Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
UK Centre for Tobacco and Alcohol Studies, Nottingham, UK.
BMC Public Health. 2019 Jun 13;19(1):742. doi: 10.1186/s12889-019-7112-7.
Smoking prevention programmes that reach adolescents before they experiment with tobacco may reduce the prevalence of tobacco use. ASSIST is a school-based, peer-led smoking prevention programme that encourages the diffusion of non-smoking norms among secondary school students (aged 12-13), and was shown in a randomised control trial (conducted 2001-2004) to reduce the prevalence of weekly smoking. This paper presents findings from a process evaluation of the implementation of ASSIST in Scotland in 2014-2017. It examines acceptability and fidelity of implementation and explores the context of message diffusion between peers.
Mixed method implementation study with students (n = 61), school staff (n = 41), trainers (n = 31) and policy and commissioning leads (n = 17), structured observations (n = 42) and student surveys (n = 2130).
ASSIST was delivered with a high degree of fidelity to the licensed manual with all elements of the programme implemented. Student survey findings indicated that the frequency of conversations about smoking increased over the ASSIST delivery period (18% at baseline, 26% at follow-up), but student recollection of conversations about smoking with peer supporters was low (9%). The delivery context of ASSIST was important when considering perceptions of message diffusion. In the study schools, survey findings showed that 0.9% (n = 19) of participants were regular smokers (at least once a week), with nine out of ten (89.9%, n = 1880) saying they had never smoked. This very low prevalence may have affected when and with whom conversations took place. Study participants indicated that there were wider benefits of taking part in ASSIST for: peer supporters (i.e. personal and communication skills); schools (an externally delivered health promotion programme that required minimal resource from schools); and communities (via communication about the risks of smoking to wider social networks).
ASSIST in Scotland was delivered with a high degree of fidelity to the licensed programme and was acceptable from the perspective of schools, students and trainers. Targeting ASSIST in deprived areas with higher youth smoking prevalence or in other countries where youth smoking rates are rising or higher than in Scotland may be particularly relevant for the future delivery.
在青少年尝试吸烟之前开展预防吸烟项目，可能会降低烟草使用的流行率。ASSIST 是一种基于学校、以同伴为主体的预防吸烟项目，旨在鼓励中学生（12-13 岁）传播不吸烟规范。一项随机对照试验（2001-2004 年进行）表明，该项目可降低每周吸烟率。本文介绍了 2014-2017 年 ASSIST 在苏格兰实施情况的过程评估结果。评估内容包括项目实施的可接受性和一致性，以及同伴间信息传播的背景。
采用混合方法对学生（n=61）、学校工作人员（n=41）、培训师（n=31）和政策与委托负责人（n=17）进行实施情况评估，开展结构性观察（n=42）和学生调查（n=2130）。
ASSIST 严格按照许可手册实施，项目的所有环节均得以执行，具有高度的一致性。学生调查结果表明，在 ASSIST 实施期间，关于吸烟的对话频率有所增加（基线时为 18%，随访时为 26%），但学生对与同伴支持者进行的吸烟对话的记忆却很低（9%）。考虑到信息传播的看法，ASSIST 的实施背景很重要。在研究学校中，调查结果显示，参与者中有 0.9%（n=19）为经常吸烟者（每周至少吸烟一次），十分之九（89.9%，n=1880）的人表示他们从未吸烟过。如此低的吸烟率可能会影响对话发生的时间和对象。研究参与者表示，参加 ASSIST 有以下广泛的好处：对于同伴支持者（即个人和沟通技巧）；对于学校（这是一项由外部提供的健康促进项目，学校无需投入太多资源）；以及对于社区（通过向更广泛的社交网络传播吸烟风险信息）。
ASSIST 在苏格兰实施的一致性高，从学校、学生和培训师的角度来看，该项目是可以接受的。针对青少年吸烟率较高的贫困地区或青少年吸烟率上升或高于苏格兰的其他国家实施 ASSIST 可能是未来实施的重点。
