circumstances they evolved (Cambon et al., 2012).
Tobacco smoking is based on the causes of reduce the death rate and also linked with 7 million deaths
yearly. This is approximated to mount to more than 8 million death yearly in 2030, with 80%.
Furthermore, it also happened to determine the income of low- as well as middle- income nations.
(Semwal et al., 2019). Most people commence smoking in youths: two thirds before they attain 18years.
There are various reason for started the smoking, which are becoming more complex, ranging
from peer pressure to behavioural issue or problem. (Public Health England (PHE) 2015). The multiple
children are likely to start the smoking The best method of reducing smoking among youths is t. o
reduce it in the world around them (PHE 2015).
In this Chapter-1, it explore the background and the rationale behind whether health education
interventions are effective in preventing smoking in adolescents.
In this Chapter-2, it also discussed about the research methodology that can be used in the research
project. Also consists of different research questions.
In this chapter-3, it is critically appraise the six different articles.
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In this chapter-4, it also discussed and recommendations of the literature in the research.
In this chapter-5, it is conducting the specific part of the research.
CHAPTER ONE
BACKGROUND
The following are the list of important concepts in Health education intervention in prevention of
tobacco use among youths: Adolescent, Cessation, Stopping, Health education, Prevention, Intervention,
Youth. These are different activities that help for providing guidance and counselling to stop smoking.
The rational of research is to understand the concept of health education and their specific intervention
in context of preventions.
Smoking in adolescents is a problem of worldwide public health concern (Starkey et al., 2009). Tobacco
is based on the most causes of death, which are linked with the 7 Million deaths every year (Semwal et
al., 2019). As per evidence, it has found that increases death approximately 8 Million deaths yearly basis
in 2030, with 80% happening within low as well as middle-income nations. (Semwal et al., 2019).
In England, it has happened one in five adults smokes cigarette and 90000 regular smokers between
ages 11-15 (PHE 2015). 17% of all death in individuals aged 35 and above are cause by tobacco use. The
risk it poses will not be spreading because people in more deprived area are more likely to smoke and
are less possible to stop (PHE, 2015). Smoking is one of the consider as underprivileged individual and
forecast to contribution within health balance imbalances in England (PHE 2015).
In United State of America (USA), tobacco is the main cause of avoidable deaths and diseases, killing
443,000 people yearly (Primack et al., 2014). The large majority of people that always die from tobacco
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use start at age 18 or younger, that is why many counter-tobacco interventions suitably concentrate on
adolescents (Primack et al., 2014).
In addition, China is considered as biggest way to produce tobacco consumers and, there are only one of
14 nations that increases the burden of tobacco useable. (Hsia et al., 2010). Initially, This research has
investigation the adolescent which report between 28% to 43% of males and 1% to 11% of females
acknowledged themselves as smokers (Chen et al., 2006). Further information suggested that smoking
incidents in youths have been on the increase, and the commencement age of tobacco use is reducing.
(Zhangi et al., 2003). Lessening the predominance of smoking among youths remains a crucial public
health preference for China (Hasting and Angus, 2008). It has always increased the death rate in china
because people are smoking very quickly manner.
In Greece, no less than one-third of students have used tobacco, with the country recorded to have one
of the highest per capita tobacco uses in the European Union, evidencing the necessity for smoking
restraint intervention in the country (Kousoulis et al., 2016).
Adolescence is the time of passing into adulthood and youth may inherit risky behaviour while making
effort to reach adulthood (Levia et al., 2018). Earlier research has acknowledged different socio-
demographic, intrinsic and environmental hazard and protective elements like vulnerability to mass
media which link with tobacco use in youth because it make them vulnerable to tobacco related content
that is connected with unfavourable smoking outcomes. Also, the use of social media exposes youth to
tobacco use which is associated with smoking in youth (Shensa et al., 2016).
The flaming, amiably and insightful changes throughout youth make adolescence a time when
adolescents are more likely to initiate tobacco use. Tobacco use by parents and friends has specific
significance at this period (Gilman et al., 2009, Hill et al., 2005 cited in Levia et al., 2018). Additionally,
other determinants like genetic, pressure, low self-respect, poor locus of control, low school awareness,
susceptibility to peer influence (Levia et al., 2018).
These factors need to contemplate the wider problems people experience in their lives. It ranges from
shortage of opportunity to social isolation, which can elevate the dangers of unhealthy behaviour (PHE
2015).
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The main prevention of smoking among adolescents is hence, specifically significant due to the
enormous attempt needed for people who are smoking since long time to stop smoking because of their
extent of nicotine addiction (Park et al., 2017). there are major evidence which indicates that the major
intervention which are delivered throuh the professional of health are efficacious for the prevention of
the smoking Health professionals’ advice has been demonstrated to elevate efforts to stop smoking and
use medicines intended at stopping smoking (Semwal et al., 2019). The effective intervention that
mainly explained the result or outcome. Furthermore, It also explained the brief overview, which is
mainly identified the cessation level. However, the shortage of relevant knowledge and skills is an
important obstacles. According to report, it has been identified the health condition while preventing by
different health professionals, which mainly giving a better counselling to prevent preventing them from
smoking cessation. However, it will give an effective advice of individual person, who are already
consume the Tobacco and many more patients suffered from it. (Semwal et al., 2019).
proper education and on time and cost effective training are significant to make sure that professional
and experts relating to health have suitable knowledge and expertise to deliver smoking cessation-
connected intervention. For Example- Government should create an effective program or event. In order
to educate the causes of tobacco. E-learning or Digital education will be provided through different
digital technology have the possibility to elevate opportunities relating to education, augment activities
for teaching and minimise the different obstacles in term of health profession event or program.
(Semwal et al., 2019).
Research recommends that efficacious programs on prevention of smoking combine various elements,
include age based educaitonal model, communty based views and many other points and
empowerment of youth (Bottorff et al., 2014). Embracing approaches that integrate these various
elements assists adolescents to be extra actively involved in programs relating to smoking prevention
and education relating to health that are therefore more possible to yield successful results (Peppler and
Kafai, 2007). Digital Media provide various possible advantages as an operative education relating to
health instrument for encouraging adolescent health together with prevention of smoking (Norman and
Yipp, 2012).
Health education is a significant subset of public health. Health education is influenced primarily by
behavioural sciences. It is from behavioural sciences that the practice of health education borrows the
strategic planning of its method (Sharma et al., 2016).
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The Theory of Reasoned Action (TRA) and Theory of Planned Behaviour (TPB) are relevant to prevention
of smoking in adolescent (Sharma, 2016). The important attributes of both theories is their assertion
that behavioural intention is the most significant factor of behaviour. The TRA and TPB argue and
explained the individuals consider the consequences of their actions before embarking on or abstain
from any specific behaviour (Sharma, 2016). These two theories stresses the role of thoughts in decision
making about involving in behaviour and they states that an individual’s intention is decided by two
antecedents, comprising of personal factors and social influences. The TPB include a third predictor, that
of control over the behaviour (Sharma, 2016).
