Ensuring that a school-based smoking cessation program for adolescents is successful: A realist evaluation of the TABADO program and the program theory.

BACKGROUND: A smoking cessation program for adolescents, TABADO, demonstrated its effectiveness following a controlled trial conducted in 2007/2009. The program is now being scaled up nationally. In order to retain its efficacy across the diversity of contexts in the generalization process, we needed to assess the processes and mechanisms that inform its effects. Theory-driven evaluation is one approach used to address these issues. The aim of the present research is to develop the TABADO program theory. More specifically, we attempt to identify the factors and mechanisms that promote or hinder the enrollment and retention of student smokers in the program. METHODS: We conducted a realist evaluation of the TABADO program through 1) a documentary analysis to construct the initial program theory, and 2) a multiple case study (n = 10) conducted in three regions in France to test and enrich the initial theory with contextual, organizational and mechanistic components. We used the Intervention-Context-Actors-Mechanisms-Outcomes configurations to guide our analysis and to present our results. RESULTS: Our analysis highlighted 13 mechanisms that foster the enrollment and retention of student smokers in the TABADO program (e.g., being prepared to quit smoking, feeling encouraged in the attempt to quit smoking). To activate these mechanisms, the involvement of various actors is required (e.g., the school nurse, teachers), together with a combination of interventional and contextual factors (e.g., confidentiality, informal speaking time). CONCLUSIONS: These findings allowed us to transform the TABADO program into a new optimized strategy, TABADO2, which is theory-based. Our research helps to explain why adolescent smokers enroll and stay in a school-based smoking cessation program. TABADO2 needs to be considered in a more comprehensive way than the original research-based TABADO, and should be tailored to its implementation context.

TABADO 2 : une stratégie d'accompagnement au sevrage tabagique des adolescents en milieu scolaire.

La consommation de tabac est une des premières causes de mortalité évitable au niveau mondial. La dépendance au tabac s'observe dès l'adolescence. En complément des actions visant à prévenir l'entrée des jeunes dans le tabagisme, il est donc nécessaire de développer des stratégies spécifiques pour les adolescents déjà fumeurs. Un programme d'accompagnement au sevrage tabagique pour adolescents, TABADO, a montré son efficacité lors d'un essai contrôlé mené dans des centres de formation des apprentis en 2007/2009. En 2018, l'Institut national du cancer a souhaité généraliser TABADO au niveau national et l'étendre aux lycées professionnels. Pour accompagner ce processus de mise à l'échelle, il était essentiel d'élaborer la théorie d'intervention et d'analyser la transférabilité de TABADO en conditions de vie réelle et dans de nouveaux contextes, et de proposer les adaptations correspondantes. Une recherche spécifique a été conduite et détaillée par ailleurs. L'objectif de cette publication pragmatique est de présenter la nouvelle stratégie TABADO 2 aux acteurs et décideurs de santé publique, et le guide afférent développé pour les accompagner dans la mise en œuvre.Une étude de cas multiples (n = 10) a été menée à partir de la mise en œuvre de TABADO dans trois régions françaises, qui reposait sur des observations, entretiens et séminaires de retour d'expérience. Elle a mis en évidence l'adaptation de l'intervention aux contextes locaux, ainsi que de nouveaux leviers interventionnels mis en œuvre. De plus, les investigations ont montré que pour instaurer un climat favorable à la démarche d'arrêt de la consommation de tabac et soutenir son maintien sur la durée, il était nécessaire d'inscrire TABADO dans une stratégie globale de l'établissement scolaire et de son environnement. Cette démarche a permis de proposer une transformation de l'intervention TABADO en une nouvelle stratégie - TABADO 2 - et de proposer un guide pour accompagner son déploiement national.

Predictors of Cigarette Smoking Cessation in Adolescents: A Systematic Review.

