A stop smoking in schools trial (ASSIST) a decade on: insights from a mixed method process evaluation

Background: ASSSIT (A Stop Smoking in Schools Trial) is a UK peer led, school based, smoking prevention programme that encourages the dissemination of non-smoking norms among 11-13 year olds. It is based on strong evidence, with results from a large cluster randomised trial showing a reduction in smoking uptake. However, data for this trial was collected in 2002-2004 and since then implementation of tobacco control policy in the UK has resulted in a further decline in adolescent smoking prevalence. This presentation will present data from an evaluation of ASSIST in Scotland, the first national evaluation of ASSIST since the original RCT. Methods: Mixed method study involving a before and after school survey (n=2166 at follow-up), in-depth interviews, paired interviews, mini focus groups, observation with school staff, trainers, students, policy and commissioning leads (n=101). Results: Three different delivery models were piloted. This did not impact on fidelity or acceptability which was rated highly. Partnership working, from the onset, was viewed as being key to successful delivery and securing school participation. Feedback was overwhelmingly positive regarding the wider benefits of taking part in ASSIST for peer supporters (i.e. personal and communication skills) but also for the school and communities. There was less certainty regarding the extent of message diffusion and the impact this may have an adolescence smoking. Student survey results showed no significant change in self-reported smoking between baseline (2.5%) and follow-up (3%) and conversation recall with a peer supporter was low at 9%. Conclusions: ASSIST is a well delivered, popular programme with additional benefit for students, their wider social network, school and community. Yet, there is uncertainty regarding the extent of message diffusion within the school year which raises questions around the continued contribution of the programme to lowering the adolescent smoking rates. Further research is needed to update the existing evidence-base