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Workshop1 r hanewinkel


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Workshop1 r hanewinkel

  1. 1. Reiner Hanewinkel, PhD Professor of Medical Psychology & Sociology
  2. 2. Structure <ul><li>Aims and description </li></ul><ul><li>Development </li></ul><ul><li>Highlights </li></ul><ul><li>Evaluation </li></ul><ul><li>Strenghts and limitations </li></ul><ul><li>Outlook </li></ul>
  3. 3. I. Aims and description
  4. 4. <ul><li>Basic idea and experiences from Finland </li></ul><ul><li>First evaluation study: Health Promotion International 1996;11:189-192 </li></ul><ul><li>A presentation at the 2 nd European „Tobacco or Health“ Conference in Helsinki 1996 </li></ul><ul><li>1996: First proposal submitted to the European Commission </li></ul><ul><li>Continous funding by the Commission between 1997 and 2009. </li></ul>
  5. 5. <ul><li>SFC is a universal school-based smoking prevention programme for pupils aged 11-14 years. </li></ul><ul><li>The main aims are: </li></ul><ul><ul><li>to delay or prevent the onset of smoking, </li></ul></ul><ul><ul><li>to motivate adolescents already experimenting with smoking to stop, </li></ul></ul><ul><ul><li>to engage adolescents in creative activities related to the subject “non-smoking”, </li></ul></ul><ul><ul><li>to help to de-normalise youth smoking in Europe. </li></ul></ul>Aims of Smokefree Class Competition (SFC)
  6. 6. <ul><li>Classes decide to be a non-smoking class for a period up to six months. </li></ul><ul><li>Pupils sign a class contract and an individual contract promising not to smoke during the competition. The contracts serve to underline their commitment. </li></ul><ul><li>The responsibility for the control of smoking lies mainly with the pupils themselves: pupils monitor their smoking status and report regularly whether they have smoked or not. </li></ul><ul><li>Classes which refrain from smoking for that period of time are rewarded. They participate in a prize draw, in which they can win a number of attractive prizes. </li></ul>Description of the intervention
  7. 7. <ul><li>A number of participating countries develop teachers’ and/or pupils’ brochures. </li></ul><ul><li>Some countries produce parents’ brochures. </li></ul><ul><li>Newsletters serve to inform classes on activities that could be carried out during the competition. </li></ul><ul><li> </li></ul>Due to the diversity of participating countries, details regarding rules and materials are tailored to the different needs and cultural circumstances in the various countries. The materials
  8. 8. II. Development of SFC
  9. 9. Countries which have conducted the competition in Europe School year 1989/90: Finland started the competition School year 1997/98: 7 countries participated School year 2005/06: 22 countries participated In some school years > 700,000 pupils and 30,000 classes participated
  10. 10. III. Highlights
  11. 11. Youth Conferences Berlin 2000 & Munich 2002
  12. 12. IV. Evaluation
  13. 13. Evaluation of SFC <ul><li>Up to now, 24 papers have been published in peer reviewed journals. </li></ul><ul><li>Topics include </li></ul><ul><ul><li>Process evaluation </li></ul></ul><ul><ul><li>Outcome evaluation </li></ul></ul><ul><ul><li>Cost-effectiveness-studies </li></ul></ul><ul><ul><li>Dissemination (diffusion) studies </li></ul></ul><ul><ul><li>Studies on possible iatrogenic effects </li></ul></ul>
  14. 14. Outcome evaluation Combined results of four published studies - Percentage of current smokers - Net difference: 6 per cent points OR=0.65 (95% CI: 0.57-0.75) Number Needed to Prevent: 17 N=12,812 Follow-up: 12 to 24 months Gesundheitswesen 2007; 69:38-44
  15. 15. Classification of SFC following the criteria of the Society for Prevention Research <ul><li>Efficacious, </li></ul><ul><li>Effective, or </li></ul><ul><li>Ready for broad dissemination. </li></ul>The Society distinguishes interventions which are
  16. 16. According to these criteria SFC can be regarded as a programme ready for broad dissemination <ul><li>Six trials have been conducted (four randomised controlled), </li></ul><ul><li>SFC has been evaluated under real-world conditions, and </li></ul><ul><li>Manuals, appropriate training, technical support, monitoring and evaluation tools as well as cost information are available to allow third parties to adopt and implement the intervention </li></ul>
  17. 17. V. Strenghts and limitations
  18. 18. Advantages of the competition <ul><li>easy to implement </li></ul><ul><li>can be conducted in different subjects in school </li></ul><ul><li>desired behaviour is reinforced positively </li></ul><ul><li>non-smoking is established as the normative behaviour </li></ul><ul><ul><li>High participation rates reflect the attractiveness of the concept </li></ul></ul>
  19. 19. Limitations <ul><li>Is there a risk of iatrogenic effects? </li></ul><ul><li>(Un-)realistic expectations about the effectiveness of the competition </li></ul>
  20. 20. Possible iatrogenic effect: Does SFC cause bullying? J Epidemiol Community Health 2010;64:202-208 <ul><li>A strong association between daily smoking and higher odds of bullying others at baseline before the intervention (adjusted proportional OR 4.66; 95% CI 3.38-6.43). </li></ul><ul><li>For being isolated the trend suggested that SFC, if anything, fostered lower levels of isolation at follow-up . </li></ul>A randomised controlled trial with 3,490 students found:
  21. 21. (Un-)realistic expectations about the effectiveness of the competition …and school-based prevention programmes in general We have to have in mind, that the competition is a low level campaign in one setting.
  22. 22. VI. Outlook
  23. 23. Even after end of European funding… <ul><li>SFC is still alive in a number of countries </li></ul><ul><li>But: Economic crisis and end of European funding stopped the implementation of the competition in some European countries – especially in Eastern European countries </li></ul>
  24. 24. Thanks very much for your attention!