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Health Education Research Advance Access published online on August 8, 2005
Health Education Research, doi:10.1093/her/cyh048
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© The Author 2005. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oupjournals.org
Received January 31, 2005
Accepted July 4, 2005

Original article

The European Smoking prevention Framework Approach (ESFA): effects after 24 and 30 months

Hein de Vries 1*, Froukje Dijk 1, Joyce Wetzels 1, Aart Mudde 1, Stef Kremers 1, Carles Ariza 2, Paulo Duarte Vitória 3, Anne Fielder 4, Klavs Holm 5, Karin Janssen 6, Riku Lehtovuori 7, and Math Candel 8

1 Department of Health Promotion and Health Education, University of Maastricht, Maastricht, The Netherlands
2 Health Promotion Service, Institute of Medicine and Health, Agència de Salut Pública de Barcelona, Barcelona, Spain
3 Portuguese Council for Smoking Prevention, Lisbon, Portugal
4 Department of Epidemiology and Health Sciences, University of Manchester, Manchester, UK
5 Department of Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
6 STIVORO for a Smoke-free Future, The Hague, The Netherlands
7 National Public Health Institute, Helsinki, Finland
8 Department of Statistics, University of Maastricht, Maastricht, The Netherlands

* To whom correspondence should be addressed.
Hein de Vries, E-mail: hein.devries{at}gvo.unimaas.nl


  Abstract

The European Smoking Prevention Framework Approach (ESFA) study in six countries tested the effects of a comprehensive smoking prevention approach after 24 (T3; N = 10 751) and 30 months (T4; N = 9282). The programme targeted four levels, i.e. adolescents in schools, school policies, parents and the community. In Portugal, 12.4% of the T1 non-smokers in the control group had started smoking at T4 compared to 7.9% of the experimental group. Smoking onset in the experimental group was thus 36% lower. In Finland, 32.4% of the T1 non-smokers started smoking compared to 27.6% of the experimental group, implying a 15% lower onset in the experimental group. In Spain, 33.0% of the T1 non-smokers in the control group had started smoking, compared to 29.1% of the experimental group, implying a 12% lower onset. In The Netherlands, the ESFA programme was effective for non-native adolescents with 11.4% new weekly smokers compared to 19.9% in the control group. An opposite effect was found in native Dutch adolescents with 19.0% new weekly smokers in the comparison group compared to 24.0% new smokers in the experimental group. Future programmes should use more standardized ways to assess process evaluations and should assess which elements are responsible for behavioral effects.


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