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North Karelia Youth Project

Evidence level:
Best PracticePromising PracticeEmergent Practice
 
Evidence of Effectiveness:
?-0+++
Transferability:
?-0+
Enduring Impact:
?-0+
Review criteria and process

Policy category

Facilitating Positive Transitions to Adulthood, Helping Vulnerable Children

Recommendation Pillars

Put in place mechanisms that promote children’s participation in decision making that affect their lives

Countries that have implemented practice

Finland

Age Groups

Teenagers (age 13 to 19)

Type of Organization Implementing Practice

National Government

Practice Overview

Practice Overview

The North Karelia Youth Project offered a community and school-based educational intervention for seventh graders (students aged 13) to decrease the social desirability of smoking and coach them to resist peer, adult, and media pressure to smoke. The goal of the program was to decrease the number of children who would start smoking for the first time and reduce all the lifetime exposure to tobacco for all children in the program area. Two versions of the intervention were each implemented at an urban and a rural school in North Karelia County in Finland.

In the first version of the intervention, peer leaders from the eighth and ninth grades (students aged 14 and 15) and program staff delivered 10 sessions of the program.  In the second version, teachers were trained and instructed to deliver 5 sessions of the program.  The program included information about a nutritionally healthy diet and the health hazards of smoking as well as demonstration and role-playing to handle social pressure to smoke. During the time of the school intervention, a community intervention for adults was taking place through mass media channels and community organizations.

A second North Karelia Youth Project involving smoking, alcohol abuse, exercise and nutrition was implemented subsequently, and a description of that program can be found in the user registry.

Evidence of Effectiveness

Evaluation 1

The following articles are two, three, four, eight and fifteen year follow-ups of the same study populations:

Vartiainen, E., Tossavainen, K., Viri, L., Niskanen, E., & Puska, P. (1991). Health promotion for specific groups: The North Karelia Youth Programs.  New York Academy of Sciences Annals 623: 332-349.

Vartiainen, E., Fallonen, U., McAlister, A., & Puska, P. (1990). Eight-Year Follow-up Results of an Adolescent Smoking Prevention Program: The North Karelia Youth Project.  Am J Public Health 80: 78-79.

Vartiainen, E., Paavola, M., McAlister, A., & Puska, P. (1998). Fifteen-Year Follow-up of Smoking Prevention Effects in the North Karelia Youth Project.  Am J Public Health 88: 81-85.

Puska, P., Vartiainen, E., Laatikainen, T., Jousilahti, P., & Paavola, M. (2009). “The North Karelia Project: From North Karelia to National Action.”  National Institute for Health and Welfare (THL): 187-208.

Outcomes were measured two, three, four, eight and fifteen years after the intervention via self-administered questionnaires.  The students were asked to report how frequently they smoked and how many cigarettes they smoked per day.  Other risk factors that were collected were parents’ occupation, parents’ education, leisure-time physical activity, hobbies, serum cholesterol, blood pressure, and body mass index.

 

Summary of Results for Evaluation 1

Outcome

Peer-led Intervention Group

Teacher-led Intervention Group

 

 

Control Group

Outcomes (statistically significant) (p<.05)

 

 

 

 

1978 (Pre-test) Students smoking

1980 Students smoking (2-year follow-up)

1981 Students smoking (3-year follow-up)

1982 Students smoking (4-year follow-up)

1986 Students smoking (8-year follow-up)

1980 Initial non-smokers smoking (2-year follow-up)

1981 Initial non-smokers smoking (3-year follow-up)

1982 Initial non-smokers smoking (4-year follow-up)

1986 Initial non-smokers smoking (8-year follow-up)

1993 Initial non-smokers smoking (15-year follow-up)

15%                         13.2%

25.3%                      24.5%

30%                         30%

33.6%                      30.7%

34.3%                      35.2%

18.5%                      18.6%

 

23.5%                      22.2%

 

28.3%                      25.8%

 

37.5%                      30.1%

 

30.8%                      29.3%

 

 

 

8.4%

34.8%

40.7%

44.4%

50%

29.2%

 

37.7%

 

41.2%

 

46.9%

 

41.2%

 

Outcomes (not statistically significant)

 

 

 

 

1993 Students smoking (15-year follow-up)

34.6%                      34.3%

 

 

42.8%


Issue to consider

This program received a “Promising” rating, because it has been shown to improve outcomes over an extended period of time in a well-designed trial.  Note that the program was evaluated by the same group that supported the development of the program. Importantly, it should be noted that the school program occurred concurrently with a community anti-smoking program aimed at adults in the region where the intervention schools were located but not in the region where the control schools were located.  Additionally, one of the control schools was located next to a high school where students were allowed to smoke and one of the teacher-led schools administered about half of the sessions recommended by the program.  Additionally, the study authors used chi-squared analysis to show statistical significance when multilevel modeling may have been more appropriate, given the clustering within the sample.

