Hamilton Greg, Cross Donna, Resnicow Ken, Shaw Therese
Community and Public Health, Canterbury District Health Board, New Zealand.
Drug Alcohol Rev. 2007 Nov;26(6):605-13. doi: 10.1080/09595230701613585.
Declines in adolescent smoking prevalence have slowed recently, resulting in increased interest and literature in tobacco harm minimisation. To date, harm reduction strategies have focused largely on modifying the product and alternative (safer) mechanisms of nicotine delivery. There has been little exploration of primary harm minimisation to prevent the onset of regular smoking among young people. A major concern expressed about harm reduction interventions and young people is that they may increase experimentation among non-users.
The Smoking Cessation for Youth Project was a 2-year school-based cluster randomised controlled trial conducted in 30 Western Australian schools. Results on the primary outcome showed a significant reduction in regular smoking among 4636 13-15-year-olds receiving a harm minimisaton versus standard intervention. This paper addresses the intervention effects on 2078 students who had not smoked at baseline.
At 20-month follow-up, smoking initiation was slightly lower among intervention students than comparison students (who received a largely abstinence-based intervention), although this difference did not attain statistical significance (OR=0.86; 95% confidence interval: 0.68, 1.09).
This study provided limited evidence to suggest that harm minimisation is a superior approach to abstinence-based interventions for non-smokers. However, this intervention did not contribute to increased experimentation among non-smokers. Although more trials are required, these results indicate that fears of potential negative iatrogenic effects from school-based harm minimisation interventions may be unwarranted.
青少年吸烟率的下降近来有所放缓,这使得人们对烟草危害最小化的兴趣增加,相关文献也日益增多。迄今为止,减少危害的策略主要集中在改变产品以及尼古丁输送的替代(更安全)机制上。对于预防年轻人开始经常吸烟的初级危害最小化措施,几乎没有进行过探索。关于减少危害干预措施与年轻人,一个主要担忧是这些措施可能会增加非吸烟者的尝试行为。
青少年戒烟项目是一项在西澳大利亚州30所学校开展的为期两年的基于学校的整群随机对照试验。主要结果显示,与标准干预相比,4636名13至15岁接受危害最小化干预的学生中,经常吸烟的情况显著减少。本文探讨了对2078名基线时不吸烟的学生的干预效果。
在20个月的随访中,干预组学生的吸烟起始率略低于对照组学生(对照组接受的主要是基于戒烟的干预),尽管这种差异未达到统计学显著性(比值比=0.86;95%置信区间:0.68,1.09)。
本研究提供了有限的证据,表明对于不吸烟者而言,危害最小化是一种优于基于戒烟的干预措施的方法。然而,这种干预并未导致非吸烟者尝试行为的增加。尽管还需要更多试验,但这些结果表明,对基于学校的危害最小化干预措施潜在的负面医源性影响的担忧可能是没有根据的。