Bauman 1991

Clusters n = 2 (SMSAs)

Individuals n = 1637

Weekly and ever‐smoking

Overall outcome ‐ No evidence of an effect

Means of all smoking variables changed significantly in the direction of more smoking. No P values are significant (authors state that F > 1.00 in all instances).

Data consistent with the conclusion that the campaign did not influence smoking.

Fallin 2015

Clusters n = 33 (nightclubs/bars)

Individuals n = 3348

Daily and non‐daily smoking

Overall outcome ‐ No evidence of an effect

Smoking rates did not change across the 3 time periods (P = 0.17), but partiers who recalled the HAVOC intervention had lower daily smoking (OR 0.30, 95% CI 0.10 to 0.95; P < 0.05), compared to those who did not recall the intervention

Flay 1995

Clusters n = 47 (schools)

Individuals n = 4134

Smoker (No quantity)

Overall outcome ‐ No evidence of an effect

There were no consistent programme effects on smoking outcomes, suggesting that the treatment was no more or less effective for different groups
Control pretest mean = 2.09 versus 2‐year follow‐up = 2.76;
TV intervention group pretest mean = 2.06 versus 2‐year follow‐up = 2.91

Flynn 1995

Clusters n = 2 (communities)

Individuals n = 2860

Daily, weekly and smokeless tobacco

Overall outcome ‐ Favours intervention

Significant difference in the school‐and‐media group only within the final 2 years, a consistent trend toward less smoking was noted prior to this.

In the 5th year the relative differences for daily smoking was 34% and for weekly smoking 35% between school‐and‐media and school‐only groups.

For smokeless tobacco behaviour the 2 groups did not differ significantly, except in the 4th year when the school‐only group was more likely to report use.

Flynn 2010

Clusters n = 98 (schools)

Individuals n = 23,246

Weekly and monthly

Overall outcome ‐ No evidence of an effect

The 30‐day smoking rates appeared to decline over the 4‐year interval between baseline and follow‐up surveys for participants in both conditions, but this trend was not significant. Similar results were obtained for 7‐day prevalence.

Hafstad 1997

Clusters n = 2 (counties)

Individuals n = 6234

Daily, weekly, monthly, non‐smoker and smoker (No quantity)

Overall outcome ‐ Favours intervention

Among non‐smokers, a significantly lower proportion of adolescents of both genders had started to smoke in the intervention county compared to the proportion in the control county.

Among those who were smokers at baseline, significantly more girls in the intervention county had stopped than in the control county, while no significant differences were detected among boys.

Longshore 2006

Clusters n = 100 (schools)

Individuals:

ALERT n = 4276

ALERT Plus n = 4015

Weekly and monthly

Overall outcome ‐ Favours intervention

ALERT Plus held down current (past month) and regular (weekly) smoking producing a 23% reduction in both measures of use, P < 0.01.

Project ALERT curbed current use among the high‐risk experimenters and the even higher‐risk baseline smokers (users) by approximately 20% (P < 0.03), and cut regular (weekly) cigarette use across all 3 groups by anywhere from 19% (P < 0.06) to 39% (P < 0.02).

Worden 1983

Clusters n = 93 (schools)

Individuals n = 4005

Weekly

Overall outcome ‐ No evidence of an effect

There were no significant differences in smoking between intervention and control groups. A trend (non‐significant) favouring the intervention group toward a lower level of smoking was noted. P values were not provided.

Bauman 1991

Clusters n = 2 (SMSAs)

Individuals n = 1637

Attitudes toward smoking (total), perceived peer attitudes

Overall outcome ‐ No evidence of an effect

No statistically significant post‐campaign differences in attitudes, suggesting that the peer‐involvement component did not impact on those characteristics.

Flay 1995

Clusters n = 47 (schools)

Individuals n = 4134

Disadvantages/negatives (toward parental smoking)

Overall outcome ‐ Favours intervention

Marginally significant overall effect (P < 0.06), but there was a significant interaction between television and social resistance conditions at immediate post‐test, (P < 0.03). In San Diego there was more positive change in the social resistance condition, (P < 0.003) toward disapproval of parental smoking (Intervention description 4 in Characteristics of included studies table).

Flynn 1995

Clusters n = 2 (communities)

Individuals n = 2860

Attitude toward smoking (total), advantages/positives, disadvantages/negatives

Overall outcome ‐ Favours intervention

A significant difference in change over time was found between girls in the 2 treatment groups with scores increasing less among girls in the media‐school communities, for positive attitudes toward smoking (P < 0.02).

Flynn 2010

Clusters n = 98 (schools)

Individuals n = 23,246

Advantages/positives, disadvantages/negatives

Overall outcome ‐ Favours control

Positive outcome expectation scores increased significantly over time in both study groups, an unfavourable change. Negative outcome expectation scores may have decreased in the comparison but not in the intervention group, although this difference was not significant.

