Programas de prevención de tabaquismo para mujeres adolescentes / Smoking prevention programs for girls

ABSTRACT

In recent years, the number of women who use tobacco has increased rapidly. Among youngsters, gender gap is closing, and the proportion of girls who smoke is already very similar to that of boys, with the added complication that the girls are more vulnerable to addiction, and tobacco use has severe consequences for their health and the well-being of their future children. The key to facing tobacco epidemic is prevention by strengthening protective factors and reducing risk factors that lead to smoking onset. School environment is the most valuable resource for anti-smoking programs. These efforts are commonly focused on elementary and secondary students because experimentation with tobacco and adoption of smoking behavior occur at this stage. There are three intervention models in schools 1. Information model (or rational), 2. Social skills model (or affective), and 3. Social influence model, which emphasizes social environment as a critical factor in tobacco use. In this model the children are informed about the immediate negative effects of smoking (unfavorable effects on appearance, economic costs and social consequences such as rejection by others). The model also conveys a positive image of non-smokers as rational people, and a negative one of a smoker as someone vulnerable to advertising tricks. It uses the peer group for showing resistance to pressure and how to adopt and to maintain the decision not to smoke, and it teaches how to identify influences from tobacco advertising, peers and family. The social influence programs tend to be the most effective strategy for achieving at least some delay in onset of tobacco use. It is necessary to develop appropriate programs for each age and for a specific gender. Recently, researchers have begun using programs based on computer systems and Internet to prevent teen smoking. The aim of this study was to design, implement and evaluate two different types of tobacco prevention programs, tailored specifically for teenage girls. The programs were computer games and an interactive workshop, as well as the combination of both of them (games plus workshop). It was suggested that in treatment groups versus control group, smoking susceptibility scores (i.e., lack of a firm commitment to not smoke) would be lower in post test. It was also hypothesized that the games plus workshop group would affect the scores of the associated variables with susceptibility, and that changes would remain in the follow-up. Material and methods 537 student girls in the three grades of secondary school were asked to answer the Smoking Susceptibility Scale. Out of this group, 160 girls that obtained the highest scores were selected, because they were considered at risk of becoming regular smokers. Six variables related with smoking susceptibility were also measured Belief in the addictive property of tobacco, beliefs in smoking benefits, empathy with smoking victims, negative attitudes toward tobacco industry, skills rejecting social pressure to smoke, and identification of diseases associated with smoking in women. The Smoking Susceptibility Scale was applied at three moments of the measurement A pretest (one week before programs starting), a post test (the last day of the program or programs), and a follow-up (four months after implementing the post test). In the last two occasions, the instruments of variables related with susceptibility were also applied. The two types of prevention programs (computer games and interactive workshop) were based on the social influence model. The purpose of the games was that the girls acquire skills to recognize and resist social pressures to smoke exerted by both the tobacco industry through advertising strategies, and their peers. The interactive workshop was designed according to the strategies of anti-smoking messages that have proved to be effective in order to prevent smoking; the immediate negative consequences suffered by smokers and the physical and psychological vulnerability of women produced by smoking were also highlighted. A mixed 4 inter-groups X 3 intra-groups design was applied (4 treatments Computer games, interactive workshop, games plus workshop, control, X 3 measurement times Pretest, post test, follow-up). The 160 participants were randomly assigned to one of the four treatment groups. The study consisted of four phases pre test, treatment (one week later), post test (on completion of program implementation) and follow-up (four months after the post test). Results There was an immediate effect of the three treatments on the smoking susceptibility by contrasting pre test versus post test, but games plus workshop group had more effect than games or workshop ones. When comparing post test and follow-up measurements in the games plus workshop group versus the control group, it was found that smoking susceptibility scores of the treatment group stayed unchanged. For related variables, the girls who participated in the games plus workshop group had higher scores than the control group in the belief of tobacco addictive property, in empathy with smoking victims, in the negative attitude toward the tobacco industry, in the refusal skills towards social pressure to smoke, and in the identification of diseases associated with smoking in women, and lower scores on beliefs in the benefits of smoking (attractive appearance, emotional well-being, popularity and social acceptance). At the follow-up, it was observed that attitudes toward tobacco companies became even more negative and that participants identified more diseases caused by smoking in women than in the post test, i.e., the treatment effect was strengthened. Discussion The main guideline in the construction of smoking behavior prevention programs evaluated in this study was its focus on adolescent girls. Furthermore, they were only addressed to those adolescents with high scores on smoking susceptibility, due to the intention of using the available resources more efficiently. Another criterion taken into a count in order to build these programs was the shortness of the intervention. The results showed that smoking susceptibility on the participants of each one of the three treatment groups decreased from the pre test to the post test, but the decline was even greater in the games plus workshop group. The smoking susceptibility of the games plus workshop group remained low in the follow-up after four months of its implementation, which did not occur with the workshop or games groups alone. It appears that the more elements used in the prevention programs the greater their impact will be. Compared with the control group, the majority of variables related with smoking susceptibility were affected by the games plus workshop treatment. In conclusion, the combination of preventive programs for smoking addiction constructed in this study specifically for girls with the implementation of psychosocial principles and the use of computer technology decreased the smoking susceptibility on participants, as well as most of the related variables. Moreover, their effects persisted at least for a period of four months. Computer games, which were of interest to participants, could be easily installed on computer rooms of secondary schools, and even uploaded in the Internet, and its effects could be enhanced by an interactive workshop, which promotes interpersonal contact and discussion of false beliefs regarding tobacco use that girls support. The girls at risk who change their smoking susceptibility as a result of their participation in these smoking prevention programs will avoid the severe consequences of using tobacco and will gain years of healthy life for themselves and their descendants.

