Original Title: Evaluación de una intervención sobre tabaquismo en enseńanza secundaria. Programa ITES

Authors' objectives: This report has three main objectives: 1. Evaluation of effectiveness of a preventive program on smoking in high schools. 2. Literature review of cost-effectiveness of educational preventive smoking programs in adolescents. 3. Evaluation of cost-effectiveness of the intervention.

Authors' results and conclusions: RESULTS: The relative risk reduction (RRR) for smokers experimenters is 57% for students who have received 4 years of intervention, with a relative risk (RR) of 0.43 (CI 95% 0.28 to 0, 64; P < 0.0001); no differences in the program's effectiveness were observed by gender. It was observed that with increasing the intervention years, the results are better, however, a significant results start from the second year. The same results were observed for smokers, with an RRR of 78.4% and an RR of 0.21 (CI 95% 0.08 to 0.55; P = 0.0001) after four years of intervention. The number of students needed to treat to prevent one experimenter is 2.7, and to prevent one smoker 4.2. Neither the average daily consumption of smokers, nor the average age of experimenters differed between intervention and control group. The literature review revealed that there are few complete economic evaluations that assess a preventive intervention against youth smoking. Five studies were identified, three of them found that the evaluated program produced savings, ie future costs saved exceed the costs of the intervention, which also confirm our results. The other two studies found a favourable cost-effectiveness ratio. The economic evaluation of the program shows an incremental cost-effectiveness ratio of -44,911 € / LYG, which means that every Euro invested in the program will produce future savings between 10€ and 20€. Taking into account the acceptability curve for willingness to pay of 9,000 € / AVG, the probability that the implementation of the ITES will be successful is 95%. CONCLUSIONS: The ITES program is effective in reducing smoking and experimenting with smoking among teenagers, without differences between gender, despite the study does not have a design with a gender perspective. Although the program could be applied by modules (years), the full implementation of 4 years offers best results. The program has proven to be cost- effective, hence the introduction of the ITES in all schools in the Canary Islands would provide future cost savings of between 10 and 22 times the amount invested in the program.

Authors' methods: The information needed to carry out the evaluation of the effectiveness of the Tobacco Intervention Program in Secondary Education (ITES) and its economic evaluation has been obtained from a randomized controlled longitudinal study. The study area was the island of Tenerife, and three schools were randomly selected as intervention centres, while six centres were assigned as controls. In the intervention cohort a preventive program was applied, consisting of 17 activities spread over 15 workshops over the four years of secondary education, which ran from 2002 to 2006. The intervention was evaluated in 180 students in 4th year of secondary education (ESO) and the control group obtained information from 1,001 students. The workshops were coordinated and moderated by teachers of each school. At the beginning and end of each school year the results were evaluated by a self-completed survey among the students. The theoretical framework for ITES is the PRECEDE model (Predisposing, Reinforcing, and Enabling Constructs in Educational / Environmental Diagnosis and Evaluation) developed by L. W. Green et al and recently adapted for diagnostic behaviour studies by J. L. Bimbela. The literature search was conducted in the electronic database of economic evaluations (NHS EED) of the Centre for Reviews and Dissemination at the University of York (CRD) in September 2008; in addition, a manual search was carried out, checking references of identified articles and Spanish journals (until February 2009). For the cost-effectiveness analysis a decision tree model was developed, in which one branch represents a scenario in which the ITES is implemented in high schools, while another branch would be a scenario without the program. The analysis was conducted from the health-care system perspective and the time horizon was the lifetime of the student. The effectiveness measure chosen was the life years gained (LYG) and costs and effects were discounted at a rate of 3%. A stochastic and multivariate sensitivity analyses were carried out and acceptability curves were calculated.

Project Status: Completed

Year Published: 2010

URL for published report: https://sescs.es/evaluacion-de-una-intervencion-sobre-tabaquismo/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es