Table of Contents
Literature review discussion.
Conclusions and Recommendations.
Conclusion and recommendations.
Adolescence is the stage in which the youth became very curious about discoveries and habits (Carey et al., 2020). As this stage is between childhood and adulthood, the decision to venture into vices becomes very common and it is easy to make due to peer pressure (Lussier & McCuish, 2020). It is known that high school students who are stressed in school and at home were keener towards smoking and drinking. Cultural patterns towards alcohol and cigarette consumption in Australia triggered the researchers to focus their study on this subject – particularly among the youth (Heris et al., 2019). The mechanism of addiction is such that it can affect the dopamine released in the brain in such a way that it can increase the requirement of the substance increases overtime (Buck et al., 2020). Health education is the process by which the awareness and knowledge of an individual, group of individual or community can be increased by the means of imparting education (Darcy, 2020). This is a tested and tried method where the health outcomes of the patients have increased over time. Health education can effectively reduce alcohol drinking and smoking of the high school students during adolescence (Shackleton et al., 2016). This study is focused on the effectiveness of health education on reducing alcohol consumption and smoking among high school students.
The adolescent stage of a person’s life was the most vulnerable part where the sense of belonging would start to foster, is the reason why most teens exhibited a “birds of the same feather” social behaviour (Carey et al., 2020). P- Participants- chosen population for this study is adolescents and high school students. The problem under focus is the use of alcohol and smoking. As budding health professionals, it is the researcher’s advocacy to promote awareness to the youth on the effects of alcohol and cigarette use at an early age. I- Intervention- , the chosen intervention is health education that informs about the adverse effects of alcohol drinking and smoking. C- Comparison- the comparison intervention is usual care. O- Outcomes- the desired outcome is increasing the level of knowledge on the impact of alcohol and cigarette use while reducing risk behaviour or substance use. The research question is: Can health education effectively improve the level of knowledge on the effects of alcohol and cigarette use and health behaviour in high school students?
For the current literature review the keywords are identified from the PICO elements and MeSH keywords are identified from the databases. the keywords identified for the formulation of search strings are health education, adolescents, school students, substance abuse, alcohol consumption, alcohol addiction, smoking, cigarette smoking. The Boolean operators are set of words, that is, AND, OR and NOT which are used in various combinations with the keywords to formulate the search strings (Scells, Zuccon & Koopman, 2019). Various databases were used to search the articles related to the PICO that is, Medline, PubMed, and CINHAL. The literature search flow chart is in appendix 1.
The articles collected from the literature search is collected the data from and the complete data extraction is present in appendix 2. The study conducted by Mahmood et al. (2018) which was a quasi-experimental study where the pre and post-test were given to understand the effectiveness of the intervention. A total of 280 randomly selected high school students were recruited into the study, they were aged between 15-18 years. The data was collected both the times by the use of a self-administered questionnaire the intervention and the post-test was conducted one month after the intervention was given. The results indicated that the use of a health education program about substance use on high school students improved the knowledge of students about the topic, with more than half (50.2%) having the improvement to good knowledge.
Orsini et al. (2019) conducted a randomized control trial located in United States where total 26 schools were randomly selected and assigned to intervention and control groups. The schools were from both from urban and rural areas of Nebraska. The participants were followed for a period of one year where pre and post-test was evaluated by the use of survey at the beginning and the end of the school year. The results of the study was similar to the one conducted previously have similar findings using a randomized control trial with parallel treatment groups of 26 schools, equally assigned to treatment and control groups.
Nurcan & Turkan (2018) conducted an interventional study where a total of 338 students aged 14-19 years from two high schools were included in the study. Intervention was a peer education for the smokers who were identified by the use of nicotine dependency test that is Fagerstrom test. The effectiveness of the intervention was done after a period of six months. The authors had sought out to explore the effectiveness of peer education in an interventional study for a good sample size of participants and volunteer students who acted as peer educators. They were able to establish that peer education can change smoking behaviour and reduce nicotine dependency in identified smokers while preventing smoking for non-smokers. Though the number of participants was more but they were limited to only two schools which restricted the generalizability of the study.
