Armstrong B K, de Klerk N H, Shean R E, Dunn D A, Dolin P J
Department of Medicine, University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands.
Med J Aust. 1990 Feb 5;152(3):117-24. doi: 10.5694/j.1326-5377.1990.tb125117.x.
How effective are peer-led programmes in preventing the uptake of smoking by children? In 1981, we conducted a randomized controlled trial of a school-based educational programme for the prevention of smoking in children who were in their seventh year at school. In this article, the reported results of two years of follow-up confirm an earlier report that both teacher-led and peer-led programmes resulted in a reduction, to about the same degree, in the uptake of smoking by girls, while only the teacher-led programme appeared to be effective in boys. In girls, both the teacher-led and peer-led programmes maintained their effects over the two years of follow-up with adjusted differences in prevalence rates of the uptake of smoking relative to the control group of -6.6% (95% CL, -17.3%, 4.0%) and -8.1% (95% CL, -18.9%, 2.7%), respectively, after two years. In boys, the effect of the teacher-led programme was reduced substantially by the second year with a difference in the prevalence rate of -2.8% (95% CL, -11.2%, 5.6%); for the peer-led programme the difference in the prevalence rate was +6.4% (95% CL, -3.6%, 16.4%). Other variables which had a significant effect on the smoking behaviour were the perceived response to cigarette advertising, parental and sibling smoking status, the perceived parental sanctions on smoking behaviour, selected peer influences and the intention to smoke. The children's perceived responses to cigarette advertising showed the strongest and most consistent evidence of an effect on the uptake of smoking by children who initially were non-smokers. After adjustment for the effects of other variables there was an excess of 15.0% (95% CL, 2.1%, 27.9%) in the prevalence rate of smoking after two years for girls who thought that they were influenced by advertising compared with those who did not. The corresponding difference for boys was 15.3% (95% CL, 4.0%, 26.6%). As smoking-prevention programmes only may delay the onset of smoking in children, it is important that legislative measures be introduced to reduce the effects of cigarette advertising.
同伴主导的项目在预防儿童吸烟方面效果如何？1981年，我们针对小学七年级学生开展了一项预防吸烟的校内教育项目随机对照试验。在本文中，两年随访的报告结果证实了之前的一份报告，即教师主导和同伴主导的项目都使女孩吸烟率降低到了大致相同的程度，而只有教师主导的项目对男孩似乎有效。在女孩中，教师主导和同伴主导的项目在两年随访期内都保持了效果，相对于对照组，两年后吸烟率的调整差异分别为-6.6%（95%置信区间，-17.3%，4.0%）和-8.1%（95%置信区间，-18.9%，2.7%）。在男孩中，到第二年教师主导项目的效果大幅下降，吸烟率差异为-2.8%（95%置信区间，-11.2%，5.6%）；同伴主导项目的吸烟率差异为+6.4%（95%置信区间，-3.6%，16.4%）。对吸烟行为有显著影响的其他变量包括对香烟广告的感知反应、父母和兄弟姐妹的吸烟状况、父母对吸烟行为的感知制裁、特定同伴的影响以及吸烟意图。儿童对香烟广告的感知反应显示出对最初不吸烟儿童吸烟行为影响的最有力且最一致的证据。在对其他变量的影响进行调整后，认为自己受到广告影响的女孩两年后的吸烟率比未受影响的女孩高出15.0%（95%置信区间，2.1%，27.9%）。男孩的相应差异为15.3%（95%置信区间，4.0%，26.6%）。由于预防吸烟项目可能只是延缓了儿童开始吸烟的时间，因此采取立法措施减少香烟广告的影响很重要。
