Process Evaluation of a Medical Student–Delivered Smoking Prevention Program for Secondary Schools: Protocol for the Education Against Tobacco Cluster Randomized Trial (Preprint)

BACKGROUND Most smokers start smoking during their early adolescence under the impression that smoking entails positive attributes. Given the addictive nature of cigarettes, however, many of them might end up as long-term smokers and suffering from tobacco-related diseases. To prevent tobacco use among adolescents, the large international medical students’ network Education Against Tobacco (EAT) educates more than 40,000 secondary school students per year in the classroom setting, using evidence-based self-developed apps and strategies. OBJECTIVE This study aimed to evaluate the long-term effectiveness of the school-based EAT intervention in reducing smoking prevalence among seventh-grade students in Germany. Additionally, we aimed to improve the intervention by drawing conclusions from our process evaluation. METHODS We conduct a cluster-randomized controlled trial with measurements at baseline and 9, 16, and 24 months postintervention via paper-and-pencil questionnaires administered by teachers. The study groups consist of randomized schools receiving the 2016 EAT curriculum and control schools with comparable baseline data (no intervention). The primary outcome is the difference of change in smoking prevalence between the intervention and control groups at the 24-month follow-up. Secondary outcomes are between-group differences of changes in smoking-related attitudes and the number of new smokers, quitters, and never-smokers. RESULTS A total of 11,268 students of both sexes, with an average age of 12.32 years, in seventh grade of 144 secondary schools in Germany were included at baseline. The prevalence of cigarette smoking in our sample was 2.6%. The process evaluation surveys were filled out by 324 medical student volunteers, 63 medical student supervisors, 4896 students, and 141 teachers. CONCLUSIONS The EAT cluster randomized trial is the largest school-based tobacco-prevention study in Germany conducted to date. Its results will provide important insights with regards to the effectiveness of medical student–delivered smoking prevention programs at school. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/13508

Download Full-text

Process Evaluation of a Medical Student–Delivered Smoking Prevention Program for Secondary Schools: Protocol for the Education Against Tobacco Cluster Randomized Trial

JMIR Research Protocols ◽

10.2196/13508 ◽

2019 ◽

Vol 8 (4) ◽

pp. e13508 ◽

Cited By ~ 1

Author(s):

Titus Josef Brinker ◽

Fabian Buslaff ◽

Janina Leonie Suhre ◽

Marc Philipp Silchmüller ◽

Evgenia Divizieva ◽

...

Keyword(s):

Medical Student ◽

Secondary Schools ◽

Randomized Trial ◽

Process Evaluation ◽

Prevention Program ◽

Cluster Randomized Trial ◽

Smoking Prevention ◽

Cluster Randomized

Download Full-text

Effects of TX Sprouts, A School-Based Cluster Randomized Gardening, Nutrition, and Cooking Intervention, on Dietary Quality

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_038 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1321-1321 ◽

Cited By ~ 1

Author(s):

Matthew Landry ◽

Fiona Asigbee ◽

Sarvenaz Vandyousefi ◽

Matthew Jeans ◽

Reem Ghaddar ◽

...

Keyword(s):

