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Implementation of a peer-led school based smoking prevention programme: a mixed methods process evaluation.

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The peer-led smoking prevention program ASSIST was implemented with high fidelity in Scotland. While direct recall of peer conversations was low, the program showed wider benefits for students and schools.

Keywords:
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Area of Science:

  • Public Health
  • Adolescent Health
  • Health Promotion

Background:

  • School-based smoking prevention programs are crucial for reducing adolescent tobacco use.
  • The ASSIST program, a peer-led initiative, aims to diffuse non-smoking norms among adolescents.
  • Previous trials demonstrated ASSIST's effectiveness in reducing weekly smoking prevalence.

Purpose of the Study:

  • To evaluate the implementation, acceptability, and fidelity of the ASSIST program in Scotland (2014-2017).
  • To explore the context of message diffusion between peers within the ASSIST program.
  • To assess the impact of ASSIST on adolescent smoking behaviors and norms.

Main Methods:

  • A mixed-method implementation study involving students, school staff, trainers, and policy leads.
  • Included structured observations and student surveys to gather data on program delivery and outcomes.
  • Data collection involved 61 students, 41 school staff, 31 trainers, 17 policy leads, 42 observations, and 2130 student surveys.

Main Results:

  • The ASSIST program was delivered with high fidelity to its manual.
  • Student surveys showed an increase in conversations about smoking, but low recall of discussions with peer supporters.
  • Very low smoking prevalence (0.9% weekly smokers) in study schools may have influenced conversation dynamics. Wider benefits included improved peer supporter skills and minimal resource requirements for schools.

Conclusions:

  • The ASSIST program demonstrated high fidelity and acceptability among participants in Scotland.
  • Future targeting of ASSIST in deprived areas or countries with rising youth smoking rates is recommended.
  • The program offers broader benefits beyond smoking prevention, including skill development and community engagement.