Periodic Reporting for period 2 - SILNE-R (Enhancing the effectiveness of programs and strategies to prevent youth smoking: a comparative realist evaluation of 7 European cities)
Reporting period: 2017-04-01 to 2018-10-31
In the early 21st century, cigarette smoking is still a major threat to the health of European populations. To prevent life-long addiction, it is critical to prevent young people from experimenting and regularly using tobacco. In principle, several effective strategies are now available to prevent cigarette smoking in Europe. However, most smoking prevention strategies have been found to effective in theory and in experiments rather than in the real world. Typically, in the real world, programs are effective in some countries or local settings, but not in others.
Given this situation, there is an urgent need for systematic evidence on how tobacco control strategies and programs work in practice to (not) influence smoking behaviour of young people. Such knowledge is needed to inform decision makers who wish to use available resources in effective and equitable ways. To address these questions, we apply the concepts and approaches of ‘realist evaluation’.
The overall objectives of this project are:
1. to assess how recent strategies and programs to prevent youth smoking have been implemented at national, municipal and school levels, and how they have influenced smoking behaviour of 16 year old adolescents in seven European countries,
2. to develop and to disseminate the fine-grained evidence that is needed to support decision makers in implementing strategies to prevent youth smoking in local settings, with due attention for program costs and for inequalities in smoking.
Given this situation, there is an urgent need for systematic evidence on how tobacco control strategies and programs work in practice to (not) influence smoking behaviour of young people. Such knowledge is needed to inform decision makers who wish to use available resources in effective and equitable ways. To address these questions, we apply the concepts and approaches of ‘realist evaluation’.
The overall objectives of this project are:
1. to assess how recent strategies and programs to prevent youth smoking have been implemented at national, municipal and school levels, and how they have influenced smoking behaviour of 16 year old adolescents in seven European countries,
2. to develop and to disseminate the fine-grained evidence that is needed to support decision makers in implementing strategies to prevent youth smoking in local settings, with due attention for program costs and for inequalities in smoking.
During the reporting periods, we have performed the work in full agreement with the plans that we had outlined in the project proposal. For each work package, we will summarise the work performed and main results achieved during the reporting period.
WP 1 (Management and coordination). We have, amongst others,
- organised three consortium meetings and one Advisory Board meeting,
- provided scientific support to the work in other WPs, e.g. by organising a two-day training workshop on ‘realist’ methods (Utrecht, January 2016).
WP 2 (Consultation, dissemination and exploitation). We have
- established and met 8 consultation groups, one for each of the 7 countries, and one international group,
- established an external communication structure, using a new project website, Twitter and Facebook pages, and the ENSP newsletter,
- presented the project at international meetings (e.g. at Brussels, April 2016; Prague, September 2016; Ljubljana, October 2016; Porto, March 2017).
WP 3 (Policy recommendations). We have
- mapped the evidence that tobacco control policy makers need with regards to the costs and impact of policies at local levels,
- made recommendations for the new scientific evidence that is to be generated in SILNE-R,
- prepared a document reporting on the consultation meetings (with WP2).
WP4 (Models of change). We have
- developed the outline of ‘models of change’ that specify how tobacco control strategies could contribute to tackling youth smoking,
- performed a series of systematic reviews of literature to support these models (with WP5-7),
- reported on these literature reviews in 5 papers for international scientific journals.
WP5 (Implementation at national level). We have
- prepared an overview of current theories and evidence on national-level factors that influence the implementation of tobacco control policies,
- performed a systematic review on these factors, and reported on this in a scientific paper,
- held semi-structured interviews with about 25 policy makers (about 4 in each country), to assess factors that influenced their decision making,
- started with the transcription and analysis of the interview data.
WP6 (Implementation at local level). We have
- prepared an overview of current theories and evidence on local-level factors,
- performed a systematic review on these factors, and reported on this in a scientific paper,
- organised a training session for local interviewers from seven countries (Berlin, September 2016),
- organised semi-structured interviews with about 30 local-level policy and stakeholders (about 5 in each country/city).
WP7 (Implementation at school levels). We have
- prepared a review of current theories and evidence regarding school-level factors,
- reported on this review in a scientific paper to be submitted to an international journal,
- organised the interviewers’ training session (with WP6),
- organised semi-structured interviews with key informants of school staff in four schools in each country (in total about 55 informants).
WP8 (School survey). We have organised the second SILNE survey, by
- designing questionnaires, translating them into different languages, and piloting them in each country,
- administering the survey in 57 schools to about 12.000 students around 14-16 years,
- administering a questionnaire among school staff (at least 3 staff members per school),
- organising data input and processing, using a data entry web platform.
WP9 (Focus group discussions). We have organised focus group discussions with adolescents, by
- identifying potential participants by teachers,
- developing the focus group topic guides, and translating these into different languages,
- providing briefing, training and support to the focus group facilitators (with WP6),
- undertaking 56 focus group discussions with 14-15 year olds drawn from 2 schools in each city.
WP10 (Costs and cost-effectiveness). We have
- reviewed previous studies on program cost estimates and related measurement methods,
- reported on the review in a paper for an international scientific journal,
- defined the scope of the new cost study (e.g. which costs to be included),
- established the list of data needed to evaluate program costs, and informants to be contacted,
- started the fieldwork.
WP 1 (Management and coordination). We have, amongst others,
- organised three consortium meetings and one Advisory Board meeting,
- provided scientific support to the work in other WPs, e.g. by organising a two-day training workshop on ‘realist’ methods (Utrecht, January 2016).