Health Promotion ◽

Randomized Trial ◽

Cluster Randomized Trial ◽

Dietary Quality ◽

Control Groups ◽

Post Intervention ◽

School Based ◽

Cluster Randomized ◽

And Control ◽

Component Scores

Abstract Objectives School gardens have become a common school-based health promotion strategy to enhance dietary behaviors in the US. The goal of this study was to examine the effects of TX Sprouts, a one-year school-based gardening, nutrition, and cooking cluster randomized trial on dietary quality. Methods Eight schools were randomly assigned to TX Sprouts intervention and eight schools to control (i.e., delayed intervention) over three years (2016–2019). The intervention arm received: formation of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly during school hours; and nine parent lessons. The following outcomes were collected on the children at baseline and post-intervention: height, weight, waist circumference, and body composition via bioelectrical impedance. Dietary intake via two, 24-hour dietary recalls (24hDR) were collected on a subsample. Dietary quality was assessed using the Healthy Eating Index 2015 (HEI-2015). Analytic sample included subjects with complete data. Mixed-effects linear regression models, accounting for the cluster effect, were used to assess changes in outcomes between intervention and control groups. Results Of the 4239 eligible students, 3135 students consented and provided baseline clinical measures. Two 24hDR were collected on a subsample of 440 children at baseline and post-intervention. Children were 54% female with the mean age of 9 years, 60% were Hispanic, and 66% received free and reduced lunch. Change in HEI-2015 total score was not significantly different between intervention and control groups [+2.02 (0.96) vs. 0.98 (1.05); P = 0.46]. The intervention group compared to control group resulted in significant increases, mean change (SE), in HEI-2015 vegetable component scores [+0.18 (0.13) vs. −0.06 (0.12); P = 0.003] and HEI-2015 greens and beans component scores [+0.13 (0.18) vs. −0.32 (0.18); P = 0.02]. Conclusions This is the largest, cluster-randomized trial to examine the effects of a school-based gardening, nutrition, and cooking program on diet quality in primarily low-income Hispanic children. School-based garden programs may serve as promising health promotion strategies in improving vegetable consumption. Funding Sources Supported by National Heart, Lung, and Blood Institute grant R01HL123865.

Download Full-text

A Smoking Prevention Program Delivered by Medical Students to Secondary Schools in Brazil Called “Education Against Tobacco”: Randomized Controlled Trial (Preprint)

10.2196/preprints.12854 ◽

2018 ◽

Author(s):

Oscar Campos Lisboa ◽

Breno Bernardes-Souza ◽

Luiz Eduardo De Freitas Xavier ◽

Matheus Rocha Almeida ◽

Paulo César Rodrigues Pinto Corrêa ◽

...

Keyword(s):

Smoking Prevalence ◽

Controlled Trial ◽

Intervention Group ◽

Smoking Prevention ◽

Control Group ◽

Classroom Setting ◽

Randomized Controlled ◽

School Based ◽

And Control

BACKGROUND Smoking is the largest preventable cause of mortality in Brazil. Education Against Tobacco (EAT) is a network of more than 3500 medical students and physicians across 14 countries who volunteer for school-based smoking prevention programs. EAT educates 50,000 adolescents per year in the classroom setting. A recent quasi-experimental study conducted in Germany showed that EAT had significant short-term smoking cessation effects among adolescents aged 11 to 15 years. OBJECTIVE The aim is to measure the long-term effectiveness of the most recent version of the EAT curriculum in Brazil. METHODS A randomized controlled trial was conducted among 2348 adolescents aged 12 to 21 years (grades 7-11) at public secondary schools in Brazil. The prospective experimental design included measurements at baseline and at 6 and 12 months postintervention. The study groups comprised randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes in the same schools (no intervention). Data were collected on smoking status, gender, social aspects, and predictors of smoking. The primary endpoint was the difference in the change in smoking prevalence between the intervention group and the control group at 12-month follow-up. RESULTS From baseline to 12 months, the smoking prevalence increased from 11.0% to 20.9% in the control group and from 14.1% to 15.6% in the intervention group. This difference was statistically significant (P<.01). The effects were smaller for females (control 12.4% to 18.8% vs intervention 13.1% to 14.6%) than for males (control 9.1% to 23.6% vs intervention 15.3% to 16.8%). Increased quitting rates and prevented onset were responsible for the intervention effects. The differences in change in smoking prevalence from baseline to 12 months between the intervention and control groups were increased in students with low school performance. CONCLUSIONS To our knowledge, this is the first randomized trial on school-based tobacco prevention in Brazil that shows significant long-term favorable effects. The EAT program encourages quitting and prevents smoking onset, especially among males and students with low educational background. CLINICALTRIAL ClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021

Download Full-text

Six-months follow-up of a cluster randomized trial of school-based smoking prevention education programs in Aceh, Indonesia

BMC Public Health ◽

10.1186/s12889-015-2428-4 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 10

Author(s):

Teuku Tahlil ◽

Richard J. Woodman ◽

John Coveney ◽

Paul R. Ward

Keyword(s):

Randomized Trial ◽

Cluster Randomized Trial ◽

Smoking Prevention ◽

Education Programs ◽

Prevention Education ◽

School Based ◽

Cluster Randomized

Download Full-text

A School-Based Sleep Education Program for Adolescents: A Cluster Randomized Trial

