A Stop Smoking in Schools Trial (ASSIST)

Study 1

Campbell, R., Starkey, F., Holliday, J., Audrey, S., Bloor, M., Parry-Langdon, N., . . . Moore, L. (2008). An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): A cluster randomised trial. The Lancet, 371(9624), 1595-1602.

Risk Factors

Individual: Favorable attitudes towards antisocial behavior, Substance use*

* Risk/Protective Factor was significantly impacted by the program

See also: A Stop Smoking in Schools Trial (ASSIST) Logic Model (PDF)

Gender Specific Findings

• Male
• Female

Subgroup Analysis Details

Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific racial, ethnic, or gender group:

In Study 1, Campbell et al. (2008) found that program effects did not differ for boys and girls but did not examine differences across ethnic groups.  Mercken et al. (2012) examined intervention effects separately across multiple measures of socioeconomic status. The results showed that the ASSIST intervention was most effective among lower SES girls.

Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:

The Study 1 sample had a mix of boys and girls.

ASSIST is a European program and has not been assessed by Blueprints for dissemination readiness in the United States.

ASSIST Training Content Overview for Schools

The ASSIST smoking prevention programme follows an alternative model of peer education which, rather than asking young people to deliver classroom-based sessions to their peers, asks them to disseminate information or messages to their peers through informal contacts.

According to the model, behaviour change is encouraged by 'early adopters' who are often influential or well-regarded individuals. With ASSIST, these influential students are identified by their peers through the completion of a simple questionnaire by the whole of Year 8 resulting in 18% of the year group being recruited as peer supporters.

The ASSIST peer supporter training takes place over two consecutive days and is delivered by external trainers in a venue away from the school site. Aside from making the students feel valued, this approach also reduces the burden on schools in terms of staffing and resourcing. The students are supported through four follow-up sessions over an 8-10 week period upon returning to school. Sessions continue to be delivered by external trainers, but on the school site as each one lasts between 45-60 minutes.

The programme builds incrementally, using the three main categories of information, skills and personal development, with peer supporters being asked to distinguish which of these was being developed at the end of each activity. This encourages them to reflect on their learning whilst considering how this new-found knowledge can be used in their peer supporter role.

Starting with a review of the skills and information which the students already possess boosts confidence and allows the group to get to know each other. The students then progress from demonstrating existing skills to acquiring new ones, from listening and observing to decision-making and team negotiation. In the final stages of the programme, the peer supporters are asked to combine both old and new skills in various scenarios so that they can put into practice what they have learned.

Throughout all of the activities, discussion using focused open-ended questioning helps to tease out the reasons why people hold particular views, and trainers provide frequent opportunities for young people to articulate their opinions in the safety of the group to see how they are received. With little emphasis on literacy skills, the programme is very accessible, but also has opportunities for differentiation built in.

Ground rules, games and group dividing activities are used to manage the energy levels and behaviour of the group as well as making the training more engaging. Activities are active or interactive wherever possible.

Day 1 of the training is designed to provide the peer supporters with sufficient information about tobacco and the benefits of remaining smoke free, to enable them to have conversations with their peers using a range of topics. There is an emphasis on facts which are relevant to Year 8 students and the importance of accuracy when passing on information is stressed. This is important because students need to have a bank of correct facts which their friends will find engaging. These include, but are not limited to:

The Media
Health
E-cigarettes/Shisha
The Environment
The Law

There is also input on dispelling common myths about smoking, especially around the link to managing weight, dealing with stress, or having smaller babies. There is time built in to deal with local issues and beliefs that the students present with on the day.

Day 2 uses the information gained on the previous day in activities which are now skills based. There is considerable input around speaking and listening, including non-verbal communication, active listening, effective questioning, and developing the ability to see the bigger picture. Debate is encouraged and facilitated.

Being non-judgemental is an important element of the peer supporter role and the second day also highlights empathy, and interpersonal skills. Trainers understand that peer supporters often have family members who smoke and the benefits of being smoke free has a greater focus than the negatives of smoking, although these are covered.

Making positive and personal choices instead of following the crowd is discussed as a way of encouraging students to think about what influences them. This highlights the impact that they can have on their peers by demonstrating positive behaviour in terms of both their knowledge around smoking and also hopefully, their choice not to smoke. The concept of choice is one which is applicable across most health behaviours and links are made to the pressures faced by young people from external sources. Reasons for choices are explored and the impact of those potential choices discussed.

Opportunities are also provided for the students to gain confidence by practicing the types of conversations that they may have back in school. These conversations are then recorded in their Peer Supporter diaries which are also a useful source of information and can be used as a prompt.

Through both training days there is an emphasis on independent learning and the students are encouraged to see themselves as part of a learning community of peer supporters so that they can support each other during and after the programme.

The four follow-up sessions have the same structure but with different activities. The purpose of these sessions is:

To reinforce the role of peer supporter.
To monitor diaries as a way of highlighting successes and areas where input is required.
To support students and boost their confidence.
To refresh and provide new information.
To practice the skills they have learnt on the training.

Also worth noting is that throughout the training the student/trainer ratio will either be 10:1 or 15:1, and there will always be a minimum of two trainers working with the group.

Anecdotally, ASSIST is well received by schools and the contact teachers who attend the sessions speak very positively of the 'hidden curriculum' elements to the programme, which is far more than just a smoking prevention intervention. The emphasis on speaking and listening and interpersonal skills will benefit the peer supporters across the curriculum long after they have finished the follow-up sessions.

For schools, aside from the potential reduction in the uptake of smoking, they also have a group of peer supporters who, subject to their desire to do so, could use their new skills in other areas.

Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.