WP 2 (Consultation, dissemination and exploitation). We have
- established and met 8 consultation groups, one for each of the 7 countries, and one international group,
- established an external communication structure, using a new project website, Twitter and Facebook pages, and the ENSP newsletter,
- presented the project at international meetings (e.g. at Brussels, April 2016; Prague, September 2016; Ljubljana, October 2016; Porto, March 2017).
WP 3 (Policy recommendations). We have
- mapped the evidence that tobacco control policy makers need with regards to the costs and impact of policies at local levels,
- made recommendations for the new scientific evidence that is to be generated in SILNE-R,
- prepared a document reporting on the consultation meetings (with WP2).
WP4 (Models of change). We have
- developed the outline of ‘models of change’ that specify how tobacco control strategies could contribute to tackling youth smoking,
- performed a series of systematic reviews of literature to support these models (with WP5-7),
- reported on these literature reviews in 5 papers for international scientific journals.
WP5 (Implementation at national level). We have
- prepared an overview of current theories and evidence on national-level factors that influence the implementation of tobacco control policies,
- performed a systematic review on these factors, and reported on this in a scientific paper,
- held semi-structured interviews with about 25 policy makers (about 4 in each country), to assess factors that influenced their decision making,
- started with the transcription and analysis of the interview data.
WP6 (Implementation at local level). We have
- prepared an overview of current theories and evidence on local-level factors,
- performed a systematic review on these factors, and reported on this in a scientific paper,
- organised a training session for local interviewers from seven countries (Berlin, September 2016),
- organised semi-structured interviews with about 30 local-level policy and stakeholders (about 5 in each country/city).
WP7 (Implementation at school levels). We have
- prepared a review of current theories and evidence regarding school-level factors,
- reported on this review in a scientific paper to be submitted to an international journal,
- organised the interviewers’ training session (with WP6),
- organised semi-structured interviews with key informants of school staff in four schools in each country (in total about 55 informants).
WP8 (School survey). We have organised the second SILNE survey, by
- designing questionnaires, translating them into different languages, and piloting them in each country,
- administering the survey in 57 schools to about 12.000 students around 14-16 years,
- administering a questionnaire among school staff (at least 3 staff members per school),
- organising data input and processing, using a data entry web platform.
WP9 (Focus group discussions). We have organised focus group discussions with adolescents, by
- identifying potential participants by teachers,
- developing the focus group topic guides, and translating these into different languages,
- providing briefing, training and support to the focus group facilitators (with WP6),
- undertaking 56 focus group discussions with 14-15 year olds drawn from 2 schools in each city.
WP10 (Costs and cost-effectiveness). We have
- reviewed previous studies on program cost estimates and related measurement methods,
- reported on the review in a paper for an international scientific journal,
- defined the scope of the new cost study (e.g. which costs to be included),
- established the list of data needed to evaluate program costs, and informants to be contacted,
- started the fieldwork.
1.3. Progress beyond the state of the art and expected potential impact
The potential impact of the project is expected to be realised by the end of the project, when the results of the new empirical analyses will be become available for dissemination. We expect to realise three key impacts.
Impact 1. Evidence for prevention. The evidence generated in this project is aimed to improve the use of five smoking prevention strategies that are strongly recommended in policy documents, but in real-world practice often yet poor in implementation and impact. The project will deliver the specific evidence that is needed to increase their cost-effectiveness and equity in impact.
Impact 2. Capacity building. The project will be the first to apply ‘realist’ methods to the evaluation of preventive programmes. Our experiences will be carefully evaluated and widely disseminated. We have already initiated efforts to contribute to capacity building in European prevention research. E.g. we have disseminated the ‘realist’ methodology via presentations at various international meetings (Brussels, April 2016; Prague, September 2016; Ljubljana, October 2016; Porto, March 2017).
Impact 3. Greater health equity and cost effectiveness. For real-world tobacco control strategies to be effective and efficient, they need to be adapted to the specific national or local context, or to the situation of disadvantaged youth. This project will generate the fine-grained evidence that policy makers badly need to enhance the equity-impact and cost-effectiveness of programs. Ultimately, this will contribute to reducing the unacceptable burden of tobacco-related disease and death in Europe.
The potential impact of the project is expected to be realised by the end of the project, when the results of the new empirical analyses will be become available for dissemination. We expect to realise three key impacts.
Impact 1. Evidence for prevention. The evidence generated in this project is aimed to improve the use of five smoking prevention strategies that are strongly recommended in policy documents, but in real-world practice often yet poor in implementation and impact. The project will deliver the specific evidence that is needed to increase their cost-effectiveness and equity in impact.
Impact 2. Capacity building. The project will be the first to apply ‘realist’ methods to the evaluation of preventive programmes. Our experiences will be carefully evaluated and widely disseminated. We have already initiated efforts to contribute to capacity building in European prevention research. E.g. we have disseminated the ‘realist’ methodology via presentations at various international meetings (Brussels, April 2016; Prague, September 2016; Ljubljana, October 2016; Porto, March 2017).
Impact 3. Greater health equity and cost effectiveness. For real-world tobacco control strategies to be effective and efficient, they need to be adapted to the specific national or local context, or to the situation of disadvantaged youth. This project will generate the fine-grained evidence that policy makers badly need to enhance the equity-impact and cost-effectiveness of programs. Ultimately, this will contribute to reducing the unacceptable burden of tobacco-related disease and death in Europe.