RESUMEN

El consumo de tabaco en las mujeres se ha incrementado aceleradamente. Entre los adolescentes, la brecha de género se está estrechando, ya que el porcentaje de fumadoras es ya muy similar al de los varones, con el agravante de que ellas son más vulnerables a la adicción al tabaco y su consumo tiene serias consecuencias para su salud y la de sus futuros hijos. La principal alternativa para enfrentar la epidemia de tabaquismo es la prevención. Existen básicamente tres modelos de intervención antitabaco en las escuelas modelo de información, modelo de habilidades sociales y modelo de influencia social, el cual ha mostrado ser el más efectivo para lograr, al menos, retrasar el inicio del consumo. Se ha señalado que es necesario desarrollar programas adecuados específicos para cada edad y género. El propósito de la presente investigación fue construir, aplicar y evaluar dos diferentes tipos de programas de prevención del tabaquismo (juegos de computadora y taller interactivo) y la combinación de ambos (¡uegos+taller), dirigidos específicamente a mujeres adolescentes. Material y métodos De las 537 mujeres estudiantes de secundaria que contestaron la Escala de Susceptibilidad Tabáquica, las 160 adolescentes que obtuvieron los puntajes más altos fueron asignadas aleatoriamente a uno de cuatro grupos de tratamiento Juegos de computadora, Taller interactivo, Juegos+taller y Control. Los programas se desarrollaron con base en el modelo de influencia social. El estudio constó de cuatro fases premedición, tratamiento, pos-medición y seguimiento (cuatro meses después). Se evaluaron además seis variables precurrentes de la susceptibilidad tabáquica creencia en la propiedad adictiva del tabaco, creencias en los beneficios de fumar, empatia hacia las víctimas del tabaco, actitud negativa hacia las tabacaleras, habilidades de rechazo ante la presión social para fumar e identificación de enfermedades asociadas con el tabaco en las mujeres. Resultados La susceptibilidad tabáquica de las participantes en los tres grupos de tratamiento disminuyó significativamente de la premedición a la post-medición, pero los efectos persistieron en el seguimiento sólo en el grupo de Juegos+taller. Respecto de las variables precurrentes, quienes participaron en el grupo Juegos+taller obtuvieron puntajes más altos que las del grupo control en la creencia en la propiedad adictiva del tabaco, en la empatia hacia las víctimas del tabaco, en la actitud negativa hacia las tabacaleras, en las habilidades de rechazo a la presión social para fumar y en la identificación de las enfermedades asociadas con el tabaco en las mujeres, y menores puntajes en las creencias en los beneficios de fumar (apariencia atractiva, bienestar emocional, popularidad y aceptación social). En el seguimiento se observó que las actitudes hacia las tabacaleras se hicieron aún más negativas y las participantes señalaron más enfermedades causadas por el tabaco en las mujeres, que en la posmedición, es decir, se reforzó el efecto del tratamiento. Discusión La combinación de los programas preventivos de la adicción al tabaco para mujeres adolescentes construidos en este estudio con la aplicación de principios psicosociales y la utilización de tecnología computacional, disminuyeron la susceptibilidad tabáquica de las participantes, así como la mayoría de las variables precurrentes. Además, sus efectos persistieron durante un periodo de cuatro meses. Los programas podrían aplicarse fácilmente en el ámbito escolar los juegos de computadora podrían instalarse en los salones de cómputo o colocarse en Internet, y su efecto se reforzaría con el taller interactivo, el cual es de intervención breve y propicia el contacto interpersonal y la discusión de las creencias falsas respecto del consumo de tabaco que sostienen las adolescentes. Las chicas en riesgo tabáquico que cambien su susceptibilidad como consecuencia de su participación en estos programas evitarán las serias consecuencias del consumo de tabaco y ganarán años de vida sana para ellas y sus descendientes.