Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

© 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background: Helping young people to avoid starting smoking is a widely endorsed public health goal, and schools provide a route to communicate with nearly all young people. School-based interventions have been delivered for close to 40 years. Objectives: The primary aim of this review was to determine whether school smoking interventions prevent youth from starting smoking. Our secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Tobacco Addiction Group's Specialised Register, MEDLINE, EMBASE, PsyclNFO, ERIC, CINAHL, Health Star, and Dissertation Abstracts for terms relating to school-based smoking cessation programmes. In addition, we screened the bibliographies of articles and ran individual MEDLINE searches for 133 authors who had undertaken randomised controlled trials in this area. The most recent searches were conducted in October 2012. Selection criteria: We selected randomised controlled trials (RCTs) where students, classes, schools, or school districts were randomised to intervention arm(s) versus a control group, and followed for at least six months. Participants had to be youth (aged 5 to 18). Interventions could be any curricula used in a school setting to deter tobacco use, and outcome measures could be never smoking, frequency of smoking, number of cigarettes smoked, or smoking indices. Data collection and analysis: Two reviewers independently assessed studies for inclusion, extracted data and assessed risk of bias. Based on the type of outcome, we placed studies into three groups for analysis: Pure Prevention cohorts (Group 1), Change in Smoking Behaviour over time (Group 2) and Point Prevalence of Smoking (Group 3). Main results: One hundred and thirty-four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group. Pure Prevention cohorts (Group 1) included 49 studies (N = 142,447). Pooled results at follow-up at one year or less found no overall effect of intervention curricula versus control (odds ratio (OR) 0.94, 95% confidence interval (CI) 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow-up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. Change in Smoking Behaviour over time (Group 2) included 15 studies (N = 45,555). At one year or less there was a small but statistically significant effect favouring controls (standardised mean difference (SMD) 0.04, 95% CI 0.02 to 0.06). For follow-up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI -0.00 to 0.02). Twenty-five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. We were unable to analyse data for 49 studies (N = 152,544). Subgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow-up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco-only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow-up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow-up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. Authors' conclusions: Pure Prevention cohorts showed a significant effect at longest follow-up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less. The combined social competence and social influences interventions showed a significant effect at one year and at longest follow-up. Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information-only approach were similarly ineffective. Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions.

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School‐based programmes for preventing smoking

The invasive mosquito species Aedes albopictus: current knowledge and future perspectives

Background There is increasing evidence that contact with other smokers, particularly in the family, is a strong determinant of risk of smoking uptake. A systematic review and meta-analysis of the magnitude of these effects is reported. Methods Studies were identified by searching four databases to March 2009 and proceedings from international conferences. Meta-analyses were performed using random effects, with results presented as pooled ORs with 95% CIs. Results 58 studies were included in the meta-analyses. The relative odds of uptake of smoking in children were increased significantly if at least one parent smoked (OR 1.72, 95% CI 1.59 to 1.86), more so by smoking by the mother (OR 2.19, 95% CI 1.73 to 2.79) than the father (OR 1.66, 95% CI 1.42 to 1.94), and if both parents smoked (OR 2.73, 95% CI 2.28 to 3.28). Smoking by a sibling increased the odds of smoking uptake by 2.30 (95% CI 1.85 to 2.86) and smoking by any household member by 1.92 (95% CI 1.70 to 2.16). After adjusting for overestimation of RRs it is estimated that, in England and Wales, around 17 000 young people take up smoking by the age of 15 each year as a consequence of exposure to household smoking. Conclusions Parental and sibling smoking is a strong and significant determinant of the risk of smoking uptake by children and young people and, as such, is a major and entirely avoidable health risk. Children should be protected from exposure to smoking behaviour, especially by family members.

https://thorax.bmj.com/content/thoraxjnl/66/10/847.full.pdf

Exposure to parental and sibling smoking and the risk of smoking uptake in childhood and adolescence: a systematic review and meta-analysis.

