In 2014 the Institute for Social Marketing and a team of collaborators were appointed to conduct a process evaluation of ASSIST (A Stop Smoking in Schools Trial). ASSIST is a peer-led, school-based smoking prevention programme that encourages the dissemination of non-smoking norms by training students aged 12-14 to work as peer supporters. ASSIST was previously evaluated via a large cluster randomised trial of 59 schools in South Wales and Avon, England. Results from this trial showed that ASSIST was effective and cost effective at reducing smoking prevalence in young people (Campbell et al 2008), (Hollingworth et al 2012). This led to the wider roll out of ASSIST in parts of England and Wales and more recently in Scotland.
The overall aim of the study was to evaluate the process of implementing ASSIST in Scotland.
Three different delivery models were piloted in three NHS boards. This did not impact on fidelity or acceptability which was rated highly. Partnership working, from the onset, was viewed as being key to successful delivery and securing school participation. Feedback was overwhelmingly positive regarding the wider benefits of taking part in ASSIST for peer supporters (i.e. personal and communication skills) but also for the school and communities. There was less certainty regarding the extent of message diffusion and the impact this may have an adolescence smoking prevalence. Student survey results showed no significant change in self-reported smoking prevalence between baseline (1.6%) and follow-up (1.8%) and conversation recall with a peer supporter was low at 9%.
However, it is important that the current context (where regular smoking prevalence is 2% overall in 13 year olds in Scotland (SALSUS, 2015 http://www.gov.scot/Resource/0050/00508401.pdf) is taken into account. Opportunities to have informal conversations about smoking with peers may now be limited due to the ongoing decline in adolescent smoking since ASSIST was first developed. In addition, the data collection mode was a self-complete survey, so there is a possibility that by follow-up (12 weeks after baseline) young people may simply not remember conversation(s) with a peer supporter or may not have known that they had spoken with a peer supporter.
Overall, this study has demonstrated that it is feasible and acceptable to deliver the ASSIST programme in Scottish schools, although questions remain about the extent of message diffusion. Further consideration is required to assess whether delivery of ASSIST still offers a suitable return on investment and what role it may play in schools in areas of deprivation where smoking rates are higher. Now may be the time to consider whether, 13 years on from the original Randomised Control Trial, an implementation trial of ASSIST is warranted to determine if it is still effective and cost effective.
24 March 2017
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