Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden.
Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden; Department of Internal Medicine and Clinical Nutrition, University of Göteborg, Sweden.
Prev Med. 2022 Feb;155:106944. doi: 10.1016/j.ypmed.2021.106944. Epub 2021 Dec 28.
Friends' and parents' tobacco use are strong predictors of tobacco uptake among adolescents, however the effectiveness of interventions based on public commitments and agreements to remain tobacco-free are not established. Here, we evaluated the effectiveness of the school-based Swedish program Tobacco-Free Duo (T-Duo) in preventing adolescents from initiating tobacco use (TOPAS study). T-Duo is a multi-component intervention witha formal agreement between a student and an adult partner to remain tobacco-free during the entire 3-year study period as core component. The standardized educational component of the same program was used as comparator (control). Primary outcome was the probability to "remain a non-user" of i) cigarettes and secondary outcomes ii) other types of tobacco at second (21-month) follow-up. Analysis was conducted according to Intention To Treat. In total 1776 adolescents (51% female) aged 12-13 in grade 7 from 34 participating high schools in Sweden were included at baseline in 2018, of which 1489 were retained after 21 months. The Risk Ratio (RR) of not having tried cigarettes 21-months after initiation of the intervention was 1.03(CI 0.98-1.08), Bayes Factor(BF) = 0.93, Absolute Risk Difference(ARD) = 3.1%. Similar associations were found for never smoked a whole cigarette and never use of other tobacco/nicotine products. There was a minimal reduction of tobacco use initiation among Swedish adolescents assigned to a multi-component intervention (T-Duo) compared to those assigned to standardized classroom education after 2 schoolyears. However, for most outcomes' findings were inconclusive and not reliably different from zero. Trial registration: ISRCTN5285808 (doi:https://doi.org/10.1186/ISRCTN52858080); Study protocol: DERR1-https://doi.org/10.2196/21100. Registration: Current Controlled Trials ISRCTN52858080 Date: January 4, 2019, retrospectively registered. Protocol: Galanti, M.R., Pulkki-Brännström, A.-M., Nilsson, M., 2020. Tobacco-free duo adult-child contract for prevention of tobacco use among adolescents and parents: protocol for a mixed-design evaluation. JMIR Res. Protoc. 9, e21100. doi:10.2196/21100.
朋友和父母的吸烟行为是青少年开始吸烟的强烈预测因素，但基于公开承诺和协议保持不吸烟以进行干预的效果尚未确定。在这里，我们评估了基于学校的瑞典项目“Tobacco-Free Duo（T-Duo）”在预防青少年开始吸烟（TOPAS 研究）方面的有效性。T-Duo 是一个多组成部分的干预措施，其核心组成部分是学生与成年伙伴之间在整个 3 年研究期间保持不吸烟的正式协议。同一计划的标准化教育部分用作比较（对照）。主要结果是在第二次（21 个月）随访时保持“非使用者”的可能性，包括 i）香烟和 ii）其他类型的烟草。分析根据意向治疗进行。总共纳入了 2018 年来自瑞典 34 所参与高中的 1776 名 12-13 岁的 7 年级青少年（51%为女性）作为基线，其中 1489 名在 21 个月后保留。在干预开始后 21 个月不尝试吸烟的风险比（RR）为 1.03（98-1.08），贝叶斯因子（BF）=0.93，绝对风险差异（ARD）=3.1%。对于从未抽过整支香烟和从未使用过其他烟草/尼古丁产品的情况，也发现了类似的关联。与接受标准化课堂教育的青少年相比，被分配到多组成分干预（T-Duo）的瑞典青少年的烟草使用起始率略有降低，在 2 年后。然而，对于大多数结果，发现结果不确定，与零没有可靠差异。试验注册：ISRCTN5285808（doi：https://doi.org/10.1186/ISRCTN52858080）；研究方案：DERR1-https://doi.org/10.2196/21100。注册：当前对照试验 ISRCTN52858080 日期：2019 年 1 月 4 日，回顾性注册。方案：Galanti，MR，Pulkki-Brännström，AM，Nilsson，M.，2020.预防青少年和父母吸烟的烟草免费双成人-儿童合同：混合设计评估方案。JMIR Res. Protoc. 9，e21100. doi：10.2196/21100.
