Müller-Riemenschneider Falk, Rasch Andrej, Bockelbrink Angelina, Vauth Christoph, Willich Stefan N, Greiner Wolfgang
Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
GMS Health Technol Assess. 2008 Oct 16;4:Doc10.
The hazardous health effects of smoking and second hand smoke have been confirmed in numerous studies. For Germany, the mortality attributable to smoking is estimated at 110,000 to 140,000 deaths per year, associated with annual smoking-related costs of 17 to 21 billion euro. Because the majority of smokers initiate this habit early in life, behavioural preventive strategies usually tried to prevent the uptake of smoking among children and youths.
The goal of this HTA is to summarise the current literature on behavioural strategies for smoking prevention and to evaluate their medical effectiveness/efficacy and cost-effectiveness as well as the ethical, social and legal implications of smoking prevention programs. In addition, this report aims to compare the effectiveness and efficacy of different intervention components and to evaluate the reliability of results in the German context.
Relevant publications were identified by means of a structured search of databases accessed through the German Institute of Medical Documentation and Information (DIMDI). In addition a manual search of identified reference lists was conducted. The present report includes German and English literature published between August 2001 and August 2006 targeting youths up to 18 years old. The methodological quality of included studies was assessed according to pre-defined quality criteria, based on the criteria of evidence-based medicine.
Among 3,580 publications 37 medical studies met the inclusion criteria. Overall study quality was satisfactory but only half the studies reported smoking uptake as an outcome, while the remaining studies reported alternative outcome parameters. The follow-up duration varied between twelve and 120 months. Although overall effectiveness of prevention programs showed considerable heterogeneity, there was evidence for the long-term effectiveness of behavioural smoking prevention programs. However, the reduction in smoking rates was only moderate. Community and multisectorial interventions reported more conclusive evidence for reductions in smoking rates, while the evidence for school-based programs alone was inconclusive. Only one study from Germany fulfilled the methodological criteria and was included in this report. Three included economic studies focused on school-based interventions. Study results suggested, that the cost-effectiveness of school-based behavioural interventions is positive.
Behavioural preventive strategies were effective to delay or decrease uptake of smoking behaviour among children and youth. The effect size, however, was only moderate. Similar to previous research, there was no conclusive evidence for the long-term effectiveness of school-based interventions, whereas community and multisectorial interventions provided more conclusive evidence. However, sustainability of intervention effects has to be regarded with caution. In addition, there is evidence that findings from international studies can be adapted to the German situation and that intervention effectiveness is comparable. The available evidence regarding the cost-effectiveness of school-based interventions is not sufficient to draw reliable conclusions.
Behavioural preventive strategies can be effective in the prevention of smoking among children and youths. It seems advisable, though, to incorporate community strategies in addition to school-based strategies in order to improve their effectiveness. Future research should, amongst others, attempt to investigate the effectiveness of specific intervention components and the cost-effectiveness in methodologically high-quality studies.
众多研究已证实吸烟及二手烟对健康具有危害。在德国，据估计每年归因于吸烟的死亡人数为11万至14万，与吸烟相关的年度成本为170亿至210亿欧元。由于大多数吸烟者在早年就养成了这种习惯，行为预防策略通常试图防止儿童和青少年吸烟。
本卫生技术评估的目标是总结当前关于吸烟预防行为策略的文献，并评估其医学有效性/效能、成本效益以及吸烟预防项目的伦理、社会和法律影响。此外，本报告旨在比较不同干预组成部分的有效性和效能，并评估在德国背景下结果的可靠性。
通过对德国医学文献与信息研究所（DIMDI）访问的数据库进行结构化搜索来识别相关出版物。此外，还对已识别的参考文献列表进行了人工搜索。本报告包括2001年8月至2006年8月期间发表的针对18岁以下青少年的德语和英语文献。根据基于循证医学标准预先定义的质量标准评估纳入研究的方法学质量。
在3580篇出版物中，37项医学研究符合纳入标准。总体研究质量令人满意，但只有一半的研究将吸烟行为作为结果进行报告，其余研究报告的是替代结果参数。随访时间在12个月至120个月之间。尽管预防项目的总体有效性存在相当大的异质性，但有证据表明行为吸烟预防项目具有长期有效性。然而，吸烟率的降低幅度仅为中等。社区和多部门干预报告了更多关于吸烟率降低的确凿证据，而仅基于学校的项目的证据尚无定论。德国仅有一项研究符合方法学标准并被纳入本报告。三项纳入的经济学研究聚焦于基于学校的干预措施。研究结果表明，基于学校的行为干预措施具有积极的成本效益。
行为预防策略在延迟或减少儿童和青少年吸烟行为方面是有效的。然而，效果大小仅为中等。与先前的研究类似，对于基于学校的干预措施的长期有效性没有确凿证据，而社区和多部门干预提供了更多确凿证据。然而，必须谨慎看待干预效果的可持续性。此外，有证据表明国际研究的结果可以适用于德国情况，且干预效果具有可比性。关于基于学校的干预措施成本效益的现有证据不足以得出可靠结论。
行为预防策略在预防儿童和青少年吸烟方面可能有效。不过，除了基于学校的策略外，纳入社区策略似乎是明智的，以提高其有效性。未来的研究尤其应尝试在方法学高质量的研究中调查特定干预组成部分的有效性和成本效益。
