A valuable ASSIST – getting teenagers to put each other off smoking

Peer pressure is the bane of a parent’s life. Anyone who has children, or indeed works with them, knows how blithely they will ignore an adult’s instructions, only to jump out of a tree if their mates recommend it.

But a group of UK researchers have found a way to turn peer pressure to their advantage – by encouraging cool kids to put their friends off smoking.

It’s no surprise that a teenager’s odds of smoking are strongly influenced by the habits of their friends. In the UK, 82 per cent of all smokers start during adolescence, which makes the schoolyard an important arena for smoking prevention.

But school-based programmes are notoriously difficult to run successfully. A few years back, a review looked at the results of 8 such programmes and found “little to no evidence of long-term effectiveness”.

Rona Campbell at the University of Bristol may change all that. Her research has shown that teenagers themselves could be the newest recruits in the fight to stop teens from getting hooked on cigarettes. And in the tradition of clever medical acronyms, her trial was called ASSIST or “A Stop Smoking in Schools Trial”.

Training teens

Campbell worked with students aged 12-13 years from 59 schools in Wales and the west of England. In half of these schools, she asked students to nominate peers in their age group who they looked up to and respected.

These influential few were then trained by youth workers and health professionals to be ‘peer supporters’ and armed with detailed knowledge of smoking along with various ‘soft skills’ including negotiating, assertiveness and communication.

Over the next 10 weeks, more than 800 of these supporters talked to their friends about the health risks of smoking and the benefits of stopping. All the chats with their friends were done informally, during breaks or after school hours. That simple step probably made a lot of difference. Other programmes have tried to get students to deliver more formal ‘lessons’, but as you might imagine, thrusting a popular teen into the role of teacher does little for their credibility.

At the end of the trial, Campbell surveyed the students at the schools to work out how many of them were smokers. To make sure that they were being honest, she took saliva samples to check for cotinine, a chemical produced when our bodies break down nicotine.

The results

The results were promising but need to be interpreted cautiously. Campbell found that immediately after the 10-week trial, students from schools with peer supporters were 25% less likely to smoke than those in the control schools.

A few years later and the trial’s benefits were diminished but still obvious. After one year, smoking rates were still 23% lower in the programme schools compared to the control ones, and after two years, they were 15% lower.

However, some of these figures were on the borderline of being statistically significant. This means that there is a small chance that the patterns were due to chance and randomness than a real effect of the programme.

Plus points

Despite these potential problems, the ASSIST programme clearly has a lot going for it.

The programme was incredibly popular among both students, who appreciated the chance to choose the supporters themselves, and staff, who liked the fact that external trainers delivered the training. The peer supporters themselves became really involved and felt able to take ownership of the programme. Hardly any of them dropped out of the training.

The programme was relatively cheap and all in all, it cost £27 per student and £4,700 per school. But Campbell notes that these low costs could be shaved even further if the programme was implemented at a local level and trainers didn’t have to travel long distances between different schools.

On the basis of these results, Campbell calculates that if the ASSIST programme was rolled out across the UK, it could prevent over 43,000 students aged 14-15 from becoming regular smokers.

And that’s just based on the effects on a single school year. If the programme was repeated year after year, the researchers feel that it could change a school’s very culture so that smoking becomes less socially acceptable.

ASSIST could also be particularly suited to rural areas where it is easier for peer supporters to regularly spread their messages among local teens. In fact, Campbell’s study found that the programme provided the greatest assistan… er, boost in the schools from rural parts of Wales.

Why it matters

The importance of reducing the number of children who take up smoking can’t be overstated. If this programme is successful, thousands of people would avoid the entire gamut of health problems associated with smoking, including cancer, heart disease, respiratory conditions and more.

And research clearly shows that childhood and early adolescence form a critical window for smoking prevention. A 2006 Cancer Research UK study showed that children who smoke just one cigarette by the age of 11 can be more vulnerable to taking up smoking several years later.

So where next?

Unlike many other such programmes, this one was evaluated very clearly, which makes it easy for other researchers to build upon the lessons learned here. In fact, Cancer Research UK has funded Professor Laurence Moore, who worked on ASSIST to build on its results and answer more questions about teenage smoking behaviour.

For example, Moore’s team will try to work out exactly why teenage smokers hang around other teenage smokers. That may seem obvious but there are actually two competing theories and it’s not clear which is more important.

Either teenagers persuade their friends to smoke – this is traditional peer pressure – or they voluntarily become friends with people who share similar habits, such as smoking, which is known as peer selection. The answer to this question will help the researchers to refine their smoking prevention programmes even further.

Ed