BACKGROUND\nSmoking rates in adolescents are rising in some countries. Helping young people to avoid starting smoking is a widely endorsed goal of public health, but there is uncertainty about how to do this. Schools provide a route for communicating with a large proportion of young people, and school-based programmes for smoking prevention have been widely developed and evaluated.\n\n\nOBJECTIVES\nTo review all randomized controlled trials of behavioural interventions in schools to prevent children (aged 5 to12) and adolescents (aged 13 to18) starting smoking.\n\n\nSEARCH STRATEGY\nWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Tobacco Addiction Group's Specialized Register, MEDLINE, EMBASE, PsyclNFO, ERIC, CINAHL, Health Star, Dissertation Abstracts and studies identified in the bibliographies of articles. Individual MEDLINE searches were made for 133 authors who had undertaken randomized controlled trials in this area.\n\n\nSELECTION CRITERIA\nTypes of studies: those in which individual students, classes, schools, or school districts were randomized to the intervention or control groups and followed for at least six months.\n\n\nTYPES OF PARTICIPANTS\nChildren (aged 5 to12) or adolescents (aged 13 to18) in school settings. Types of interventions: Classroom programmes or curricula, including those with associated family and community interventions, intended to deter use of tobacco. We included programmes or curricula that provided information, those that used social influences approaches, those that taught generic social competence, and those that included interventions beyond the school into the community. We included programmes with a drug or alcohol focus if outcomes for tobacco use were reported. Types of outcome measures: Prevalence of non-smoking at follow up among those not smoking at baseline. We did not require biochemical validation of self-reported tobacco use for study inclusion.\n\n\nDATA COLLECTION AND ANALYSIS\nWe assessed whether identified citations were randomized controlled trials. We assessed the quality of design and execution, and abstracted outcome data. Because of the marked heterogeneity of design and outcomes, we computed pooled estimates only for those trials that could be analyzed together and for which statistical data were available. We predominantly synthesized the data using narrative systematic review. We grouped studies by intervention method (information; social competence; social influences; combined social influences/social competence; multi-modal programmes). Within each group, we placed them into three categories (low, medium and high risk of bias) according to validity using quality criteria for reported study design.\n\n\nMAIN RESULTS\nOf the 94 randomized controlled trials identified, we classified 23 as category one (most valid). There was one category one study of information-giving and two of teaching social comeptence. There were thirteen category one studies of social influences interventions. Of these, nine found some positive effect of intervention on smoking prevalence, and four failed to detect an effect on smoking prevalence. The largest and most rigorous study, the Hutchinson Smoking Prevention Project, found no long-term effect of an intensive eight-year programme on smoking behaviour. There were three category one RCTs of combined social influences and social competence interventions: one provided significant results and one only for instruction by health educators compared to self-instruction. There was a lack of high quality evidence about the effectiveness of combinations of social influences and social competence approaches. There was one category one study providing data on social influences compared with information giving. There were four category one studies of multi-modal approaches but they provided limited evidence about the effectiveness of multi-modal approaches including community initiatives.\n\n\nAUTHORS' CONCLUSIONS\nThere is one rigorous test of the effects of information-giving about smoking. There are well-conducted randomized controlled trials to test the effects of social influences interventions: in half of the group of best quality studies those in the intervention group smoke less than those in the control, but many studies failed to detect an effect of the intervention. There are only three high quality RCTs which test the effectiveness of combinations of social influences and social competence interventions, and four which test multi-modal interventions; half showed significant positive results.

School-based programmes for preventing smoking: School-based programmes for preventing smoking

OBJETIVO: O tabagismo e uma das principais causas de enfermidades evitaveis e incapacidades prematuras. Nesse sentido, realizou-se estudo com o objetivo de medir a prevalencia e estudar fatores de risco associados ao tabagismo nos adolescentes. METODOS: A partir de um delineamento transversal de base populacional, estudou-se uma amostra representativa de 1.187 adolescentes de 10 a 19 anos, da zona urbana de Pelotas, sul do Brasil. Todos os adolescentes da amostra, de cada domicilio, foram entrevistados por meio de questionario pre-codificado, individual e confidencial. Utilizou-se o teste de Kaplan-Meier para analise da curva de sobrevida. RESULTADOS: A prevalencia de tabagismo na amostra foi de 12,1% (IC95% 10,3%-14%). As prevalencias foram similares para os sexos femininos e masculinos. Os fatores de risco para tabagismo na analise multivariada, por regressao logistica, foram: maior idade, odds ratio (OR) de 28,7 (11,5-71,4), irmaos mais velhos fumantes, OR de 2,4 (1,5-3,8), tres ou mais amigos fumantes, OR de 17,5 (8,8-34,8) e baixa escolaridade OR de 3,5 (1,5-8,0). CONCLUSOES: A prevalencia de tabagismo na adolescencia mostrou-se alta, na cidade de Pelotas. Campanhas antitabagicas devem ser direcionadas a comunidade e a familia tendo o adolescente como alvo. Medidas legais adotadas pelo governo sao importantes para impedir o acesso dos adolescentes ao cigarro.

