Thomas Roger E, McLellan Julie, Perera Rafael
Department of Family Medicine, Faculty of Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BMJ Open. 2015 Mar 10;5(3):e006976. doi: 10.1136/bmjopen-2014-006976.
To assess effectiveness of school-based smoking prevention curricula keeping children never-smokers.
Systematic review, meta-analysis.
MEDLINE (1966+), EMBASE (1974+), Cinahl, PsycINFO (1967+), ERIC (1982+), Cochrane CENTRAL, Health Star, Dissertation Abstracts, conference proceedings.
pooled analyses, fixed-effects models, adjusted ORs. Risk of bias assessed with Cochrane Risk of Bias tool.
50 randomised controlled trials (RCTs) of school-based smoking curricula.
Never-smokers age 5-18 (n=143,495); follow-up ≥6 months; all countries; no date/language limitations.
Information, social influences, social competence, combined social influences/competence and multimodal curricula.
Remaining a never-smoker at follow-up.
Pooling all curricula, trials with follow-up ≤1 year showed no statistically significant differences compared with controls (OR 0.91 (0.82 to 1.01)), though trials of combined social competence/social influences curricula had a significant effect on smoking prevention (7 trials, OR 0.59 (95% CI 0.41 to 0.85)). Pooling all trials with longest follow-up showed an overall significant effect in favour of the interventions (OR 0.88 (0.82 to 0.95)), as did the social competence (OR 0.65 (0.43 to 0.96)) and combined social competence/social influences curricula (OR 0.60 (0.43 to 0.83)). No effect for information, social influences or multimodal curricula. Principal findings were not sensitive to inclusion of booster sessions in curricula or to whether they were peer-led or adult-led. Differentiation into tobacco-only or multifocal curricula had a similar effect on the primary findings. Few trials assessed outcomes by gender: there were significant effects for females at both follow-up periods, but not for males.
RCTs of baseline never-smokers at longest follow-up found an overall significant effect with average 12% reduction in starting smoking compared with controls, but no effect for all trials pooled at ≤1 year. However, combined social competence/social influences curricula showed a significant effect at both follow-up periods.
Cochrane Tobacco Review Group CD001293.
评估以学校为基础的预防吸烟课程对于使儿童保持不吸烟状态的有效性。
系统评价、荟萃分析。
MEDLINE（1966年起）、EMBASE（1974年起）、护理学与健康领域数据库（Cinahl）、心理学文摘数据库（PsycINFO，1967年起）、教育资源信息中心数据库（ERIC，1982年起）、Cochrane系统评价中心对照试验注册库（Cochrane CENTRAL）、健康之星数据库（Health Star）、学位论文摘要数据库、会议论文集。
汇总分析、固定效应模型、调整后的比值比。采用Cochrane偏倚风险工具评估偏倚风险。
50项以学校为基础的吸烟课程随机对照试验（RCT）。
5至18岁从不吸烟者（n = 143,495）；随访时间≥6个月；涵盖所有国家；无日期/语言限制。
信息类、社会影响类、社会能力类、社会影响/能力综合类以及多模式课程。
随访时仍为从不吸烟者。
汇总所有课程，随访时间≤1年的试验与对照组相比无统计学显著差异（比值比0.91（0.82至1.01）），不过社会能力/社会影响综合课程试验对预防吸烟有显著效果（7项试验，比值比0.59（95%置信区间0.41至0.85））。汇总所有随访时间最长的试验显示干预措施总体有显著效果（比值比0.88（0.82至0.95）），社会能力课程（比值比0.65（0.43至0.96））以及社会能力/社会影响综合课程（比值比0.60（0.43至0.83））也是如此。信息类、社会影响类或多模式课程无效果。主要研究结果对课程中是否包含强化课程或课程是由同伴主导还是成人主导不敏感。分为仅针对烟草或多焦点课程对主要研究结果有类似影响。很少有试验按性别评估结果：两个随访期女性均有显著效果，但男性没有。
对基线时为从不吸烟者进行最长随访的随机对照试验发现总体有显著效果，与对照组相比开始吸烟的平均减少率为12%，但随访时间≤1年的所有试验汇总分析无效果。然而，社会能力/社会影响综合课程在两个随访期均显示有显著效果。
Cochrane烟草评价组CD001293