These two theories have been criticized in that they project behavioural intention and behaviour but do
not necessarily clarify behaviour modification which is the primary responsibility of health education and
health promotion programs (Sharma, 2016). In addition, they failed to view personality-connected
elements, ethnic elements and demographic variables that structure behaviour.
Peer-led approach intervention programs aimed to include or recognized school-based classroom and
training session in both older as well as same age group, which help for prevention of smoking among
adolescents (Starkey et al., 2009). The reason for employing peer-led approached comprises the view
that peer education draw into youths’ natural manner. it has been performed the different activities
regarding the information sharing process, Also utilizing the certain impact of social network on
adolescents' behaviour for favourable ends. Innovation diffusion theory is being used for
comprehending how opinions and practices circulate all over a community. The most important part of
the diffusion activities which help for modelling and applicable for implementing the innovations that
has been already embraced by influential individuals (Starkey et al., 2009). This type of theory, which
mainly practically applied witihn the different areas of public health by Kelly which majorly emphasizes
over the significance of identifying the natural potential of the leaders. It includes the people who are
more popular and most liked and trusted by other people and who promote the behaviours of good
health of the target population. Opinion leaders are only peer but those whose opinions, attitudes and
behaviour can impact others because of their social standing’ (Kelly).
A participatory video production program by adolescents themselves is use as an intervention to slow
down or avert smoking commencement among youths (Park et al., 2017). This intervention is based on
theoretical model, emanated from both Self- determinations Theory (SDT) and the Global Youth Voices
model with smoking (Park et al., 2017). This theory is helping for applicable different principal crucial
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constructs, autonomy, competence and connectedness in context of smoking. On other hand, from SDT
represents the contributors of the factors urging the preferred health behaviour result (Little et al.,
2002). The theory assists to develop a greater outcome via the media production procedure: autonomy
denotes the volitional choice allowing commencement of action; competence denotes self-assured and
efficacious in controlling action; and connectedness denotes feeling related to others with a sense of
belongings (Park et al., 2017).
Also, a School-based smoking intervention programs for the prevention of smoking among adolescents.
Such programs intends to provide smoking-connected health information and carry on plan based on
social competence and social influence (Wiche et al., 2005)
Mass media literacy intervention programs aim to prevent smoking among adolescents in a school-
based setting (Primack et al., 2016). With regard to Theory of Reasoned Action (TRA) a theory of health
behaviour which was applied to project adolescents’ tobacco use, an individuals’ behaviour is decided by
his or her aims to carry out the behaviour which is in turn estimated by his or her attitudes toward the
behaviour and sense of subjective normative beliefs respect of it (Primack et al., 2016).
In regarding the context of School-based anti-smoking intervention program that has transferred by Oral
Health Therapy (OHT) relating to impacts of health on the smoking and the prevention of smoking
(Matias et al., 2013). the present intervantion is based on Rollnick's and Miller principle relating to
motivational interviewing. These principles are based over the five A that assist, arrange, ask, advice and
assess and is been said that American National Career Institute ofr the Oral Health professional and also
giving the counselling or guideline which help for reduced the use of smoking among adults people.
Afterwards, it has provided the specific guideline to support through different cessation protocol in
Australian by consideration of effective practices (Matias et al., 2013).
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CHAPTER TWO
METHODOLOGY
Literature review is the broad study and explanation of literature that connects to particular question
(Aveyard, 2018). I have used the research question that help for attempting to identify the positive
response of different research questions. Furthermore, it is also assessing and evaluating the pertinent
literature using a structured approach (Aveyard, 2018). In addition, literature review is a piece of
research and has a particular method. The method of carrying out a literature reviews follows the
identified phases of the research procedure (Moule et al., 2016). Thus, a literature review will have a
distinct clarified research question that is answer by searching for pertinent literature and then
assessing and evaluating that literature (Aveyard, 2016). It comprises of the following (Aveyard, 2018).
* Research question: that is provided in the brief introduction about whole research project;
* Method section: It obviously state the way the question will be answered, it can be used qualitative
methodology and other type of search strategy, Through this literature, it can be appraisal and other
type of analysing the literature;
*Result question: It is set of identifying accurate results, it become obvious thing to represent and also
integration of the critical appraisal of the studies.
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*It has discussed and recommended the effective practices in research project.
The PICO framework has been in existence for long and can be used for both redefining questions and
developing strategies. PICO stands for population, intervention, comparison and outcome. The PICO
framework was meant for questions that include intervention and comparisons, which makes it
cumbersome to use in its real form for developing and refining questions that do not include these
components (Hewitt-Taylor, 2017).
In addition, The purpose of PICO framework that help for explaining the concentration on
interventions to prevent the effects of smoking. Afterwards, it also comparisons between health
interventions program Afterwards, it can be evaluating the specific result or outcome. It is one of the
most amenable to questions intended at evaluating the evidence from quantitative instead of
qualitative research (Cooke et al., 2012). The aim of using a framework is to assist in developing a
distinct and focused question, not to create difficulties. At the same manner, whilst some questions have
no comparison, some do have various comparisons (Guyatt et al., 2011). However, even if PICO
framework does not exactly fit your questions, using its principles can assist you to think about what you
want to research, even if you do not end up with a true PICO question (Hewitt-Taylor, 2017).
In this research project, it is basically considered PICO framework to examine the specific review of the
literature that is 'is education for health intervention effective in order to prevent smoking habit among
the adolescent?':
Population: adolescents
Intervention: eduction relating to health
Comparison: education counselling and nursing database.
Outcome: smoking
Intervention
the library chosen for the current study is the Medline (Ovid) and CINAHL.
A study was conducted within the database of CINAHL that is Cumulative Index of Nursing and Allied
Health Literature. Thus this study was an instrument for the nursing professionals wherein the users of
informaiton can have acces to the fast and good essay relating to the data. This data of CINAHL involved
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the 50 nursing staffand the speech and pathology relating and the nutrition and medicine and other
related thing (www.uwl.libguides.com/az.php).
This research included keywords like: adolescents AND health education AND Intervention AND smoking
AND prevention AND effective. This produces research result of around 93. . Two limiters were used.
Firstly, year of publication was limited to 2009 – 2019 and it produced 35 search results. Secondly,
effective was included and it resulted in 11 search results.
The data relating to the Medline was more respected and necessary data which includes good literature
relating to the clinical background and different aspect of bioscience and is published at National library
of Medicin in US (www.uwl.libguides.com/az.php).
The major keyword searched were like health education, smoking, prevention, adolescent, effective and
many others. It produced 121 search results. Two limiters were applied. Firstly, publication year was
reduced to commence from 2009 – 2019 and 50 search results produced. Secondly, effective was added
to the keywords and it produced 26 results. There was no much detail in the search but used the
Boolean operator and was employed for the researching relating to the research data. In this study the
26 things were researched and three connected studies were used.
Exclusion and inclusion crietria
Criteria for inclusion
Criteria for exclusionPopulationThis study is intended towards youths to avert commencement of
smoking.
