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• An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. (PDF) 

The absence of any effect on young people who were already smoking every week, as well as their sense of addiction, calls for greater attention to programmes for smoking cessation. The processes that affect initiation are probably different from those that affect progression and maintenance of regular smoking,6 and youth-specific cessation programmes need to become more available to adolescents. There is growing evidence for the promise of interventions for tobacco cessation for young people,8 but more high quality, rigorous controlled trials—like ASSIST—are needed to move this area forward.

We also need to consider other social influence factors that could have an equal, if not greater, effect on youth smoking than could peers. Adolescents are more likely to smoke if a parent smokes, and sibling smoking might have an even stronger effect on an adolescent’s smoking.9,10 Some family interventions might prevent adolescent smoking,11 but rarely do these programmes include a sibling component. Yet siblings, even those who smoke, could be able to provide powerful antismoking messages, given that anecdotally these young people often state that they hope their younger siblings never smoke or become addicted like they are. Siblings remain an untapped resource for the extension of prevention programmes. Social influence processes also come into effect with marketing and advertising by tobacco companies, and some researchers have noted that teenagers are more likely to be influenced to smoke by cigarette advertising than they are by peer pressure.12

Both bold policy solutions and effective interventions are needed to reduce smoking in adolescents. As encouraging as ASSIST’s findings are, an important message is the need to go beyond the classroom setting and into the many domains of social influence that adolescents encounter.

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