# Evaluation of the Effectiveness of a School-Based Smoking Prevention Program Among Young Adolescents in Central Greece: An Analytical, Non-Randomized Interventional Study

## TL;DR

This study evaluates a school-based smoking prevention program for young adolescents in Greece, showing it improves knowledge and reduces smoking initiation.

## Contribution

The study provides evidence that school-based smoking prevention can be effective in elementary school students, a group underrepresented in tobacco research.

## Key findings

- The intervention improved smoking-related knowledge and attitudes in students.
- The program reduced the likelihood of smoking initiation among participants.
- Results suggest such programs can be effective in routine school settings.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Smoking initiation occurs early in adolescence, contributing to long-term tobacco-related morbidity and mortality.Yet, relevant research focused solely on elementary school students is limited.

Smoking initiation occurs early in adolescence, contributing to long-term tobacco-related morbidity and mortality.

Yet, relevant research focused solely on elementary school students is limited.

Public health significance—Why is this work of significance to public health?
The findings of this study contribute to the international literature on early smoking prevention. The findings demonstrate that preventive interventions are effective even before regular smoking behaviors are established.By evaluating school-based intervention among elementary school students using a longitudinal, interventional design, this study adds evidence from a developmental stage that remains underrepresented in global tobacco prevention research

The findings of this study contribute to the international literature on early smoking prevention. The findings demonstrate that preventive interventions are effective even before regular smoking behaviors are established.

By evaluating school-based intervention among elementary school students using a longitudinal, interventional design, this study adds evidence from a developmental stage that remains underrepresented in global tobacco prevention research

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Integrating structured smoking prevention programs into primary school curricula can strengthen early tobacco control strategies.The characteristics of our intervention (brief and delivered within routine school settings) enhance its potential applicability to other countries, particularly those with high adult smoking prevalence or national settings with limited resources.

Integrating structured smoking prevention programs into primary school curricula can strengthen early tobacco control strategies.

The characteristics of our intervention (brief and delivered within routine school settings) enhance its potential applicability to other countries, particularly those with high adult smoking prevalence or national settings with limited resources.

Background: Smoking remains a major global public health challenge. As smoking often begins in early adolescence, early preventive programs are essential, yet research focusing exclusively on elementary school students is limited. This study measured smoking prevalence, smoking-related knowledge and attitudes, and the impact of a school-based intervention on these outcomes among 12–13-year-old students in Larissa, Greece. Methods: A total of 769 students participated (response rate: 75%). Knowledge, attitudes, and smoking prevalence were assessed at baseline. The intervention group (n = 316) was exposed to audiovisual and printed materials, and both groups were followed up at three- and twelve months post-intervention. Multivariable linear mixed-effects models and generalized estimating equations were used to evaluate intervention effects. Results: Baseline characteristics were balanced between groups. A statistically significant stage × group interaction was observed, indicating improvements in smoking-related knowledge and attitudes (p < 0.001) and a reduced likelihood of smoking initiation (p = 0.011) in the intervention group. Conclusions: This school-based intervention demonstrated significant improvements in knowledge and attitudes toward smoking and reduced the likelihood of smoking initiation. These findings support integrating early prevention programs into school curricula as a potentially effective approach to improving smoking-related outcomes.