Study relating to adult who have initiated smoking already.
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Intervention
The study which are relating to smoking and health education intervention carried for setting in school,
community, web- based media and others.Various intervention including other
substance.ComparatorStudy which involves prevention of smoking among childrennone
OutcomesSmoking prevention in adolescentsLanguagesLanguage including English onlyNonePeriod of
timeBetween 2009 to 2019NoneStudy type Preliminary non-randomized controlled study
Cluster randomized trial
Randomized controlled trial
Pilot studiesMeta-analysis
Systematic Review
Critical Appraisal is the systematic assessment of the strengths and weaknesses of a paper, hence
enabling you to make an assessment of its standard and the way it assists you to respond to research
question (Aveyard, 2018). Once the main papers has been read and re-read, then one can advance
further with critical appraisal. In addition, critical appraisal of a paper enable you to determine either
how much weight it should carry in review, or if indeed it should be include at all (Aveyard, 2018).
Critical appraisal tools (CATs) are suggested by most researchers in order to develop a constant
approach to the critique of research and other information. More so, using an appraisal tool will assist in
questioning the literature in a more organized and in-depth way that is possible without such a tool.
However, these tools have their own flaws. CATs are very useful (Crowe and Sheppard, 2011) and no
specific tool is better than any other tools (Aveyard, 2018). for the more experienced researcher these
tool may not provide more effort and insight relating to research paper. Validity and Reliability of the
study are use to assess the quality relating to the quantitative work. Validity refers to whether the study
estimates what it purport to estimate. On the other side reliability is defined as the fact that whether the
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whole study is dependent on other or will make the same result if the study is conducted repeatedly
(Aveyard, 2018). The finding from quantitative research should always show how generalizable the
findings are. Thus, the test describe the former section do not, of themselves, show how generalizable a
result is to the population as a whole (Hewitt-Taylor, 2017).
Ethical approval and informed consent is based on the significance of protecting human subject in
clinical research. The declaration of Helsinki 1964 was issued by the World Medical Association which
formulated the control relating to International ethics for studies relating to medical comprising human
subject with subsequent update. The declaration outlined two parts of ethical consideration:
participants’ right relating to getting informed for all the study and the to provide for consent and
committee for ethical approval in order to make sure that design is proper before beginning a research
(Wu et al., 2019). In addition, it is the duty of journals and publishers to make sure that ethical approval
of human research has been obtained before papers are submitted (Wu et al., 2019).
CHAPTER THREE
CRITICAL APPRAISAL
Martias et al., (2013) used a preliminary non-randomized controlled trial to assess the efficacy of data
transferral from Oral Health Therapist (OHT) to the students within a school based anti-smoking
movement on the wellness impacts. It helps in examining the smoking and changes within smoking
purpose related with the participants subsequently after the intervention program. The anti- smoking
intervention focuses on delivering the health risk data on impact of smoking, stopping of smoking and
the prevention program for the feminine high school students within dental setting. The female high
school students were from Queensland, Australia in Years 8, 9, and 10. They were given an data sheet
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and also a ‘QUIT GIRLS pack’ that comprises of toothbrush, Colgate whitening toothpaste, and
sunglasses. Every participant filled a questionnaire at the time of waiting for their normal dental
appointment carried out by an Oral Health Therapist within mobile Dental Clinics. Participants were
requested to pinpoint a 18 systemic and also 12 oral health impacts of smoking within the questionnaire
at the baseline. The intervention was supported by the Miller and Rollnicks’ principles linked with
motivational interrogation. Participants were giving information on the oral well- being impacts linked
with smoking and the interview has been planned to be carried out in 5 to 10 minutes associated with
the clinical time. The strength of this study was the important number recruited for a one-to-one
intervention in a limited time frame. The limitation was the need to finish the programme within the
school time period.
Primack et al., (2014) study used a cluster-randomized trial and the study aim to decide if theory driver,
schooling supported three session anti-smoking related with media literacy syllabus which has been
given to the 9th grade scholars impact media literacy of the student and the elements moderating youth
smoking in proportion to fundamental conceptual model founded on the Theory of Reasoned Action
(TRA). The cluster randomized trial within the classroom randomly has been done. Three high schools
were selected from Pittsburg, PA- area with the help of community representatives to give anti-smoking
education in Allegheny County, America. The students were all 9th grades because smoking rates
increased from grade 8 to 12 and 9th grades can easily assimilates the abstract notions of media literacy
that need theoretical idea. Parents received a consent form informing them of the programme and all
participants provided written consent. There were two curriculums, the experimental and the control
syllabus. The experimental syllabus mainly comprise of 3 session of 120 minutes, b means version of the
‘AD IT UP’ syllabus which is a theory supported anti smoking media literacy syllabus initiated and
experimental tested with foundation allocation finance. This syllabus teaches adolescents to access,
analyse and appraise mass media messages on smoking like advertisements, promotions, or film
product placements. Every letter of the title denotes one of the 6 lessons included in the syllabus that
were linked with basic notions from a conceptual model of media literacy and a crucial question
connected to media literacy. The strength was that students vulnerable to a media-literacy based anti-
smoking program had importantly enhanced smoking media-literacy and enhanced views of the actual
predominance of smoking contrast to adolescent vulnerable to a standard school-based social influences
and smoking program. The limitation is that the intervention was not linked with important
enhancement in general media-literacy, anti-tobacco attitudes or assessments of perceived smokers’
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status. Lastly, whilst substantial number of people that have intention to smoke at baseline regressed to
no intent in the intervention contrast with the control and it was no statistically important.
Park et al., (2017) study experiment the impact related with the participatory video creation programme
as specific intervention in order to detain or prevention of commencement of smoking where youths
establish the anti-smoking messages on their own. The suggested intervention of the influence of
participatory video creation is theory-driven, extracted from both Self-Determination Theory and also
the Global Youth Voices Model. The study concentrated on utilizing a video creation program for
prevention of tobacco use among adolescent and was carried out during summer period at community
youth centre in a Midwestern Urban area. 4th to 8th grades both female and comprises of
white/Caucasian Americans, black/African, Latino/Hispanic. Both students and parents signed informed
consent form. It is a 60 minutes intervention carry on two times a week for 4 weeks, aggregate of 8
classes. The feedback obtained from the participants’ shows that they were highly contented with the
program comprising of their learning experience and positive to the program. The strength is that
information assembled in respect of the participants’ inspiration for finishing this program show that
creating video was viewed as a chance for operative participation, promoting the health of their local
community, and individual development and healthy growth, which is significant awareness for people
advancing subsequent smoking programs on smoking prevention. The limitation is that it show an
important alteration in intent to smoke (i.e., no smoking in the future) among the non-smoking
adolescent who took part in the program. The study does not comprise of any control group.