Contact Information

Name

Professor Erkki Vartiainen

Title

Director General of Welfare and Health Promotion

Organization

The National Institute for Health and Welfare

Address

P.O. Box 30, FI-00271 Helsinki, Finland

Phone

+358 029 524 8622

Email

erkki.vartiainen@thl.fi

Website

 

Name

 

Title

 

Organization

World Health Organization: Regional Office for Europe

Address

 

UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark

 

Phone

+45 45 33 70 00

Email

 

Website

Evaluation details

The North Karelia Youth Project was evaluated at four schools in North Karelia county and two schools in a neighboring county in Finland.  All seventh graders at these schools participated in this study.  Each intervention group and the control group included an urban and a rural school.  The peer-led and teacher-led intervention schools were in North Karelia and the control schools were in a neighboring county.  The interventions consisted of a two year program between 1978 and 1980 of health education sessions where the hazards of tobacco were discussed along with techniques and practice dealing with social pressure to smoke.  Students were assessed for smoking habits and smoking frequency before and after the intervention was delivered, and again 3, 4, 8 and 15 years after the start of the intervention by completing self-administered questionnaires.  Risk factors for smoking were collected at baseline through a parent survey.

At the immediate conclusion of the program intervention, a third fewer students in both intervention groups reported smoking than in the control group.  For students who had not smoked before the intervention period, 30% fewer started smoking in the intervention group than in the control group by the time of the 15 year follow-up.  The overall number of smokers in each group was lower at posttest in the intervention groups but the difference failed to be statistically significant after the time of the 8 year follow-up.  At the end of the 15 years, cumulative exposure to tobacco was 22% lower in the intervention groups than in the control group.

Available Resources

Puska, P., Vartiainen, E., Laatikainen, T., Jousilahti, P., & Paavola, M. (2009). “The North Karelia Project: From North Karelia to National Action.”  National Institute for Health and Welfare (THL): 187-208.

National Institute for Health and Welfare webpage on the North Karelia Project (available in Finnish only) http://www.thl.fi/fi_FI/web/fi/tutkimus/tyokalut/nuorten_paihteiden_kayton_ehkaisyohjelma

Bibliography

Vartiainen, E., Tossavainen, K., Viri, L., Niskanen, E., & Puska, P. (1991). Health promotion for specific groups: The North Karelia Youth Programs.  New York Academy of Sciences Annals 623: 332-349.

Vartiainen, E., Fallonen, U., McAlister, A., & Puska, P. (1990). Eight-Year Follow-up Results of an Adolescent Smoking Prevention Program: The North Karelia Youth Project.  Am J Public Health 80: 78-79.

Vartiainen, E., Paavola, M., McAlister, A., & Puska, P. (1998). Fifteen-Year Follow-up of Smoking Prevention Effects in the North Karelia Youth Project.  Am J Public Health 88: 81-85.

Puska, P., Vartiainen, E., Laatikainen, T., Jousilahti, P., & Paavola, M. (2009). “The North Karelia Project: From North Karelia to National Action.”  National Institute for Health and Welfare (THL): 187-208.

Transferability

The North Karelia Youth Project was only implemented in its specific form in North Karelia, Finland.   Since the school aspect of the program was implemented concurrently with a community-wide anti-smoking effort, it may be difficult to reproduce the project in other contexts.

Sustainability

The long term effects of the North Karelia Youth Project have been assessed at intervals up to 15 years after the intervention.  In the sample of 903 students who were in the seventh grade in 1978, Vartiainen et al. (1998) found significant differences in the number of students smoking between the intervention and control group up to 8 years after the intervention, after which time the difference was not significant.