Discussion
’ smoking behavior
MINOR
This study examined the effectiveness of a multi-component and multi-level intervention to reduce smoking among young people in upper-secondary schools with high smoking prevalences (Danish VET and PBE schools). The results showed no effects of the intervention on the primary outcomes, i.e., daily cigarette consumption and students’ smoking status. However, a rather consistent tendency was found that students in the intervention group were less likely to smoke at follow-up compared with schools in the control group. Subgroup analyses showed that the intervention effect differed according to gender, school type, and level of implementation. Specifically, intervention effects were seen for girls as well as social and healthcare VET schools – although the size of effect was relatively minor. Moreover, schools where the intervention was delivered in full had higher benefits of the intervention in terms of reduced smoking prevalence at follow-up than schools with partial delivered intervention.Most school-based tobacco interventions have focused on younger adolescents and the primary school setting [In a qualitative process evaluation of the Focus intervention, we saw that VET schools educating health personnel (the social and healthcare trade) were more prone to implement and make sense of the intervention [The intervention was more effective on girls’ smoking behavior than boys. Consequently, the intervention may have appealed more to girls than boys, which is important to bear in mind when interpreting the results. Other research has shown similar gender effects of health interventions and intervention adoption; thus, girls were more responsive to smoking preventive interventions and had more positive attitudes towards tobacco policies [Knowledge about the effects of smoking prevention in high-risk groups are lacking, and evidence-based knowledge may inform and guide political decision-making. We know that smoking prevention as early as possible is important to prevent individuals to initiate smoking, i.e., as early as primary school. Nonetheless, many, especially in the VET setting, escalate smoking when they enter upper-secondary education [