Chen et al., (2014) study used a school-based pilot study aims to investigate the smoking condition of
scholars at 2 different settings I.e, Linzhi and Guangzhou and also between two ethnic groups I.e,
Tibetan and Han. and to contrast the efficacy of the intervention among these scholars. The setting was
carried out in Linzhi of Tibet Autonomous Region and Guangzhou of Guangdong Province. The school-
based intervention was carried out from Sept 2008 to Sept 2009 (one year). Two each were randomly
picked in Linzhi and in Guangzhou. Written and oral consent has been taken from teachers of the school
and students respectively. The interventions were drawn in accordance with the literature of effective
interventions in youths' smoking regulation (Wen, Chen, and Lu, 2007). The outcomes indicated that
tobacco use of middle school students of Linzhi, Tibet was more severe compare to that of Guangzhou
Han. The intervention elevated the experience in the two ethnic groups and enhanced the attitudes in
Tibetan group but not that of Han group, but did not modify the behaviors of smoking in the two ethnic
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groups. Also, no significant impact on the student smoking behaviour with the intervention because the
intervention strength was proportionately moderate in view of the amount of students it intended to get
to. For instance, the prevalence of smoking associated lectures of health education has been scarce.
Additionally, the proportionately short period of intervention activities (one year) may also impact its
efficacy. More so, the intervention impacts may be reduced by shortage of comforting messages in the
community which students experience outside school, since the messages students obtain at school
could be sabotaged. Lastly, successful of intervention may be different by culture.
Starkey et al., (2009) study used a randomized-controlled trial developed through a feasibility study of a
peer supported anti smoking intervention which has been tested at the time of A Stop Smoking in
Schools Trial i.e., ASSIST based on diffusion of innovations theory. ASSIST employed a whole-community
identification method i.e., scholars in year 8 and are aged between 12 to 13 years. The major trial has
been carried out in 59 secondary schools within the West England and Southeast Wales between the
year 2001 till 2004. The extent of schools involved are independent and state, English speaking and
Welsh language, non- category school, different sized student population, single and mixed sex, and
varied degree of free entitlement to school meal. The program used a questionnaire related with the
peer nomination to recognize which scholars were highly considered as authoritative by 8 peers. The
one with the highest nomination are trained as ‘peer supporters’. If they consent and had their parent
agreed, they are picked from school to a two-day training course promoted by health promotion
multidisciplinary team experts and adolescent employees. The training programmes comprises,
information given, communication expertise and personal growth. Most of the activities concentrated
on oral instead of written communication expertises. Follow up sessions has been carried out within
every school for four times at the time of 10 weeks period at the time trainers provide assistance and
supervised the peer assistance advancement. Every supporter of the peer received a certification of
accomplishment and peer supporters that propose a absolute diary received as a gift voucher. The
strength of this study is that the ASSIST peer- nomination enquiry has been generated and clarified
employing adolescent’s personal terms of reference and response, a component of the procedure that
may have added to its efficacious in acknowledging different form of influential students.
Kousoulas et al., (2016) study used a pilot study design related with 6 step intervention (comprises of
online and offline components). This is a simple intervention comprising of a school room presentation
and a suggested interaction with social media, within 6 steps drawn to be executed as effective part of
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current curriculum. Step 1 till 3 (offline) comprise of the effective option related with the sponsoring
company of the intervention and also training within communication skills, interactive presentation
method, and behaviour within classroom and also the health-related topic in particular. The intervention
for the student was performed at the time of smoking prevention program delivered to 225 high-school
scholar (between 15 to 18 years) within a sole high school lecture within Athens, Greece year 2012. The
presenter used contemporary textbook as background for the presentation which concentrated on
burden on morbidity or mortality, national epidemiology and socio- economic parts associated with
smoking, and also an enumeration of 14 take home points. At steps 4 - 6 i.e., online, in a 3 day window.
However, the presenters connected along the scholars utilizing a social media platform, and furnished
the take home major constituent. They picked Facebook as the well- known social connectivity website
where the generality of adolescents are progressive on a daily basis. Those that attended were asked to
upload smoking associated take home messages on the Facebook status. The limitation is that it is a
novel pilot study but the results emanates from a sole Greek high school and it is cumbersome to argue
that they may be extend to all settings. The importance of the little feedback rate (16%) is cumbersome
to judge because of absence of other pertinent studies to compare.
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CHAPTER FOUR
DISCUSSION AND RECOMMENDATION
As per analysis, it has been focused on the different prevention in the smoking because it is considered
the one of common health issues or problem. Furthermore, it is also emerging with different themes
that always support for developing from the health education intervention in respect of it. These
comprises of anti-smoking intervention on health risk information delivered by oral health therapist in a
dental settings, school-based anti-smoking media-literacy curriculum, participatory video production
program produced by the adolescent themselves health education will be creating an effective policies
as well as procedures, that always support for creating an effective healthy culture or environment
Generally, it should include , wellness situation in school and individual wellness ability, a peer-led anti-
smoking intervention and create the effective visual presentation and suggested to use digital
technology by using social media network.
In Martias et al., (2013), It can be identified the concept of smoking cessation and also considered the
effective event or programme. These are supporting the female and school students based on the high
schools. This program will support for delivered in context of dental setting. It is one of important
aspects in Australia (Martias et al., 2013). Through this study, it has been representing the program or
event that help for student of educational secondary school. In order to increase the actual rate of
smoking which directly impact on the student. It also increasing the significant impact of smoking.
Afterwards, it can be included the significant or effective model for purpose of prevention. (Ridout,
Charlton and Hutchison, 2008). In additional, it can be delivered better facilities in term of dental in
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order to provide the better opportunity to develop an effective environment. Afterwards, it resolved the
problem or issues related smoking.
Theme: Advantage of face to face intervention technique
The Benefit or advantage of this face to face related intervention program. It always supported for
health professional, also giving the confirmation and reduce the actual rate of smoking among adults
between 2% to 3% (Chapman, 1993). Furthermore, it is also understanding the concept of intensive
interventions that should be used in both with or without pharmaceutics, in order to increase the rate of
stopping rather than one-off interventions. Furthermore, it should be included suitable skill, time, which
improving the large number of smokers (Laniado-Laborin, 2010). Afterwards, it can be targeting at early
stage in order to give better prevention through effective intervention technique among adolescence.
On the basis of evidence, it will be supporting the significant use of school-based educational event as
well as programmes. These are providing the awareness and guidance regarding the anti-smoking
message. In order to reduce the complex situation in proper manner. This programme furnished always
inspired or motivated to use best material, which help for student to understand causes of smoking and
their effects among the adolescents.
In this study, it has been representing the essential alteration in term of intention for smoking.
However, This type of research study has been consumed the limited time and identifying the higher
rate of smoker in Australia. The original time frame should be contained (Five months recall time and
one-off intervention), it should uptake among different students, which mainly controlled the suitable
group of individual. Afterwards, it is stronger way to intention for controlling the possible result or
outcome. The behavioural change of intention to smoke that was evoked by this programme in this
study should be promote analyse. The possibly healthful impact of this programme looks likely.
In Primack et al., (2014), a media-literacy intends to cushion this effect of large number of adults, who
always attract towards smoking these are inspired the more adolescents, which are empowered the
adolescent to investigate or appraise. The digital media is the best option to participate in the
awareness among people. In order to target more and more individuals people (Pinkleton et al., 2007).