Longshore 2006

Clusters n = 100 (schools)

Individuals ALERT n = 4276

ALERT Plus n = 4015

Advantages/positives, disadvantages/negatives, perceived peer attitudes

Overall outcome ‐ No evidence of an effect

Neither boys nor girls exhibited significant differences for tobacco cognitions.

Flay 1995

Clusters n = 47 (schools)

Individuals n = 4134

Intentions to smoke

Overall outcome ‐ No evidence of an effect

There were no significant condition‐related differences at any wave in Los Angeles or San Diego. No consistent programme effects on behaviours

Flynn 1995

Clusters n = 2 (communities)

Individuals n = 2860

Intentions to smoke

Overall outcomes ‐ Favours intervention

A significant difference in change over time was found between girls in the 2 treatment groups, with a lower increase among girls in the media‐school communities in intentions to smoke cigarettes (P < 0.01).

Flynn 2010

Clusters n = 98 (schools)

Individuals n = 23,246

Intentions to smoke

Overall outcome ‐ No evidence of an effect

Intentions to smoke appeared to decline over the 4‐year interval between baseline and follow‐up surveys for participants in both conditions, but this trend was not significant.

Hafstad 1997

Clusters n = 2 (counties)

Individuals n = 6234

Intentions to smoke

Overall outcomes ‐ Favours intervention

A significant difference between the intervention and the control counties was detected regarding expectation of future smoking habits measured in 1995. In the intervention county, 9% expected to be smokers in 3 years, with 13% in the control county (P < 0.01). No significant gender difference was revealed.

Flay 1995

Clusters n = 47 (schools)

Individuals n = 4134

Tobacco and health knowledge (overall)

Overall outcome ‐ Favours control

Tobacco and health knowledge was significantly higher in the attention control group than in any of the other conditions in Los Angeles at the immediate post‐test (P < 0.001), 1‐year follow‐up (P < 0.001) and 2‐year follow‐up (P < 0.001). However, both smokers and non‐smokers in the attention control condition learned more than students in any of the other conditions.

Unexpectedly, tobacco and health knowledge also increased in the social resistances programme in San Diego at the immediate post‐test (P < 0.001). However, this effect was not statistically significant at the 1‐ and 2‐year follow‐ups.

There were significant differences in the social influences and resistance skills knowledge scale between conditions in Los Angeles at the immediate post‐test (P < 0.001), 1‐year follow‐up (P < 0.001) and 2‐year follow‐up (P < 0.001).

The combined television and social resistance condition did not improve as much, relative to the control conditions, as the social resistance condition.

Flay 1995

Clusters n = 47 (schools)

Individuals n = 4134 (whole sample)

n = 2245 for control sample only

Self‐efficacy

Overall outcome ‐ No evidence of an effect

Refusal self‐efficacy did not differ significantly between groups for the primary population comparison. In Los Angeles, there were no significant condition‐related effects at any of the waves. In San Diego, refusal/self‐efficacy was unexpectedly improved in the control condition, relative to the social resistance condition, at the immediate post‐test, (P < 0.004).

Longshore 2006

Clusters n=100 (schools)

Individuals ALERT n=4276

ALERT Plus n=4015

Self‐efficacy

Overall outcome ‐ No evidence of an effect

Neither group exhibited significant differences for tobacco cognitions.

Flay 1995

Clusters n = 47 (schools)

Individuals n = 4134

Perceived adult smoking, perceived peer smoking

Overall outcome ‐ Favours intervention

There were significantly lower prevalence estimates, (peer) for the social resistance, (P < 0.001) and television (P < 0.006) conditions, and at 2 years the main effect of the social resistance conditions remained. However, the presence of a significant interaction between the television and social resistance conditions (P < 0.05) indicated that the lower prevalence estimates of the social resistance condition was increased in the television plus social resistance condition.

Flynn 1995

Clusters n = 2 (communities)

Individuals n = 2860

Perceived norms, perceived adult smoking, perceived peer smoking, perceived sibling smoking.

Overall outcome ‐ Favours intervention

A significant difference in change over time was found between girls in the 2 treatment groups with scores increasing less among girls in the media‐school communities, for perceived peer smoking (P < 0.01). This difference was likely due to the slightly older age and greater representation of boys in the school‐only group.

A significant difference was evident at grades 5 to 7, that persisted at grades 8 to 10, for perceived norms (P < 0.01).

Flynn 2010

Clusters n = 98 (schools)

Individuals n = 23,246

Perceived norms, perceived peer smoking

Overall outcome ‐ No evidence of an effect

Significant favourable changes in both study groups for perceived prevalence and peer norms, but there were no between‐group differences

Longshore 2006

Clusters n = 100 (schools)

Individuals ALERT n = 4276

ALERT Plus n = 4015

Perceived norms

Overall outcome ‐ No evidence of an effect

Neither group exhibited significant differences for tobacco cognitions.