PEDIATRICS ◽

10.1542/peds.2014-2419d ◽

2015 ◽

Vol 135 (3) ◽

pp. X23-X23

Keyword(s):

Randomized Trial ◽

Education Program ◽

Cluster Randomized Trial ◽

Sleep Education ◽

School Based ◽

Cluster Randomized

Download Full-text

School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial

BMC Medicine ◽

10.1186/1741-7015-12-56 ◽

2014 ◽

Vol 12 (1) ◽

Cited By ~ 74

Author(s):

Wietse A Tol ◽

Ivan H Komproe ◽

Mark JD Jordans ◽

Aline Ndayisaba ◽

Prudence Ntamutumba ◽

...

Keyword(s):

Mental Health ◽

Randomized Trial ◽

Cluster Randomized Trial ◽

Health Intervention ◽

Mental Health Intervention ◽

School Based ◽

Cluster Randomized

Download Full-text

Assessing the impact of a school-based latrine cleaning and handwashing program on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial

Tropical Medicine & International Health ◽

10.1111/tmi.12360 ◽

2014 ◽

Vol 19 (10) ◽

pp. 1185-1197 ◽

Cited By ~ 22

Author(s):

Bethany A. Caruso ◽

Matthew C. Freeman ◽

Joshua V. Garn ◽

Robert Dreibelbis ◽

Shadi Saboori ◽

...

Keyword(s):

Randomized Trial ◽

Cluster Randomized Trial ◽

Nyanza Province ◽

School Based ◽

Cluster Randomized ◽

The Impact

Download Full-text

Spread and scale of an electronic deprescribing software to improve health outcomes of older adults living in nursing homes: study protocol for a stepped wedge cluster randomized trial

Trials ◽

10.1186/s13063-021-05729-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Marc-Eric Nadeau ◽

Justine L. Henry ◽

Todd C. Lee ◽

Émilie Bortolussi-Courval ◽

Carole Goodine ◽

...

Keyword(s):

Older Adults ◽

Randomized Trial ◽

Study Design ◽

Long Term Care ◽

Cluster Randomized Trial ◽

Stepped Wedge ◽

Term Care ◽

Medication Reviews ◽

Cluster Randomized

Abstract Background Medication overload or problematic polypharmacy is a major problem causing widespread harm, particularly to older adults. Taking multiple medications increases the risk of potentially inappropriate medications (PIMs), and residents in long-term care (LTC) are frequently prescribed 10 or more medications at once. One strategy to address this problem is for the physician and/or pharmacist to perform regular medication reviews; however, this process can be complicated and time-consuming. With a prescription review, medications may be decreased, changed, or stopped altogether. MedReviewRx is a software that runs an analysis using deprescribing rules to produce a report to guide medication reviews addressing medication overload for residents in LTC. Methods This study will employ a mixed methods effectiveness-implementation hybrid type 2 study design. To measure effectiveness, a stepped wedge cluster randomized trial design is planned, which allows us to approximate a randomized clinical trial. Approximately 1000 residents living in LTC will be recruited from five facilities in New Brunswick. The study will begin with 3 months of baseline data on rates of deprescribing. Thereafter, every 3 months a new cluster will enter the intervention mode. The intervention consists of medication reviews augmented with the MedReviewRx software, which will be used by staff and clinicians in the facilities. The estimated study duration is 18 months and the main outcome will be the proportion of patients with one or more PIMs deprescribed (reduced/stopped or changed to a safer alternative) in the 90 days following a prescription review. The goal is to study the impact of MedReviewRx on medication overload among older adults living in LTC. In typical fashion of a stepped wedge cluster randomized trial, each cluster acts as an internal control (before and after) as well as a control for the other clusters (external control). Qualitative data collected will include resident/caregiver attitudes towards deprescribing and semi-structured interviews with staff working in the long-term care homes. Discussion This study design addresses issues with seasonality and allows all clusters to participate in the intervention, which is an advantage when the intervention is related to quality improvement. This study will provide valuable information on PIM use, cost savings, and facilitators and challenges associated with medication reviews and deprescribing. This study represents an important step towards understanding and promoting tools to guide safe and rational reduction of PIM use among older adults. Trial registration NCT04762303, Registered February 21, 2021.

Download Full-text