According to this Theory of Reasoned Action (TRA), which is a theory of health behavior that has
been identified the rate of smoking among the adolescent. By using this theory, it can be identified the
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behavior and then providing the intervention through attitude towards smoking. Afterwards, As a result,
it can be projected through certain behavior, attitude through own view or point.
This type of theory can be specified the pertinent to handle the appropriate media and their
effective literacy event or program due to their likelihood to minimize the effect of in bulk message on
the attitude as well as normative concerns. (Primack, Douglas and Miller, 2014).
Various type of Media literacy event or programs, which tends to separate the different
traditional as well as social influencer towards program. It also concerning “heavy-handedness.” Due to
influence by the effective social event or programs, incline to concentrate on way to say “no” to
smoking, and may be less successful among people that ate very disobedient people who tend to
disobey authority (Burt et al., 2000). Nevertheless, media-literacy programs attempt to concentrate this
innate disobedience against corporate impacts rather than their relatives, peers and teachers.
There is need to widening the TRA as an implicit in theory. For instance, the Message Interpretation
Process Model recommends that conduct options are impacted not limited to reasoning procedures
stressed by the TRA but also by affectional elements like goodness of, individual relevancy to, and
designation with representations. Hence, it is likely that, while conventional participation may infuse
specific unfavourable cognition, media skill programs may be further subtly impact communication
explanation which is connected to the literacy programs within the schools and university. Equally, the
TRA does not stress the notion of authorization in decision-making, which is speculate to connect
wellness skill to upbeat consequences. Thus, it will be precious to measure an additional entire fixed of
abstractive concept in subsequent survey.
It is recommended for future research to investigate the various ways of curriculum execution, in which
normal schoolroom teachers could be drilled in performing these subjects by introducing the issues in
order to determine the training and executing the same for future. And it is suggested that an virtual
learning should be provided in order to meet the define aim and provide best working environment to
their students.
In Park et al., (2017), the study furnishes significant information on adolescent participatory digital
media creation program for prevention of smoking in adolescents. The participants’ feedbacks show
high extents of contentment, with reply to all the questions on program contentment, comprising their
learning experience and being positive. These collection recommend that the employ of analogue
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media, in recording production, served as involving learning bringing manner for this difficult to involve
pupil age unit. The technology provided in this program engage the students to take part in it and also
easy and challenging enough to keep them inspired all over. Former studies like the TRUE project in
Florida indicate the impact of media drive provided through different kinds of digital media on
hindrance and stopping of smoking among adolescent participants (Bier et al., 2013).
This study is at its top position in order to create a media as a democratic way, allowing the production
and distribution of communication by the adolescent on their own, and researched the media impact on
associate. Digital media may furnish a method of linking single adolescent to social group as operative
creator of communication encouraging anti-smoking movement. Considering the comparative
sufficiency of video creation made likely by today's profession and set right to a broader online
gathering, this is possible only when the promotion programs are develop at its best in all society.
The present survey has bespeak for paediatric and teenage attention. School health professional,
medicine health professional practitioners or national wellbeing caregiver may be well informed of the
significance of timely capital hinderance attempts in respect of smoking problems, and adolescence is a
critical time. Although, little analysis have particularly examined the forms of learning style or approach
most possibly to be proficient and successful for involving adolescent in such programs (Flicker et al.,
2008).
The results of this study indicate important changes in intention to smoke (excluding future tobacco use)
among the non-smoking adolescent who take part in the system. This outcome is imposing compared to
the one reported in former survey of bar of smoking for this age group, especially considering the rather
little total of associate. This obviously shows the necessity for a comprehensive study to examine the
elements steering this impressive change. The efficacy of this program should be research with various
population groups.
In future studies, long-term follow-up should be provided for smoking behaviors to investigate the long-
term results. Additionally, there is need for additional studies to develop the results of this study which
has a high group action charge notwithstanding is performance in a community-based setting during the
summer. Additional consistent in order to higher and retain the people who are not only be furnished by
a school based settings , but it would be absorbing to decide whether school-based settings are also
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executable and able of furnishing successful outcomes for event like this. Such that the element of the
event are used as well as implanted in the middle school syllabus or else after the programs of schools
In Chen et al., (2014), argue that significant the efficacy of various intervention program or events. These
was being evaluated on the multiple areas in regards of smoking. Through this process, it can evaluating
the behaviors, attitude and knowledge, skill about intervention. This type of intervention elevated will
help for gained more knowledge because it has rapidly changing the behavior of individuals, sometimes,
it does not altered the significant behavior smother in context of ethnic groups. Furthermore, as
comparison between the different findings, in order to estimate the accurate result or outcome. (Wen,
Chen, & Liang, 2007),
On the basis of different school-related intervention that always used for enhancing the knowledge
about the smoking and their effects. Sometimes, it can be identified the changes in the behaviors in
ethical manner. Furthermore, it has been examined the certain attitude, intervention, which are
becoming successful among the different students.
In this research project, it is mainly focused on the significant finding and their efficacious in context of
intervention program. This will support for altering smoking in regards to gain more knowledge as well
as attitudes. The study has examined the certain aspects of individual, focused on their behavior,
attitudes. (Soldz et al., 2000).
Afterwards, it can be easily clarified with the help of skill, behavior knowledge, attitude, and practice
model in term of health educational program. The primary aim is to understand the specific thinking
towards smoking and their dangerous causes, which directly affecting on the health condition of
smokers. By using study, it has gained more scientific knowledge regarding the disease, therefore, it
would require to utilize the information to change the behavior of smoker.
Apart from that, it also implied the suitable skill or knowledge but does not required the necessary
changes in the behavior. In this way, it has leads to a change in attitudes as well as behaviors. According
to research study, it has been recommendations to gain more knowledge and also changing the
attitudes as well as knowledge. it may precursors to behavior changes ( Klein and Wilson, 2002).
(Bruvold, 1993).
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Through this study, it has been demonstrated with the specific attitudes, behavior of smoker. Afterwards
it might be more specific to change or modify within knowledge and gain more data.. Apart from that,
individual behavior that will be completely changed and very difficult to gain the specific is knowledge
and attitudes in context of ethnic manner.
As per considered the behavioral theories, it is mainly defined the smoker and their behavior.
Sometimes, it is not rely on the specific elements such as smoking stopping-connected, self-efficacy,
social norms or standards, pressure of peer, benefits as well as obstacles in the smoking stopping,
availability of cigarettes. On the other hand, it may change the smoking behaviors. These are helping to
examine the current situation or condition in proper manner. (Bian et al., 2012)
It can be performed the systematic review with help of Harden et al.. it can be delivered the effective
health intervention program or event which always support for inspiring or motivating young adults. As
per analysis, it can be examined the effectiveness as well as shortage of accurate result or outcome. It
can be generated through different evaluation program. Sometimes, it has recommendation to identify
need or requirement of research. In order to gain more knowledge about the health promotion event or
program.