PURPOSE: To update a systematic review published in 2012 that identified predictors of cigarette smoking cessation among adolescents. METHODS: The PubMed and Web of Science databases were searched for relevant articles published between September 2010 and January 2018, using the following keywords: smoking OR tobacco OR cessation; quit OR stop; longitudinal OR prospective OR cohort. Our search identified 3,399 articles. Inclusion criteria included longitudinal studies (intervention and cohort studies) evaluating cigarette smoking cessation in young people (aged 10-24 years). After screening, in total, 34 articles were included in the review. RESULTS: In total, 63 predictors of smoking cessation among adolescents were identified, with 36 new predictors that were not identified in the previous review: nine sociodemographic factors, 13 psychosocial factors, five behavioral factors, 19 social influences factors, eight smoking related variables, six environmental factors, 2 health related variables, and one genetic factor. CONCLUSIONS: To increase the probability of successful smoking cessation, strategies targeting young smokers should consider both individual and environmental predictors of cessation.

Spa therapy with physical rehabilitation is an alternative to usual spa therapy protocol in symptomatic knee osteoarthritis.

The objective of the study was to demonstrate the non-inferiority of low-frequency spa therapy combined with rehabilitation (Spa-rehab) versus standard spa therapy at 6 months for symptomatic knee osteoarthritis (KOA). A prospective, randomized, monocenter, non-inferiority trial with recruitment of community-based symptomatic KOA patients was performed. Standard spa therapy comprised standardized spa treatment, 6 days a week for 3 weeks, and Spa-rehab therapy comprised spa sessions, 3 days a week for 3 weeks, followed by a dedicated rehabilitation program, 3 days a week for 3 weeks. The primary endpoint was achieving at 6 months a minimal clinically important improvement (MCII) for pain on a visual analog scale and/or an MCII for function on the WOMAC index and no knee surgery (composite MCII). Secondary endpoints were composite MCII at 3 months and achieving a Patient Acceptable Symptom State (PASS) for pain and function at 3 and 6 months. Among 283 patients included, 145 were allocated to standard spa therapy and 138 to Spa-rehab therapy. We could not demonstrate the non-inferiority of Spa-rehab therapy for the primary endpoint: difference for responders - 0.08 [90% CI (- 0.18 to 0.02), p = 0.14]. However, the difference test between the groups was not significant (p = 0.18). Spa-rehab therapy was not inferior to standard spa therapy for the composite MCII at 3 months or the PASS at 3 and 6 months. Spa-rehab therapy can reasonably be proposed to patients with symptomatic KOA. This protocol may be more cost-effective than standard spa therapy and avoid absenteeism from work and accommodation costs for patients who live close to a centre.

Evaluation of osteoarthritis knee and hip quality of life (OAKHQoL): adaptation and validation of the questionnaire in the Hungarian population.

BACKGROUND: At least 17% of the population suffers from osteoarthritis (OA) in Hungary, according to the European Health Interview Survey. In Hungary, until now there was no OA-specific questionnaire available for the lower limb, in order to monitor the health-related quality of life (HRQoL). This gap gave the relevance of this research. The aim of the study was to perform the Hungarian cross-cultural adaptation and validation of the French-developed Osteoarthritis Knee and Hip Quality of Life (OAKHQoL) questionnaire. METHODS: The five-step translation procedure of the original OAKHQoL was performed by the expert panel and the translators. The created Hungarian version (OAKHQoL-HUN) was tested in six different geographical areas of Hungary. The validity and the reliability of this adapted tool was analyzed by our research group. RESULTS: A total of 99 patients completed the questionnaires (78 women and 21 men), with the average age of 66.6 years (standard deviation (SD) 12.1), living with OA for more than 10 years. Excellent internal consistency was observed in the following domains: physical activity (α = 0.93), mental health (α = 0.91) and pain (α = 0.89). Good correlation was determined between physical subscales (r = 0.615-0.676) and mental subscales (r = 0.633-0.643) compared to generic quality of life instruments (World Health Organization Quality of life - BREF questionnaire and EQ-5D-3L). CONCLUSION: The OAKHQoL-HUN is the first valid and reliable tool for measuring the Hungarian lower limb OA patients' quality of life. TRIAL REGISTRATION: This study is registered (24950-3/2016/EKU) by the National Ethics Committee: the Hungarian Medical Research Council.