Health Education Research, Vol. 18, No. 6, 649-663,
December 2003
© 2003 Oxford University Press
The European Smoking Prevention Framework Approach (ESFA): short-term effects
Department of Health Education, Maastricht University, 6200 MD Maastricht, The Netherlands, 1 Municipal Institute of Health, Health Promotion Unit, 08023 Barcelona, Spain, 2 Portuguese Council for Smoking Prevention, 1700-165 Lisbon, Portugal, 3 Department of Epidemiology and Health Sciences, University of Manchester, M13 9PT Manchester, UK, 4 Department of Cancer Prevention and Research, Danish Cancer Society, 2100 Copenhagen, Denmark, 5 DEFACTO, 2500BB The Hague, The Netherlands, 6 National Public Health Institute, 00300 Helsinki, Finland, and 7 Department of Statistics, Maastricht University, 6200 MD Maastricht, The Netherlands
e-mail: devries{at}gvo.unimaas.nl
The European Smoking Prevention Framework Approach (ESFA) resulted in a smoking prevention project for six European countries. It included activities on four levels: adolescents, schools, parents and out-of-school activities. Common goals and objectives were developed, but countries were also able to include additional objectives. National diversities required country-specific methods. The most important common element was a school-based programme consisting of at least five lessons paying attention to social influence processes and training in refusal skills. During the first year, significantly more smoking prevention activities were realized in experimental schools compared with control schools. Not all countries had the same number of lessons on resisting peer pressures. Significant cognitive changes were observed in Spain, resulting in more negative attitudes, increased self-efficacy levels and a more negative intention towards smoking in the experimental group. Counter-productive cognitive effects were observed in the UK. Significantly less onset of weekly smoking in experimental groups was found in Finland (4.7%) and Spain (3.1%). Counter-productive effects were observed in Denmark and the UK. In conclusion, while having common objectives, the ESFA approach allowed for a great deal of diversity. Fundamental research using dismantling designs is needed to be able to detect the most effective elements of smoking prevention programmes for different age groups. Attention to parenting styles and practices is also needed.
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