This study has focused on the accurate finding that always representing the effective intervention
program. Afterwards, it can be adopted the intervention for being efficacy to understand the smoking
behaviors.
The primary strength of intervention for understanding the more prevalence in term of health
educational events. Various professional will give best lectures in order to reduce the complex situation
or condition. the current necessity is that when examined the social community and other related the
family-based smoking prevention event or programs. It should help for making the message to reduce
certain risk of smoking. This type of program can be applicable in different school, home and other
community. Moreover, it applicable the essential intervention that can be analysed the environment or
culture. Another way, it has included the embody collectivism activities, that mainly designed in proper
manner. For example- group competition plan and activities in prevention of smoking.
In Starket et al., (2009), the significance of peer educated with regards to gender balance is stressed
upon the study and that is why, it is analyzed that with the help of Assist Method, of separating the year
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all the gender based make sure that they attain the task. With the help of planned sub group, there is no
intervention which has been differ from the gender. Thus, there is a need to be applying the proper
research methods in order to meet the define aim. But due to lack of positive behavior change, there is a
need to apply the self reflection points that assist to determine the actual performance and tested
positively.
Furthermore, Kelly, (2004), suggested that with the help of Assist Approach, most of the leader identify
the strength as well as present the diversity of social group in better manner to examine the issue. Also,
it is determine that from the selected approach, most of the four intervention schools are selected for
in-depth process evaluation in order to determine the results. Also, it is examine that once the success
fluctuate to meet the define aim across whole community then it creates a direct implication with the
health promotion. Also, most of the selected respondents are determine the significance of person
based credibility and they further emphasize the group (Wolf and Bond, 2002). In addition to this, author
further recommended that due to this similiarity, may be the chances of less personal chracteristic from
peer educator increases with this.
In Kousoulas et al., (2016), a easy participation, comprising a schoolroom ceremony and a recommended
social media action, in six steps was drawn to be enforced as aspect of a present curriculum which need
to delivered as per the specific and designed part and it must be include the careful selection to choose
the respondents whether it is gender and 30 year old people. Moreover, the training needs to be done
which in turn help to improve the overall communication skills, behavior within a classroom and also
require health related issue. A synchronous textbook was employed as foundation indication for the
existing, who by agreement evolved an enumeration of themes with concentration on political unit
medicine, load on incidence/impermanence, and socioeconomic parts of smoking, and also an
enumeration of 14 take-home component. During steps 4 to 6 (online), in a 3-day framework, the
existing connected up with the scholar using a social media network, and furnished the take-home key
points.
This study explains the execution of an learning engagement for smoking hindrance among high building
educatee. A plan of a six-step involution to employ social media as methods of wellness publicity with
joint of smoking-related take away communication that can dispersed all over a vast amount of youths
via Facebook.
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This intercession flyer execution adds to the restrained present indication on how social media may
elevate tobacco power, (Hefler, Freeman and Chapman, 2012) and furnishes penetration into a unusual
manner of furnishing wellness publicity and instruction to adolescent via Facebook messaging.
Tobacco use is in specific cobble still of widespread part and one of the least severe public health
problems. However, there is very small investigating on the possible employ of well known social media
for wellness publicity intent on tobacco hindrance, particularly among youths who aim to be
meaningfully impacted by their peers.
CHAPTER FIVE
CONCLUSION
The above journal articles have demonstrated how health education can be carry out at various levels
such as through one-off one-on-one intervention programme delivered by oral health therapist in a
dental settings showing the importance of dental health to cessation of smoking by adolescents.
Additionally, media-literacy curriculum intervention also shows the significance of health education
taught in school-based in respect of prevention of smoking in youth. This is seen to be more effective
among those rebellious youth than the traditional social influences program that tends to concentrate
on saying NO to smoking because focussing the intervention on media exposure robustly linked with
yielded results. Furthermore, a participatory video produced by the youth themselves to prevent
starting of smoking among adolescents. In addition, digital media are exceptionally effective and view as
suitable for educational mode because they are possible to attract youth’s attention and inspire them as
active learner (Benneth, 2008). More so, school-based intervention program on attitudes and behaviour
towards smoking which see the intervention program based on health education on health policies in
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school, health environment in school and personal health skills. A peer-led anti-smoking intervention
carried out in a community involving a large number of schools and a classroom presentation and
suggested social media interaction all demonstrated how health education has been used through
multiple-channel and multiple campaign to prevent smoking in adolescents.
All these health educations are not alone without being based on different theories of key health
promotion ranges from different theories that help for performing the actions towards health condition
of employee. Action, a widely applied theory of health behaviour that has been utilized to predicted
attitudes and behaviour towards smoking in adolescents. As per discussion, it has identified the features
and examine the background with the help of different theories it can be assertion that examine the
current aspects of behavioural intention is the most meaningful element of behaviour. The TRA and TPB
allege that individuals consider the results of their actions before going on or abstain from any particular
behaviour (Sharma, 2016). These two theories stresses the role of thoughts in decision making about
involving in behaviour and they states that an individual’s intention is decided by two antecedents,
including personal factors and social influences. The TPB include a third predictor, that of control over
the behaviour.
Also, Diffusion of innovations theory has been used as a significant to understanding on how opinions
and practices spread throughout a community. The self-determination Theory and the Global Youth
Voices model were all applied to various health education interventions in this research.
It is pertinent to note that for health education to be effective a single intervention cannot be sufficient
to avert smoking in adolescents because of the multifactorial nature of the health issues. This is shown
in all of the journal articles because they all have one or two limitations and further research is still
required in most of the interventions used.
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APPENDIX
CASP
Article detailsAimStudy designDetails of participantsDetails of intervention Key findingsLimitations
RecommendationsMartias et al.,
2013
AustraliaTo evaluate the effectiveness of information transfer from OHT to students in a school based anti-
smoking campaign regarding the health effects of smoking and to evaluate changes in smoking intention of
participants after the intervention program.Preliminary non-randomized controlled trial
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Year 8 to 10 female secondary school students from 13 public high schools in the Logan area were provided with
an information sheet and a ‘QUITGIRLS pack’ that included Colgate Whitening toothpaste, toothbrush and
sunglasses
13 public schools took part in the study and were randomly assigned to one of two study arms - the intervention
arm and the observational arm.
Ten OHTs trained in smoking cessation and prevention strategies from the Oral Health Program (Logan–
Beaudesert Division).
All participants completed a questionnaire while waiting for their regular dental appointment carried out by an
OHT in mobile dental clinics. The questionnaire was derived from the Australian Secondary School Alcohol and
Drug Survey (ASSADS). Participants were also asked to identify a set of 18 systemic and 12 oral health effects of
smoking in the questionnaire at baseline and at the five months recall. In addition, data were collected relating to
attitudes and behaviours towards smoking
In the intervention group, they were provided information on the systemic and oral health impacts of smoking and
received intervention/prevention interviews. Minimal intervention based on Miller and Rollnick's principles of
motivational interviewing was delivered
The whole interview protocol was designed to be conducted within 5 to 10 minutes of clinical time. The control
group received routine dental care without the ntervention.The findings of this study are important, as far as it
confirms the role of the oral health practitioner in providing advice and education in smoking cessation and
prevention. Utilization of OHT to provide an anti-smoking message in their normal routine setting is a practical and
potentially effective strategy that complements the Australian National Tobacco Campaign. Including a 5–
10 minute brief interview within the bounds of a dental check-up did not appear to be overly intrusive for both
operator and patient.
