Manske S R, Brown K S, Cameron A J
Health Behaviour Research Group, University of Waterloo, Ont.
Cancer Prev Control. 1997 Aug;1(3):196-212.
Within the context of a framework for cancer control, this article reviews evidence and suggests research directions for 3 types of school-based smoking interventions: elementary school prevention, secondary school interventions and interventions linking community and school. Directions for smoking research in elementary schools include improving adoption through the provision of effectiveness criteria, tailoring interventions to schools and training. Monitoring at micro and macro levels may help planning and implementation, but clearer evidence is required of its feasibility. Fundamental research should explore new options to understand why youth do not start smoking. Smoking intervention research at the secondary school level is less well established, with only 1 effectiveness trial reported. We recommend testing models that involve youth in developing their own solutions and examining the interaction of various control measures. Sustainability issues have led researchers to embed school-based smoking interventions in community-wide activities. Intervention research of this sort still needs to determine how to apply approaches (e.g., comprehensive school health) and what the appropriate roles are (such as technical assistance) for community agencies. All research using these school-community approaches needs to include process measures to explain potential failures to obtain significant differences between components. In addition, we call for research on the training of educators and health personnel, to increase the priority given to smoking prevention and improve the implementation of existing programs. Research on policy initiatives that lead to effective training needs to be explored. Finally, we argue that application of the principles incorporated into the cancer control framework (e.g., through participatory research methods) strengthens the research process and results.
在癌症控制框架的背景下，本文回顾了相关证据，并针对3种基于学校的吸烟干预措施提出了研究方向：小学预防、中学干预以及将社区与学校联系起来的干预措施。小学吸烟研究的方向包括通过提供有效性标准来提高采纳率、根据学校情况定制干预措施以及开展培训。微观和宏观层面的监测可能有助于规划和实施，但还需要更明确的证据证明其可行性。基础研究应探索新的方法，以了解青少年为何不开始吸烟。中学层面的吸烟干预研究尚不完善，仅报告了1项有效性试验。我们建议测试让青少年参与制定自身解决方案的模式，并研究各种控制措施之间的相互作用。可持续性问题促使研究人员将基于学校的吸烟干预措施纳入全社区活动中。这类干预研究仍需确定如何应用相关方法（如全面学校健康），以及社区机构应扮演何种合适角色（如技术援助）。所有采用这些学校 - 社区方法的研究都需要纳入过程指标，以解释在各组成部分之间未能取得显著差异的潜在原因。此外，我们呼吁开展关于教育工作者和卫生人员培训的研究，以提高对吸烟预防的重视程度，并改进现有项目的实施。需要探索关于能带来有效培训的政策举措的研究。最后，我们认为应用纳入癌症控制框架的原则（如通过参与式研究方法）可加强研究过程和成果。