https://www.scielosp.org/pdf/rsp/2003.v37n1/1-7/pt

Prevalence and risk factors for smoking among adolescents

OBJETIVO: Descrever a prevalencia do tabagismo em adolescentes e os fatores associados ao tabagismo nesse grupo etario na America do Sul. METODOS: Foram pesquisadas as bases de dados MEDLINE (1966-2002) e Literatura Latino-Americana e do Caribe em Ciencias da Saude ("Lilacs") (1982-2002), alem de documentos governamentais e nao-governamentais e sites na Internet. Foram identificados 315 artigos, dos quais 45 foram considerados relevantes para o presente trabalho. RESULTADOS: Em todos paises estudados, foi grande a variacao nos niveis de prevalencia; tal variacao dependeu, em parte, do grupo etario enfocado e da definicao de fumante utilizada no estudo. O habito de fumar entre irmaos e amigos foi o principal fator de risco para tabagismo na adolescencia. O baixo rendimento escolar, a idade mais avancada, o sexo masculino, o trabalho remunerado e a separacao dos pais tambem foram identificados como fatores de risco. CONCLUSAO: Sao necessarios mais estudos de base populacional representativos dessa faixa etaria e criterios uniformes para definir os fumantes.

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Prevalência e fatores de risco para tabagismo em adolescentes na América do Sul: uma revisão sistemática da literatura

OBJETIVO: Descrever a frequencia com que escolares adolescentes de Pelotas (RS) estao seguindo as recomendacoes nacionais para uma alimentacao saudavel. METODOS: Estudo transversal aninhado a um estudo longitudinal em 2004, incluindo adolescentes de 13 e 14 anos matriculados em 32 escolas publicas de Pelotas (RS). A amostra incluiu 2.209 adolescentes. Para avaliacao da frequencia de consumo alimentar, foi utilizado questionario proposto pelo Instituto Nacional do Câncer. Foram construidos desfechos baseados nos dez passos para a alimentacao saudavel propostos pelo Ministerio da Saude do Brasil. RESULTADOS: Os habitos alimentares saudaveis mais frequentes foram o consumo diario de feijao e leite, relatado por cerca de metade dos adolescentes. Quase metade dos jovens referiu ingerir batata frita e salgadinhos no maximo uma vez por semana. Verificou-se consumo adequado de alimentos conservados e enlatados em 44,6% dos adolescentes. Pouco menos da metade dos jovens (43,6%) nunca colocava sal adicional na comida. Quanto ao consumo de doces e outros alimentos ricos em acucar, constatou-se que aproximadamente um terco deles consumia bolos ou biscoitos no maximo duas vezes por semana. CONCLUSAO: Verificou-se baixa frequencia de habitos alimentares saudaveis em todos os subgrupos estudados, sendo a frequencia mais baixa entre jovens de maior nivel socioeconomico e entre as meninas. O habito alimentar que apresentou mais baixa frequencia - 5,3% dos adolescentes - foi o consumo de frutas e verduras cinco ou mais vezes por dia. Politicas publicas de promocao da saude voltadas a melhoria da alimentacao e nutricao dos adolescentes sao necessarias e urgentes.

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Hábitos alimentares de escolares adolescentes de Pelotas, Brasil

Agreement between Self-Reported Smoking and Cotinine Concentration in Adolescents: A Validation Study in Brazil

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Maura C. Malcon

Papers

Prevalence and risk factors for smoking among adolescents

Prevalência e fatores de risco para tabagismo em adolescentes na América do Sul: uma revisão sistemática da literatura

Hábitos alimentares de escolares adolescentes de Pelotas, Brasil

Agreement between Self-Reported Smoking and Cotinine Concentration in Adolescents: A Validation Study in Brazil

Prevalência e fatores de risco para tabagismo em adolescentes Prevalence and risk factors for smoking among adolescents