The consequences of the study indicated that the dental setting is an efficacious avenue for educating individuals
on smoking connected conditions.The major limitation of this study was the need to complete the project within
the ‘school year’. This defined the five-month recall and number of interventions that could be delivered.
The current study similarly did not show significant change in intention to smoke. The behavioural change of
smoking intent that was elicited by this programme needs to be further investigated.
The possibly preventive impact of this programme looks promising.Primack et al.,
2014,
USA
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To decide if a theory-driven, school-based, 3-session anti-smoking media literacy curriculum delivered to 9th
grade students influences students’ media literacy (both general and smoking-particular) and the elements
mediating youth smoking according to our fundamental conceptual model based on the TRACluster-randomized
trial3 Pittsburgh, PA area high schools with the assistance of community agencies get in touch with to deliver anti-
smoking education in Allegheny County.
9th grade students were chosen because their age is an better time for intervention (i.e, smoking rates increase up
to 3-fold between the 8th and 12th grades)
The classrooms randomly nominated to either an experimental media-literacy curriculum or a standard
educational program about smoking tobacco.
There were no crucial differences between the intervention and control groups in terms of any measured
covariate.
1170 possibly eligible students representing 64 classrooms, 578 (49.4%) students from 33 classrooms were
randomized to the control educational program and 554 (47.4%) students from 31 classrooms were randomized
to the intervention curriculum.
Overall, 412 (71%) of the 578 students nominated to the control arm, and 388 (70%) of the 554 students
nominated to the intervention arm.The experimental curriculum was a 3-classes (120 minutes) version of the “AD
IT UP” curriculum—a theory-based anti-smoking media literacy curriculum initiated and pilot tested with
foundation grant funding. This curriculum educate adolescent to access, analyze, and evaluate mass media
messages comprising smoking, like advertisements, promotions, or film product placements. Each letter of the
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title refers to one of the 6 lessons contained in the curriculum, which were linkited with core notions from a
conceptual model of media literacy and a crucial question connected to media literacy.
The control curriculum was founded on the 3-classes anti-smoking program (120 minutes) featured in the most
widely used health textbook in the region.
These 3 lessons, got from a representative “social influences” program, describe both short- and long-term
impacts of smoking, support students’ self-efficacy in saying “no” to smoking, and discuss social and psychological
problems involving smoking.This study discovered that students susceptibility to a media-literacy-based anti-
smoking program had significantly enhanced smoking media literacy and enhanced awareness of the true
predominance of smoking compared to adolescent vulnerable to a standard school-based social influences anti-
smoking program.
This study extends earlier findings by employing an extra meticulous experimental design.
This study employs a well-studied estimate of media literacy. Whereas no measure of this complicated, multi-
faceted construct is ideal, it is encouraging that intervention assignment was connected with relevant impact size
changes in the measure.The limitation is that the intervention was not linked with important enhancement in
general media-literacy, anti-tobacco attitudes or assessments of perceived smokers’ status. Lastly, whilst
substantial number of people that have intention to smoke at baseline regressed to no intent in the intervention
contrast with the control and it was no statistically importantFuture research to investigate various ways of
curriculum execution. Hence, regular classroom teachers could be trained in carrying out these curricula, it would
introduce challenges with respect to standardizing training and execution fidelity. An interactive Web-based
approach may optimize curriculum standardization, but this approach may lessen in-person teacher-student
interactions and spontaneity.Park et al.,
2017
USA
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A study testing the impact of a participatory media creation program as an intervention to impede or avert
smoking beginning where youths produce the anti-smoking messages themselvesPilot study 4th–8th graders,
smokers and non-smokers; and, 2) interest in taking part in the video creation program.
All 23 of the adolescents who took part in the video creation program were enrolled as study participants.
A convenience sampling plan was applied.
Fourteen of the participants also took part in individual interviews and were choose using a non-probabilistic,
purposive sampling approach in order to ensure data variability.
The majority of the participants were female (65%) and African American (46.4%).
Two-thirds reported average or above average school achievement, and almost all (96%) planned to go to
collegeThe suggested intervention in this study on the effect of participatory video creation is theory-driven,
extracted from both Self-Determination Theory (SDT) and the Global Youth Voices Model. There are three main
significant constructs, autonomy, competence and connectedness, from SDT portray the contributors of the
elements driving the suitable health behavior result.
The 60-minute classes took place two times a week for 4 weeks, for a total of 8 sessions. On the first day, groups of
3 to 5 participants were formed and allotted the duty of creating a video. The process comprised of three phases,
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namely pre-production, creation, and sharing. The pre-production stage was comprises of ice-breaking classes,
goal sharing, and interview activities.
Participants generated questions for interviews to appraise the perspectives of individual about smoking and
cordinated interviews with other teenagers and adults at the community center to learn about smoking problems.
These interview activities also allowed students to learn video recording skills. In the second week, participants
acknowledged the factors and results of smoking and researched problems connected to smoking, concentrating
on media and tobacco companies. In the third week, the creation stage, the participants planned scenes and plots,
wrote scripts, and shot videos. In the fourth week, the participants edited the videos produced and reshot scenes
if necessary. In the final sharing session, the participants invited members of their social networks, including other
adolescents at the community youth center, to a formal viewing.The findings recommend that the employ of
digital media, served as an involving educational delivery mode for this difficult-to-reach middle school student
age group. The adolescent enrolled in the study indicated a high involvement extent by taking part in each activity
in the program. The technology furnished in this program not only allured the students to engage in the first place
but was also easy and demanding enough to keep them inspired throughout.
This finding regarding the high feasibility of an adolescent video creation program is particularly promising as
today's adolescents are contemplated the “YouTube Generation”, digital natives with high levels of accessibility
and involvement in the utilize of technologies.
The study's findings recommend that video creation of anti-smoking messages uplifts the participants' intention
not to smoke at the individual level of health behavior changes, which could eventually add to a more smoke-free
society. Digital media can although give a useful and efficacious new approach to changing the adolescent health
behaviors, assisting them to become healthy individuals adding to a healthy society.Sample prejudices connected
with small, convenience sampling could possibly limit the generalizability of the findings.
The convenience sample employed in this study may also not be portrayal of both smokers and non-smokers in
this age group, a possibly serious limitation given the fact that this study originally intended to investigate the
impact and feasibility of the program on both smokers (lessening the amount of smoking) and non-smokers.
As no regular smokers were recruited as participants, the study analysis was able to concentrate solely on the
smoking prevention impact on non-smoking adolescents.
