Preventive Intervention of Teenage Smoking | Essay

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Introduction
This essay explores the effectiveness of preventive intervention of teenage smoking and
smoking uptake in European adolescence in school settings. The essay discusses the background
to this public health topic, the literature review methodology followed by the results and issues
related to three studies identified through the literature search and a discussion of emerging
themes.
Prevalence in smoking among European youths has driven governmental policies in most
European countries and beyond to put age restriction of 18 years plus to purchase cigarettes. The
development of smoking habits is usually developed in adolescent and it is patterned by socio-
economic position (Green et al., 2014).Tobacco, which is a major content in cigarettes, is one of
the leading causes of health complications and deaths among adults and adolescence. It has been
estimated that smoking will be one of the prevailing causes of mortalities in the 21st century and
causality of around 1 billion deaths. Evidences also suggest that mortality rate is much higher in
people who smoke and smoking tobacco causes at least 10 years loss of life. Hence, there is an
urgent call for developing and implementing an effective intervention strategy with the aim of
reducing this prevalence and preventing long-term health problems, morbidities and mortalities.
In a study by Thomas, McLellan and Perera (2015) it has been found that in the UK, the smoking
rate among 11-15 age group children is 6%. Smoking has lifelong implications and the behaviour
usually lasts for decades with the difficulty of quitting among smokers. Therefore, focusing on
the target population, that is, young adolescents, many studies have suggested the necessity and
efficiency of school-based interventions in promoting healthy behaviours among students and
encourage them to quit smoking in order to increase their quality of life and wellbeing.

Background
Smoking of tobacco epidemic is one of the largest health treats the world is facing. This
is because smoking kills more than 8 million people a year around the world and 1.2 million of
this is as a result of indirect exposure to second hand smoke. Around 80% of the world’s 1.1
billion smokers live in low- middle income countries. Smoking is also one of the leading external
cause of some non-communicable diseases such as cardiovascular and respiratory diseases,
coronary heart disease, lung cancer and other smoking related complications (Who.int, 2020).
In addition to that, the use of water pipes in German teens has been improved in recent
years and has likewise been identified as harmful to human health (Thomas, McLellan and
Perera 2015). The school environment has been a subject of campaigns in the last three decades,
to control smoking and healthy choices in young people. Almost all children are perceived as
being accessible via schools and therefore tobacco education via schools is an important channel
of intervention. Education Against Tobacco (EAT) is a multinational smoking prevention
network of more than 3500 volunteering medical students and also physicians from more than 14
countries. EAT has been a driving force in smoking prevention promotion programmes,
delivering school-based interventions on smoking related diseases, educating more than 50,000
adolescence per year in classroom setting on smoking and the health consequences.One of the
key advantages of EAT offers educational services for mutual decision-making and uses
interactive sessions to engage with student in these sessions.Currently,the EAT multinational
programme, includes Austria, Pakistan, Uruguay, Germany, Sudan, Switzerland,Bangladesh,
Bosnia and Herzegovina and the USA(Lisboa et al., 2019).Recent studiesindicate that, relative to
other chronic conditions, tobacco addiction is under-treated, primarily due to a lack of
motivation knowledge and ability (Andersen et al. 2015).

Five forms of curriculums have been used in classrooms, each with a specific theoretical
direction: curricula on information purposes alone, curricula on social skills, curricula on social
influences and curricula on multimodal cognitive and technical competences mixed (Andersen et
al. 2015).The Smoke-free Class Competition is a popular scholastic tobacco prevention program
implemented across many countries in the EU. Nonetheless, a longitudinal 2012 Cochrane study
found that primary and secondary smoking reduction intervention in teens did not work. More
common secondary school services featuring medical professionals such as EAT have shown
substantially positive impact, though not widely available (Lisboa et al., 2019).
Among Danish youths the prevalence of smoking is high compared to other Nordic
countries. However, over the last few decades Danish teenagers have seen an overall decrease in
smoking, a recent update suggests that a smoking reduction in Denmark is urgently
needed(Brinker et al. 2018).Previous studies have repeatedly shown that smoking in lower socio-
economic communities is more common and leads to health socio-economic inequalities. When
young people get to smoke, socio-economic disparities develop in adolescent smoking behaviour
(Kolovelonis, Goudas and Theodorakis 2016). A comprehensive review reveals that socio-
economic status and the actions of smoking are harmful combination (Michie et al., 2009). The
stigma is more consistent with the fact that,younger teens aged 10-14 years start to smoke in
younger ages in the lower socio-economic community. Adolescence is therefore the best time to
avoid socio-economic inequalities in smoking behaviour. Several experiments have been carried
out to determine the efficacy of youth smoking cessation strategies. Nevertheless, the gaps
between the socio-economic classes are still unclear in these efforts to prevent smoking
(Kolovelonis, Goudas and Theodorakis 2016).

Methodology
Research question
The research question has been developed and refined using the PICO framework. The
PICO framework is also used to break down a review question to identify search keywords. The
abbreviation for PICO represents: P–population, I –intervention C–comparison, O–outcome
(Eriksen and Frandsen 2018).
The literature review question that has been developed was:
Are school-based interventions effective in preventing smoking among European
adolescents?
PICO framework elements:
Elements Keywords
P (Population) Adolescents
I (intervention/indicator) School based smoking prevention intervention
C (comparison) None or those adolescents not taking part in these interventions
O (outcome of interest) Reduced rate of smoking
Search strategy
CINAHL (Cumulative Index of Nursing and Allied Health professionals) was the main scientific
bibliographic database used. The main keywords used were: like “School based intervention”,
“smoking among adolescents”, “smoking among school students”, “tobacco smoking

prevention”, “smoking prevalence among adolescents”, “school based intervention
effectiveness”
A total of 25 papers were considered to be relevant to the subject, but only 10 were found to
meet inclusive requirements from those 25 publications. Papers were analysedfor relevance on
the basis of information available to them by reading the title and abstract of the papers. Growing
research was evaluated based on inclusion requirements and omitted from the sample articles not
meeting the study criteria. In order to retrieve relevant results and extend search, Boolean
operators like AND, OR, NOT were used by mixing or restricting words and phrases in online
search. The main search limiter that was used was year of publication and the studies were
restricted to those carried out between 2012-19.