European Smoking Prevention Framework Approach (ESFA / PASE.bcn) - addressing young people, parents, school environment and out-of-school situations

The European Smoking Prevention Framework Approach (ESFA) addresses four target groups/situations: young people, parents, schools and the out-of-school situation. Programme components consist of (i) smoking prevention through health education within the curriculum (a range of smoking prevention lessons that use the essential elements of a social skills approach); (ii) stimulating a smoke-free school environment (e.g. smoking regulation policies, smoking cessation training for teachers and parents); and (iii) out-of-school regional smoking prevention activities (e.g. ongoing regional publicity and out-of-school smoke-free activities for adolescents). The programme is teacher-led and lasts about two school terms.

The programme has been implemented in six countries. In each of the participating countries, a special national project manager was appointed, who was responsible for the development and implementation of the project. The project manager worked in conjunction with a national steering group made up of representatives of relevant national organisations in the field of smoking prevention. The content of the ESFA programme was finalised when consensus was reached on goals and core objectives during meetings between the contractors and national project managers. Despite reaching consensus on the core objectives, all countries wanted the freedom to aim for other objectives, so each country used and/or developed its own materials, taking into account the core goals and objectives. The programmes were all implemented in the autumn and winter of 1998, and were all teacher-led.

Finland: this programme has been implemented in 13 experimental schools. The programme includes five one-hour lessons that provide information on smoking prevention in general; how to say no; the consequences of smoking and reasons for smoking; the development of refusal skills; and opinions on and reasons for not smoking. A video demonstrates social influences and a drama group demonstrates social influence resistance skills. The participants do not receive a student manual. The lessons are teacher-led; the teachers receive 20 hours of training, manuals and credits for following training. At school level, the ESFA School Policy Guide is used. Parents receive a ‘Quit & Win’ brochure on smoking cessation and are invited to participate in the ‘Quit & Win’ competition. For the out-of-school component, three posters are developed to be displayed in places in schools where children spend much of their free time. Finally, the participants are sent two tabloid-style newsletters, which include peer models explaining their decision to be non-smokers and offering advice on how to avoid smoking.

Denmark: this programme has been implemented in 30 schools. The programme includes six one-hour lessons that discuss smoking prevention in general; personal responsibility and alternatives to smoking; social pressure; refusal skills; making one’s own choices; skills training; the impact of advertising; and smoking policies. Pupils receive a student manual. Teachers receive a tutorial, background information, transparencies, and worksheets for the children. At school level, the ESFA School Policy Guide is disseminated. Parents receive a letter about the ESFA project, how to discuss tobacco use with their child and how to order smoking cessation materials. For the out-of-school component, two posters are developed for schools, classroom walls, canteens and public places such as libraries, swimming halls and sports centres. The participants are sent three postcards featuring the same images as the posters. Finally, a brochure is disseminated to community youth leaders describing how to discuss non-smoking with adolescents.

The Netherlands: this programme includes five one-hour lessons. The first three lessons consist of the national programme, providing information on general smoking prevention, personal decision making, and intentions. The lessons use teacher and student manuals. Two video lessons using soap operas demonstrate social influences and social influence resistance skills using verbal and non-verbal communication. At school level, the ESFA School Smoke-Free Policy Guide is used. Regional health coordinators receive a package describing how to inform parents and school personnel about smoking prevention and the ESFA project, along with examples of presentations and letters introducing the ESFA project, promotional materials (posters, postcards and stickers) and cessation materials. Posters and flyers are disseminated out of school in cases where schools are interested in this.

The United Kingdom: this programme includes five lessons, lasting 30 minutes each. The lessons address smoking prevention in general; economic and environmental consequences of smoking; reasons for smoking; advertising; and decision making. The schoolchildren use worksheets and computer games. Teachers attend a one-day training course and receive manuals. Quit, a national non-smoking organisation, implements drama sessions where children interact with actors, discussing their opinions about smoking and how to stick to their opinions. The Seven Steps to Success policy manual produced by the Health Education Authority is disseminated in schools. There are no parental or community activities.

Portugal: this programme includes six lessons, partly based on the adapted PASE project implemented in Barcelona, that address the effects of tobacco; reasons for not smoking; and social influences, skills and decision making. The schoolchildren use worksheets. Teachers attend a 48-hour training course and receive a manual, and they are given credits for following the training course and giving lessons. Schools receive the ESFA non-smoking policy manual and a non-smoking poster for the national no-smoking day. On that day, teachers receive a letter asking them to discuss issues relating to smoking again with their pupils, and many schools also organise other activities (mainly involving sports). At the community level, the Portuguese health minister and the mayor of the local community publicise the ESFA project on the national no-smoking day.

Spain: in this programme, at the individual level, the PASE project has been adapted to the standards of ESFA, and includes sessions on increasing self-efficacy and training in refusal skills. The materials include teacher manuals, two videos, and worksheets for the children. Pupils receive six lessons on the effects of tobacco; peer pressure; advertising; the prevalence of smoking behaviour; the difficulty of quitting; refusal skills training; and planning future behaviour. Teachers receive four training sessions of two hours. Schools receive the ESFA schools policy manual, along with a letter for parents and non-smoking stickers. One poster is disseminated out of school.