There are also possible problems in respect of the trustworthiness of the qualitative data connected to the
researchers' prejudice, possible sampling errors, and lack of participants' disclosures. Since the intervention group
in this study was not balanced by a control group, this also limits our understanding of the intervention's impact
on changes in smoking intention.
Additionally, since the participants volunteered to take part, there is a degree of self-selection prejudice.In future
studies, smoking behaviors may need to be followed up for long time to investigate the long-term outcomes.
Additional studies will be able to build on the findings of this study, which had a high attendance rate
notwithstanding that it was conducted in a community-based setting during the summer. A school-based setting
would not only give a more stable setting for the recruitment and retention of participants, but it would be
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interesting to decide whether school-based settings are also feasible and able of providing successful outcomes
for programs like this. Chen et al.,
2014
China
To assess the effectiveness of school-based intervention intended to elevate knowledge, to change attitudes and
to lessen smoking-connected behavior in both Linzhi Tibetan and Guangzhou Han middle school students in
China.A pilot studyParticipants of the study were first and second year middle school students. Randomization
happened at the school level to prevent contamination between groups. Two out of seven middle schools were
randomly chosen in Linzhi and two were randomly selected in Guangzhou. The two chosen schools of each site
were then randomly nominated to the intervention or control group. All students of first and second years of the
chosen schools (712 in Linzhi and 1,105 in Guangzhou) were invited and all of them consented to take part in the
study.The contents of intervention were designed according to the literature of effective interventions in youths'
tobacco control.
The intervention targeted at students and teachers in the school. The preliminary list of intervention activities was
assembled by a panel of health education experts, after a critical review of Chinese and English literature. Then
this list was revised after in-depth interviews with school administrators to ensure feasibility. Focus group
discussions with smoking students were also held to discuss the acceptability of interventions. Families were not
engaged because most of the Tibetan students live in school. The intervention program lasted for an entire school
year and covered following aspects: Health Policies in School, Health Environment in school and
Personal Health Skills.
The findings recommended that presently adopted intervention was far from effective to decrease smoking
behaviors. The intervention intensity, for example, the frequency of health education lectures, Tobacco Control
Group activities, could be elevated.Only two study sites and four schools, which may limit the generalization of
study findings. Second, as the intervention was school-based, differences between schools existed even though
some baseline differences were adjusted in the analyses. Third, intervention in this study was packaged together,
so we could not identify the effectiveness of each individual intervention activity. Fourth, our study focused on
school-based intervention and evaluation; hence there might be a lack of supporting messages in the environment
outside school, which may weaken the effectiveness of the intervention. Lastly, data were gathered at baseline
and at follow-up one year later, there was no intermediate data collection in between.There is need for
community and family-based smoking prevention programs so that the messages about the dangers of smoking
are consistent across school, home and the widerer community.
Intervention can also be more culture-connected.
Activities embody collectivism could be designed, e.g., group competition activities in smoking prevention. More
pertinent interventions targeting adolescents and sensitive to ethnic and cultural differences are greatly
warranted.Starkey et al.,
2009
United Kingdom
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To develop and evaluate an effective whole-community approach to acknowledging a diverse group of influential
young people to effectively diffuse health promotion messages among their peers.Cluster randomized-controlled
trialThe main trial was undertaken in 59 secondary schools in the west of England and south east Wales from 2001
to 2004 and involved 10 730 Year 8 students (12–13 years old) at baseline.
A range of schools was represented including the following: independent and state, Welsh language and English
speaking, non-denominational and faith schools, mixed and single-sex, different-sized student populations and
varying levels of free school meal entitlement.
Those in the control group (n = 29 schools, 5372 students) were asked to continue with their normal smoking
education.
The intervention group (n = 30 schools, 5358 students) continued with their normal smoking education, but also
received the ASSIST intervention.A two-day training course facilitated by a multidisciplinary team of health
promotion specialists and youth workers. The training programme included information giving, communication
expertise and personal development. Bearing in mind the range of young people, and their eventual role as peer
supporters, most of the activities were concentrated on oral instead of written communication skills.
During the following 10 weeks, the peer supporters were asked to have informal conversations with other Year 8
students in their school to persuade them not to smoke and to record brief details of these conversations in a
simple diary. Four follow up classes were undertaken in each school during the 10-week period, at which the
trainers offered support and monitored the peer supporters’ progress.The suggestion that health promotion
interventions based on diffusing new behavioural norms may work best in clearly defined fairly close-knit
communities, where peer supporters are in regular contact with members of a more clearly defined and stable
community.
Carefully designed and developed peer-led interventions like that employed by ASSIST have potential
for delivering efficacious smoking prevention among youths.There was no positive behaviour change
resulting from school- based peer education projects that use self-selection or staff selection to identify peer
educators.
The need to emphasize the importance of allowing all students in the year group to nominate influential members
and permitting all nominated students, even those who appear challenging or disaffected, to be trained as peer
supporters.
An evaluation of the wider Odds ratios from ASSIST multi-level model. Reprinted from Campbell et al. F. Starkey et
al. 986 execution of the ASSIST intervention is planned, with fidelity of execution a significant attribute.
Social network analysis recommends that the ASSIST peer nomination approach identified peer leaders from
various clusters within the year group. This complies with suggestions that opinion leaders should represent a
diversity of social groups to facilitate diffusionKousoulis et al.,
2016
Greece
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The design of a six-step intervention (including an offline and online component) to use social media as means of
health promotion among youth.A pilot study225 students that attended the presentation.
201 (89.3%) reported having a Facebook account.
Assessed 72 hours following the lecture (the allowed time window to connect with the presenter), 32 students
(15.9%) had posted a smoking-related sentence in their Facebook account, a take-home message that was spread
to their 20,095 cumulative friends as a note on their wall via news feed. Notably, all the messages were posted at
least once, and 16 students (50%) posted more than one. Finance or mortality-related messages were the ones
shared more widely (numbers 6–9 and 12–14 in the Table). A contemporary textbook was employed as
background reading for the presenters, who by agreement evolved an enumeration of themes with a focus on
national epidemiology, burden on morbidity/mortality, and socioeconomic parts of smoking, and also an
enumeration of 14 take-home points.
During steps 4 to 6 (online), within a 3-day window, the presenters linked up with the students using a social
media platform, and provided the take-home key points.
Face book was chosen as the most popular social networking Web site in which the vast majority of youth are daily
active and already maintain active accountsThis intervention’s pilot implementation adds to the limited existing
evidence on how social media may advance tobacco control, and furnishes insight into a novel way of giving health
promotion and education to adolescent via facebook messaging.The results come from a single Greek high school
and it is difficult to argue that they may be extrapolated to all settings.
The significance of the low response rate (16%) is difficult to judge because of lack of other relevant studies for c
Limited demographic information was collected for this pilot, and the important information of how many of the
students who posted a take-home message were smokers or anti-smokers is missing.
Researchers are encouraged to take into account focused online data and the dynamics of the degrees of impact
within the students’ social networks when designing future studies
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