Sahadat Hossain, Harry Tattan-Birch, Emma Beard, Lion Shahab
{"title":"评估以学校为基础的预防和减少中低收入国家青少年烟草使用的干预措施：系统回顾和荟萃分析","authors":"Sahadat Hossain, Harry Tattan-Birch, Emma Beard, Lion Shahab","doi":"10.1016/j.amepre.2025.107656","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Tobacco-related disease and death remain high in many low- and middle-income countries (LMICs), and most people start using tobacco during adolescence. This study evaluated the effectiveness of school-based interventions in preventing and reducing tobacco use among adolescents in LMICs.</p><p><strong>Methods: </strong>Seven databases were searched until 20 March 2024. The primary outcome was tobacco use prevalence (ever or point prevalence) at the longest follow-up. Risk of bias (RoB) was assessed, and random-effects meta-analyses were conducted, exploring heterogeneity via meta-regression (PROSPERO registration CRD42022330329).</p><p><strong>Results: </strong>Twenty-seven studies (n=57,292) were summarised descriptively, and 20 were meta-analysed. Most studies were from Brazil (n=5, 18.5%), India (n=5, 18.5%), China (n=3, 11.1%), and Pakistan (n=2, 7.4%); twelve (44.4%) assessed newly developed and fifteen (55.6%) culturally adapted existing interventions; and over half (n=14, 51.9%) focused solely on preventing and reducing tobacco use while the rest addressed multiple behaviours. Overall, interventions reduced adolescent tobacco use (odds ratio [OR] 0.76, 95% confidence interval [CI]: 0.64-0.91; I²=47%; n=20; 50,056 participants). Stratification by outcome measure showed significant reductions in point prevalence (OR 0.69, 95% CI: 0.57-0.85; I²=32.4%). After adjusting for study duration, interventions with higher contact time had lower effectiveness than shorter interventions (adjusted OR 1.36, 95% CI: 1.01-1.84; p=0.045; I²=22%). Low RoB studies demonstrated lower odds of tobacco use among participants (OR 0.66, 95% CI: 0.50-0.87; I²=14%; n=6).</p><p><strong>Discussion: </strong>School-based interventions in LMICs effectively reduce the proportion of adolescents who use tobacco. Shorter interventions appeared to be effective, suggesting that brief yet engaging interventions may offer practical advantages and could contribute to addressing the tobacco epidemic in LMICs. Further research is needed to determine optimal intervention duration and intensity for sustained effectiveness.</p>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":" ","pages":"107656"},"PeriodicalIF":4.3000,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluating School-based Interventions for Preventing and Reducing Tobacco use among Adolescents in Low- and Middle-income Countries: A Systematic Review and Meta-Analysis.\",\"authors\":\"Sahadat Hossain, Harry Tattan-Birch, Emma Beard, Lion Shahab\",\"doi\":\"10.1016/j.amepre.2025.107656\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Tobacco-related disease and death remain high in many low- and middle-income countries (LMICs), and most people start using tobacco during adolescence. This study evaluated the effectiveness of school-based interventions in preventing and reducing tobacco use among adolescents in LMICs.</p><p><strong>Methods: </strong>Seven databases were searched until 20 March 2024. The primary outcome was tobacco use prevalence (ever or point prevalence) at the longest follow-up. Risk of bias (RoB) was assessed, and random-effects meta-analyses were conducted, exploring heterogeneity via meta-regression (PROSPERO registration CRD42022330329).</p><p><strong>Results: </strong>Twenty-seven studies (n=57,292) were summarised descriptively, and 20 were meta-analysed. Most studies were from Brazil (n=5, 18.5%), India (n=5, 18.5%), China (n=3, 11.1%), and Pakistan (n=2, 7.4%); twelve (44.4%) assessed newly developed and fifteen (55.6%) culturally adapted existing interventions; and over half (n=14, 51.9%) focused solely on preventing and reducing tobacco use while the rest addressed multiple behaviours. Overall, interventions reduced adolescent tobacco use (odds ratio [OR] 0.76, 95% confidence interval [CI]: 0.64-0.91; I²=47%; n=20; 50,056 participants). Stratification by outcome measure showed significant reductions in point prevalence (OR 0.69, 95% CI: 0.57-0.85; I²=32.4%). After adjusting for study duration, interventions with higher contact time had lower effectiveness than shorter interventions (adjusted OR 1.36, 95% CI: 1.01-1.84; p=0.045; I²=22%). Low RoB studies demonstrated lower odds of tobacco use among participants (OR 0.66, 95% CI: 0.50-0.87; I²=14%; n=6).</p><p><strong>Discussion: </strong>School-based interventions in LMICs effectively reduce the proportion of adolescents who use tobacco. Shorter interventions appeared to be effective, suggesting that brief yet engaging interventions may offer practical advantages and could contribute to addressing the tobacco epidemic in LMICs. Further research is needed to determine optimal intervention duration and intensity for sustained effectiveness.</p>\",\"PeriodicalId\":50805,\"journal\":{\"name\":\"American Journal of Preventive Medicine\",\"volume\":\" \",\"pages\":\"107656\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2025-05-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Preventive Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.amepre.2025.107656\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Preventive Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.amepre.2025.107656","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Evaluating School-based Interventions for Preventing and Reducing Tobacco use among Adolescents in Low- and Middle-income Countries: A Systematic Review and Meta-Analysis.
Introduction: Tobacco-related disease and death remain high in many low- and middle-income countries (LMICs), and most people start using tobacco during adolescence. This study evaluated the effectiveness of school-based interventions in preventing and reducing tobacco use among adolescents in LMICs.
Methods: Seven databases were searched until 20 March 2024. The primary outcome was tobacco use prevalence (ever or point prevalence) at the longest follow-up. Risk of bias (RoB) was assessed, and random-effects meta-analyses were conducted, exploring heterogeneity via meta-regression (PROSPERO registration CRD42022330329).
Results: Twenty-seven studies (n=57,292) were summarised descriptively, and 20 were meta-analysed. Most studies were from Brazil (n=5, 18.5%), India (n=5, 18.5%), China (n=3, 11.1%), and Pakistan (n=2, 7.4%); twelve (44.4%) assessed newly developed and fifteen (55.6%) culturally adapted existing interventions; and over half (n=14, 51.9%) focused solely on preventing and reducing tobacco use while the rest addressed multiple behaviours. Overall, interventions reduced adolescent tobacco use (odds ratio [OR] 0.76, 95% confidence interval [CI]: 0.64-0.91; I²=47%; n=20; 50,056 participants). Stratification by outcome measure showed significant reductions in point prevalence (OR 0.69, 95% CI: 0.57-0.85; I²=32.4%). After adjusting for study duration, interventions with higher contact time had lower effectiveness than shorter interventions (adjusted OR 1.36, 95% CI: 1.01-1.84; p=0.045; I²=22%). Low RoB studies demonstrated lower odds of tobacco use among participants (OR 0.66, 95% CI: 0.50-0.87; I²=14%; n=6).
Discussion: School-based interventions in LMICs effectively reduce the proportion of adolescents who use tobacco. Shorter interventions appeared to be effective, suggesting that brief yet engaging interventions may offer practical advantages and could contribute to addressing the tobacco epidemic in LMICs. Further research is needed to determine optimal intervention duration and intensity for sustained effectiveness.
期刊介绍：
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health.
Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women''s health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and substance use disorders. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community.
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