Abstract Aims To investigate whether effects of the ASSIST (A Stop Smoking In Schools Trial) school‐based smoking prevention intervention diffused from students to the people they lived with. Design Secondary analysis of a cluster‐randomized control trial (cRCT). Setting England and Wales. Participants A total of 10 730 students aged 12–13 years in 59 schools assigned using stratified block randomization to the control (29 schools, 5372 students) or intervention (30 schools, 5358 students) condition. Intervention and comparator The ASSIST intervention involves 2 days of off‐site training of influential students to encourage their peers not to smoke during a 10‐week period. The control group continued with their usual education. Measurements The outcomes were the proportion of students who self‐reported living with a smoker and the smoking status of each resident family member/caregiver. Follow‐up assessments were immediately after the intervention and at 1 and 2 years post‐intervention. Findings The odds ratio (OR) for living with a smoker in the intervention compared with the control groups was 0.86 [95% confidence interval (CI) = 0.72, 1.03] immediately after the intervention, OR = 0.84 (95% CI = 0.72, 0.97) at a 1‐year follow‐up and OR = 0.86 (95% CI = 0.75, 0.99) at 2‐year follow‐up. In a three‐tier multi‐level model with data from all three follow‐ups, student‐reported smoking by fathers (OR = 0.90, 95% CI = 0.80, 1.00), brothers (OR = 0.78, 95% CI = 0.67, 0.92) and sisters (OR = 0.80, 95% CI = 0.69, 0.92) was lower in the intervention compared with control group. Subgroup analyses by baseline smoking status suggested that these effects were more consistent with prevention of uptake than prompting cessation. Conclusions A Stop Smoking In Schools Trial (ASSIST) school‐based smoking prevention intervention may have reduced the prevalence of smoking in people who lived with ASSIST‐trained students. This indirect transmission is consistent with the predictions of diffusion of innovations theory which underpins the design of ASSIST.

中文翻译：

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ASSIST 学校吸烟预防干预措施对非参与家庭成员的影响扩散：随机对照试验的二次分析

摘要 目的 调查 ASSIST（学校戒烟试验）基于学校的吸烟预防干预措施的效果是否从学生传播到与他们一起生活的人。设计整群随机对照试验（cRCT）的二次分析。设置英格兰和威尔士。参与者 59 所学校的 10 730 名 12-13 岁学生采用分层分组随机分配方法分配至对照（29 所学校，5372 名学生）或干预组（30 所学校，5358 名学生）条件。干预和比较 ASSIST 干预包括对有影响力的学生进行为期 2 天的场外培训，以鼓励他们的同龄人在 10 周内不要吸烟。对照组继续进行通常的教育。测量结果是自我报告与吸烟者生活在一起的学生的比例以及每个居民家庭成员/照顾者的吸烟状况。干预后立即以及干预后 1 年和 2 年进行随访评估。结果 与对照组相比，干预组中与吸烟者一起生活的比值比 (OR) 在干预后立即为 0.86 [95% 置信区间 (CI) = 0.72, 1.03]，OR = 0.84 (95% CI = 0.72， 1 年随访时 OR = 0.86（95% CI = 0.75，0.99），2 年随访时 OR = 0.97）。在包含所有三个随访数据的三层多水平模型中，学生报告父亲吸烟（OR = 0.90，95% CI = 0.80, 1.00）、兄弟吸烟（OR = 0.78，95% CI = 0.67，与对照组相比，干预组中的姐妹（OR = 0.80，95% CI = 0.69，0.92）较低。按基线吸烟状况进行的亚组分析表明，这些作用与预防吸烟比促使戒烟更一致。结论 学校戒烟试验 (ASSIST) 以学校为基础的吸烟预防干预可能降低了与接受过 ASSIST 培训的学生住在一起的人的吸烟率。这种间接传播与支持 ASSIST 设计的创新扩散理论的预测一致。