Objectives: To evaluate the long-term effectiveness of recent behavioral interventions in the prevention of cigarette use among children and youth and to compare the effectiveness of different school-based, community-based, and multisectorial intervention strategies.
Data sources: A structured search of databases and a manual search of reference lists was conducted. Randomized controlled trials published in English or German between August 2001 and August 2006 targeting youths up to 18 years of age were assessed independently by two researchers according to pre-defined inclusion criteria and with regard to methodological quality.
Data extraction: Data abstraction was performed and cross-checked by two researchers. Where appropriate, pooled effect estimates were calculated and tested in sensitivity analyses.
Data synthesis: Out of 3555 articles, 35 studies met the inclusion criteria. The follow-up duration ranged from 12 months to 120 months. Although the overall effectiveness of prevention programs showed considerable heterogeneity, the majority of studies reported some positive long-term effects for behavioral smoking prevention programs. There was evidence that community-based and multisectorial interventions were effective in reducing smoking rates; in contrast, the evidence for school-based programs alone was inconclusive. Regardless of the type of intervention, the reductions observed in smoking rates were only modest.
Conclusion: The present review identified moderate evidence for the effectiveness of behavioral interventions to prevent smoking. Although evidence for the effectiveness of school-based interventions was inconclusive, evidence for the effectiveness of community-based and multisectorial interventions was somewhat stronger. Future research should investigate the effectiveness of specific intervention components and the cost-effectiveness of interventions analysed in methodologically high-quality studies.
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