3. Findings of the assessment Table 1: Evidence Table ASSIST Study Details design Outcome measures Main findings Results Evidence Grading Include? Reason for exclusion NICE, 2010 Review/ Guidelines Not specific – change in prevalence Summary of the recommendations (refer to full guidance for detail) Consider offering evidence based peer-led interventions designed to prevent smoking uptake such as ASSIST The guidance is based on a series of evidence rievews and evidence statements – refer to the full guideline and NICE website for details ++ Include 2. Campbell R et, al (2008) ASSIST School age children Cluster Randomised Trial 127/233 schools invited to participate; 113 went forward of 66 Smoking in the past week; immediately post intervention; 1 year and 2 year follow up Intervention has the potential, if implemented on a population basis, to lead to a reduction in adolescent smoking prevelanece of OR of being a smoker in intervention group compared with control schools was 0.75 (95% CI 0.55-1.01) immediately after the intervention (n=9349 students), 0.77 (0.59-0.99) at 1-year follow-up (n=9147), and 0.85 Evidence Grading + Sample size not achieved; effect size of borderline significance Include trial
underwent stratified block randomisation (stratified by Country; size; mixed/single sex; type of school; free school meals); 59 signed agreement 29C and 30I, schools committed to maintain usual smoking education. Self reported smoking status validated in a sample (12C, 12I) of schools by salivary cotinine public health importance at 2-year follow-up (n=8756). The corresponding ORs for the high-risk group were 0.79 (0.55-1.13 [n=3561]), 0.75 (0.56-0.99 [n=3483]), and 0.85 [n=3294]), respectively. 3. Holiday J et al, 2010 ASSIST Observational Interviews, observation, questionnaires and an n/a The ASSIST programme can be successfully translated from to delivery Delivery of the ASSIST Programme in during Phase One was been successful, however, a number of important issues were encountered; Evidence Grading – evaluation – Include
‘implementation diary’ were used to obtain data from trainers involved in delivering the Programme, trainers who would train trainers to deliver the Programme, researchers, teachers and others, such as Welsh Government personnel Using mixed training teams caused some organisational problems where trainers were based a long way from the school, and because it was sometimes difficult to engage a group of trainers with different styles of delivery. On occasion, schools did not provide suitable venues for school-based sessions, suggesting a need to stress the importance of appropriate school facilities. 4. Hollingworth W et al (2012) ASSIST Study See Campbell et al, 2008 for study design. The public sector cost, prevalence of weekly smoking, and cost per The intervention is cost-effective under realistic assumptions regarding the extent to which Previous work has demonstrated that the ASSIST programme achieved a 2.1% (95% CI = 0%-4.2%) reduction in smoking prevalence Evidence Grading + Limitations: opportunity cost of peer supporters time not included
Costs included ASSIST trainer and researcher teacher time and expenses; student time (nomination process) and peer supporter time; time for conversations not included. Intervention costs recorded. Costs estimated using public sector perspective. additional student not smoking at 24 months were assessed these reductions in adolescent smoking lead to lower smoking prevalence and/or earlier smoking cessation in adulthood. ASSIST programme cost of £32 (95% CI = per student. The incremental cost per student not smoking at 2 years was £1,500 (95% CI = £669-£9,947). e.g. educational opportunity forgone; programme fidelity and to maintain trial outcomes Include 5. Merken et al, 2012 Secondary Data Analysis Prevention of smoking (various Interventions that use a social network approach All three studies differed in effectiveness by SES. The Dutch class competition study Evidence Grading +/- Limitations: wider applicability
ASSIST; Smoke Free Class; European Smoking Prevention Framework Secondary data analysis using multi-level modelling by various SES measures for the three programmes independently. measures) by Status (SES) in which youngsters are allowed to deliver the intervention themselves may be a successful strategy in targeting adolescents from lower groups. only had a significant effect among higher SES adolescents. The results for the ESFA study and ASSIST study were mixed and depended on which SES indicator was used (ASSIST intervention more effective in ‘Valleys Schools’ and those with low Family Affluence Scores. not different SES indicators used; self reported measures of SES; original sample size did not take account of sub-group analysis Include 6. Jit et al, 2010 Lifetime benefit of school Secondary data analysis General Household survey data to Lifetime cessation of smoking related to age at initiation; smoking School based smoking prevention programmes have potential for a benefical effect Age of regular smoking was associated strongly with probability of stopping in later life (coefficient -0.103; P<0.001); reduced effect by still significant when allowing Evidence grading + Potential recall bias; differences between excluded and economic established
prevention (uses ASSIST data) conduct a logistic refression model to examine assoicatio between age of initiation and cessation in later life. Uses ASSIST data as model programme. prevalence and impact on mortality over the life-time of the participants even if they have no apparent effect at school leaving age for confounders (coefficient P<0.001). Intervention that delays smoking initiation without reducing prevalence at 18 years may reduce adult smoking prevalence by and all-cause mortality by 0.09% over the lifetime of the sample. included groups based on of changes over time in smoking initiation and cessation, effects may be different for each age cohort. Include National Institute of Health and Clinical Excellence (2010) School based interventions to prevent the uptake of smoking among children and young people. PH23. London. NICE.
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