The European Smoking prevention Framework Approach (EFSA): An example of integral prevention

Hein De Vries, Aart Mudde, Ingrid Leijs, Anne Charlton, Errki Vartiainen, Goof Buijs, Manuel Pais Clemente, Hans Storm, Andrez González Navarro, Manel Nebot, Trudy Prins, Stef Kremers

Research output: Contribution to journalArticlepeer-review

285 Scopus citations


A smoking prevention project in six European countries (European Smoking prevention Framework Approach) was developed, featuring activities for adolescents, schools and parents, including out-of-school activities. Consensus meetings resulted in agreement between the countries on goals, objectives and theoretical methods. Countries' specific objectives were also included. National diversities required country-specific methods to realize the goals and objectives. The community intervention trial was used as the research design. Since interventions took place at the community level, communities or regions were allocated at random to the experimental or control conditions. Complete randomization was achieved in four countries. At baseline, smoking prevalence among 23 125 adolescents at the start of the project was 5.6% for regular smoking and 4.0% for daily smoking. Smoking prevalence rates were higher among girls than boys in all countries as far as weekly smoking was concerned. Process evaluations revealed that the project's ambitions were high, but were limited by various constraints including time and delays in receiving funds. Future smoking prevention projects should aim to identify the effective components within the social influence approach as well as within broader approaches and on reaching sustained effects.

Original languageEnglish (US)
Pages (from-to)611-626
Number of pages16
JournalHealth Education Research
Issue number5
StatePublished - Oct 2003
Externally publishedYes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Education


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