Renaud L, O'Loughlin J, Déry V
Public Health Department, Montreal Centre/Université de Montréal/UQAM, Montreal, Quebec, Canada.
Tob Control. 2003 Sep;12(3):302-9. doi: 10.1136/tc.12.3.302.
Although some school based smoking prevention programmes have shown positive impacts, others have had only short term effects, no effects, and in some cases reverse effects. The St-Louis du Parc Heart Health Project was a five year heart health promotion programme targeting children in eight elementary schools aged 9-12 years in disadvantaged multiethnic neighbourhoods in Montreal. In a controlled, longitudinal evaluation, the programme produced reverse effects on smoking--children exposed to the programme were more likely to initiate and to continue smoking than control children. This article explores hypotheses to explain the reverse effects.
Following work by an in-house committee, a consensus workshop with international experts was conducted to develop hypotheses to explain the reverse effects. This was complemented by an analysis of the programme's concordance with the standard guidelines on the school based prevention of tobacco use, and discussions with experts at the Centers for Disease Control and Prevention.
The programme respected most standard guidelines for smoking prevention programmes with respect to content and mode of delivery. Hypotheses to explain the reverse effects include: an unfavourable environment characterised by strong pro-smoking models and resistance to environmental interventions; heightened sensitivity to smoking among children most exposed to the programme; defence mechanisms among children stimulated by cognitive dissonance or anxiety; unanticipated effects associated with the health educator who delivered the programme; inadequate attention in programme development to the diverse cultural origins of the population targeted; and intervention content inappropriately targeted to children's stages of cognitive development.
Elementary school based interventions should aim to develop a clear and coherent social norm about the non-use of tobacco, as a precursor to or in close conjunction with having children as their primary target. Programme design should take key student characteristics into consideration and ensure that the modes of communication are adapted to the targeted group's characteristics. Neighbourhood level interventions should be orchestrated to complement regional, provincial, and national programmes.
尽管一些以学校为基础的吸烟预防项目已显示出积极影响，但其他项目却只有短期效果、没有效果，甚至在某些情况下产生了相反的效果。圣路易公园心脏健康项目是一项为期五年的心脏健康促进项目，目标人群是蒙特利尔处于弱势的多民族社区中8所小学的9至12岁儿童。在一项对照纵向评估中，该项目对吸烟产生了相反的效果——与对照组儿童相比，参与该项目的儿童更有可能开始吸烟并持续吸烟。本文探讨了解释这些相反效果的假设。
在一个内部委员会开展工作之后，与国际专家举行了一次共识研讨会，以提出解释这些相反效果的假设。此外，还分析了该项目与以学校为基础的预防烟草使用标准指南的一致性，并与疾病控制和预防中心的专家进行了讨论。
该项目在内容和实施方式方面符合大多数吸烟预防项目的标准指南。解释这些相反效果的假设包括：以强大的吸烟示范和对环境干预的抵制为特征的不利环境；接触该项目最多的儿童对吸烟的敏感度提高；因认知失调或焦虑而激发的儿童防御机制；与实施该项目的健康教育工作者相关的意外效果；在项目开发过程中对目标人群不同文化背景的关注不足；以及干预内容与儿童认知发展阶段不匹配。
以小学为基础的干预措施应旨在形成关于不使用烟草的明确且连贯的社会规范，作为将儿童作为主要目标的前提或紧密结合的内容。项目设计应考虑关键的学生特征，并确保沟通方式适合目标群体的特征。应精心安排社区层面的干预措施，以补充地区、省级和国家级项目。
