ASSIST GLOBAL: ‘Scaling out’ of a UK Adolescent Peer Led Smoking Prevention Intervention to Address Global Health Challenges
Published by Kate Reid
ASSIST GLOBAL is a smoking prevention study led by the University of Glasgow with colleagues in the Institute of Health and Wellbeing (Led by PI Professor Sharon Simpson), School of Education (Dr Kate Reid) and a not-for-profit company – Evidence to Impact. The study has been funded by the Medical Research Council for 5 years to enable us to implement a feasibility mixed methods cluster randomised controlled trial (Complex Intervention) with embedded process and economic evaluation in two middle income countries in South East Asia. Our partners are Universitas Gadjah Mada (Indonesia) and De La Salle University (Philippines).
Tobacco is the world's main cause of avoidable poor health and early death. Around 8% of the world’s tobacco smokers live in lower and middle income countries (WHO, 2021). Tobacco companies are marketing products to minority, immigrant and child populations in these countries to expand their customer base in light of falling demand in countries such as the UK. Our feasibility trial focuses on two middle-income countries with high smoking rates: Indonesia and the Philippines.
Since most smoking starts in youth, it is crucial to prevent uptake in adolescence. In a large, randomised control trial (RCT), a peer led intervention called ASSIST (A Stop Smoking In Schools Trial) was found to be effective in preventing smoking update for 12-13 year olds, with the results published in the Lancet (Campbell et al. 2008). Since then, it has been recommended for use by the National Institute of Clinical Excellence (NICE) and its implementation across schools has been facilitated by a not-for-profit company set up to support the scaling out of ASSIST called ‘Evidence to Impact Ltd’. In the UK over 160,000 students aged 12-13 years have taken part in the ASSIST prevention intervention.
ASSIST recruits and trains 12 to 13 year olds who are nominated by same age peers as ‘influential’ among their school year group. In this role they are supported to become ‘peer supporters’, to spread messages among their friendship networks via informal conversations about the risks of smoking and the benefits of not smoking. The peer supporters are provided with live, in-person training (following a manualised delivery method), away from school to equip them for this peer supporter role.
Example of educational resources used in training of peer supporters.
The ASSIST model has potential to be effective in low and middle income countries where smoking is higher for younger age groups than in UK. ASSIST is relatively low cost, but its implementation relies on an informal peer supporter model, rather than educator led model which may make it less acceptable in countries with more formal or hierarchical school systems. This feasibility trial aims to assess: 1) whether ASSIST can be successfully adapted and implemented to one or more of these countries and 2) whether a full effectiveness evaluation (a randomised control trial) is feasible in one or more of the countries.
Our research has supported the capacity building of local teams of researchers in both countries and integrates PPI (patient and public involvement); including youth advisory groups and local and national policy stakeholders to advise us on the feasibility of scaling out the ASSIST model. We are supported by colleagues from ‘Evidence to Impact’ to integrate quality assurance and training support for our South East Asian academic partners who are implementing ASSIST GLOBAL across 10 lower secondary schools (200-500 students) in each country.
The study is nearing the end of its funded period (December 2025) and we will be reporting the outcomes of the trial across traditional academic dissemination routes and importantly through the youth and wider policy stakeholder groups which have helped to guide and inform our research since the beginning of our trial.
ASSIST Global Team Meeting in Person in Indonesia 2024.
Some of the ASSIST GLOBAL resources to train peer supporters. Local adaptations were needed for language and cultural context.
References
Campbell, R., Starkey, FA., Holliday, J., Audrey, S., Bloor, M., Parry-Langdon, N., Hughes, RA., & Moore, LAR. (2008). An informal school-based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. Lancet, 371(9624), 1595 - 1602. https://doi.org/10.1016/S0140-6736(08)60692-3
Comma AP, V, d'Espaignet E.T. WHO global report on trends in prevalence of tobacco use 2000-2025. Geneva: World Health Organization; 2021
Evidence to Impact – Not for Profit Company https://www.evidencetoimpact.com/assist/
Funded by Medical Research Council. Reference: MR/T040416/1
A young man smokes in the street : Photo Kevin Frayer/Getty Images