de Vries Hein, Mudde Aart, Kremers Stef, Wetzels Joyce, Uiters Ellen, Ariza Carles, Vitória Paulo Duarte, Fielder Anne, Holm Klavs, Janssen Karin, Lehtuvuori Riku, Candel Math
Department of Health Education, Maastricht University, 6200 MD Maastricht, The Netherlands.
Health Educ Res. 2003 Dec;18(6):649-63; discussion 664-77. doi: 10.1093/her/cyg033.
The European Smoking Prevention Framework Approach (ESFA) resulted in a smoking prevention project for six European countries. It included activities on four levels: adolescents, schools, parents and out-of-school activities. Common goals and objectives were developed, but countries were also able to include additional objectives. National diversities required country-specific methods. The most important common element was a school-based programme consisting of at least five lessons paying attention to social influence processes and training in refusal skills. During the first year, significantly more smoking prevention activities were realized in experimental schools compared with control schools. Not all countries had the same number of lessons on resisting peer pressures. Significant cognitive changes were observed in Spain, resulting in more negative attitudes, increased self-efficacy levels and a more negative intention towards smoking in the experimental group. Counter-productive cognitive effects were observed in the UK. Significantly less onset of weekly smoking in experimental groups was found in Finland (4.7%) and Spain (3.1%). Counter-productive effects were observed in Denmark and the UK. In conclusion, while having common objectives, the ESFA approach allowed for a great deal of diversity. Fundamental research using dismantling designs is needed to be able to detect the most effective elements of smoking prevention programmes for different age groups. Attention to parenting styles and practices is also needed.
欧洲预防吸烟框架方法（ESFA）促成了一个面向六个欧洲国家的预防吸烟项目。该项目包括四个层面的活动：青少年、学校、家长及校外活动。项目制定了共同的目标，但各国也能够纳入额外的目标。由于存在国家差异，需要采用针对各国具体情况的方法。最重要的共同要素是一个校本课程，该课程至少包含五节课，关注社会影响过程并开展拒绝技巧培训。在第一年，与对照学校相比，实验学校开展了显著更多的预防吸烟活动。并非所有国家在抵制同伴压力方面的课程数量都相同。在西班牙观察到了显著的认知变化，实验组中出现了更多负面态度、自我效能水平提高以及对吸烟更负面的意向。在英国观察到了适得其反的认知效果。在芬兰（4.7%）和西班牙（3.1%），实验组中每周吸烟的开始率显著更低。在丹麦和英国观察到了适得其反的效果。总之，虽然有共同目标，但ESFA方法允许存在很大差异。需要开展采用拆解设计的基础研究，以便能够找出针对不同年龄组的预防吸烟项目的最有效要素。还需要关注育儿方式和做法。
