, 2008). More than two thirds of adult smokers report starting before the age of 18 years (Robinson & Lader, 2007). Younger age at initiation is associated with a decreased probability of quitting in later life (Jit, Aveyard, MEK162 FDA Barton, & Meads, 2010). These factors emphasize that preventing smoking initiation among adolescents remains a public health priority. A central theme of U.S. and U.K. government policy is ��to stop the inflow of young people recruited as smokers�� (Centers for Disease Control and Prevention, 2007; Department of Health, 2010; National Institute for Health and Clinical Excellence [NICE], 2010). School-based smoking prevention programmes can be effective in preventing or at least delaying smoking among adolescents (Thomas & Perera, 2006).
However, a review of economic evaluations in health promotion concluded that ��Little is known about the cost-effectiveness of social interventions in schools, despite the importance of school climate on child and adolescent health �� �� (Rush, Shiell, & Hawe, 2004). A recent review by Jit et al. (2009a) identified just six cost-effectiveness analyses of interventions, including peer-led education (Vijgen, van Baal, Hoogenveen, de Wit, & Feenstra, 2008), class competitions with prizes to discourage smoking (Hoeflmayr & Hanewinkel, 2008), and additional education about the physical and social consequences of smoking (Dino, Horn, Abdulkadri, Kalsekar, & Branstetter, 2008; Wang, Crossett, Lowry, Sussman, & Dent, 2001). Only two were based on randomized controlled trials (RCTs) and neither collected resource use data prospectively.
In this paper, we report a cost-effectiveness analysis of a school-based ��peer-led�� intervention aimed at reducing adolescent smoking conducted alongside the previously published ASSIST (A Stop Smoking In Schools Trial) RCT (Campbell et al., 2008). Methods Study Design ASSIST was a cluster RCT, which, at baseline, included 10,730 Year 8 (12�C13 years old) students in 59 schools in South East Wales and the West of England. Participants were followed up for 2 years in 29 control schools (5,372 students) and 30 intervention schools (5,358 students). Schools were stratified block randomized either to their usual smoking prevention education (control) or to receive the ASSIST programme in addition to their usual smoking prevention education.
Details of the trial design and the primary outcomes have been previously reported (Campbell et al., 2008; Starkey, Moore, Campbell, Sidaway, & Bloor, 2005). The ASSIST Programme The ASSIST programme consisted of the identification of influential students (peer supporters) who were trained to have informal conversations with their peers about the effects of smoking Cilengitide and the benefits of not smoking (Audrey, Cordall, Moore, Cohen, & Campbell, 2004). The intervention entailed eight stages (Table 1).