On the contrary to the above findings, was a study conducted by Chen et al. (2014) where two schools’ students were included in the study where middle school children were randomly assigned to interventional and control group. The method of data collection was similar to other studies conducted previously, that is, a self-administered questionnaire was used pre and post the intervention. The results of the present study reflected that despite the significant increase in scores in smoking-related knowledge and attitudes, the self-reported smoking behaviour did not significantly decrease after the education intervention. Thus, the studies show a significant increase in knowledge among high school students after an education intervention on smoking and alcohol use, but conflicting results in changes in behaviour or substance use.
The discussion can be concluded as cigarette smoking and alcohol drinking is a usual scenario among high school students. Studies included in the review reveal that education intervention is effective in increasing the knowledge of high school students about substance use-related information. The use of peer education to reduce the influence of peer pressure on risky behaviour was also found to be relevant in health education interventions. However, there was an insignificant association between educational interventions and behavioural change. Thus, further studies can help determine interventions that can improve healthy behaviour among adolescents.
From the discussion it can be seen that the authors have recommended that the design of an effective and workable school-based health education program that address behaviour change. The potential of engagement on sports activities or advocacy programs as extracurricular activities that divert their attention away from substance use and research to determine their effectiveness in improving health behaviour. Future researchers may include determining significant factors, such as socioeconomic, demographic and environmental factors that influence substance use in the adolescent population.
The articles collected from the literature search were critiqued by the use of CASP tool and the complete critique is present in appendix 3. CASP tool is a critical appraisal tool which helps in articles appraisal as per the checklist which is different for the different study designs. Mahmood et al. (2018) were reliable in determining the effectiveness of an educational intervention on improving knowledge about substance abuse and has an adequate sample size. Orsini et al. (2019) also demonstrated reliability, although it was considered a pilot test due to the attrition of two schools in the control group. Nurcan & Turkan (2018) made a significant and reliable contribution in the use of peer education as a strategy against smoking and other forms of substance use because peer pressure is an essential indicator for starting risky behaviours during the adolescence stage. All the studies have limited generalizability as they were conducted in other countries and factors, such as ethnicity and culture, may affect the effectiveness of an education intervention on high school students or adolescents in the target setting, which is Australia.
The study aimed to determine the improvement in knowledge level and health behaviour of high school students after an education intervention on alcohol drinking and cigarette smoking. The researchers used quantitative designs in conducting the studies. The instrument that the researchers used contains the participants’ data such as age, gender, religion, and knowledge on the effects of alcohol drinking and cigarette smoking. Before conducting the research study, the researchers sought ethical approval from the necessary authority and the parents of the high school students by sending them a consent letter. The primary instruments used to gather data from the respondents were surveys, self-reported questionnaire, and observation. Mahmood et al. (2018) and Orsini et al. (2019) tested the reliability of its questionnaire. Nurcan & Turkan (2018) used the validated tool, The Fagerstrom Test for Nicotine Dependency, in determining nicotine dependency. On the other hand, Chen et al. (2014) only used a non-validated self-reported questionnaire for outcome measures. The studies have large sample sizes ranging from 280 to 2415 high school or middle school students. The findings revealed that the students increase their knowledge level on substance use-related information after the education intervention.
The present study is a literature review which for the research topic of interest whether imparting health education to high school adolescents can improve the knowledge and reduce the consumption of alcohol and prevalence of alcohol. For the literature review the keywords were taken from the research question MeSH keywords were derived from the PICO components and with the use of Boolean operators search strings were created which would help in the collection of articles for the literature review. A total of 4 appropriate articles were selected and included in the literature review. The data was extracted and the critique was done by the use of CASP tool. It was seen that the health education can help in the improvement of the awareness regarding the substance abuse at such a young age. Though there were conflicting results and it can be concluded that depending on the participants and exact method of intervention there can be significant or non-significant results but there is improvement. Though the articles were selected from different parts of the world and similar results were seen it can be said the similar results can be expected if the study is replicated.
Buck, S. A., Torregrossa, M. M., Logan, R. W., & Freyberg, Z. (2020). Roles of Dopamine and Glutamate Co‐Release in the Nucleus Accumbens in Mediating the Actions of Drugs of Abuse. The FEBS Journal. https://doi.org/10.1111/febs.15496.
Carey, R. L., Akiva, T., Abdellatif, H., & Daughtry, K. A. (2020). ‘And school won’t teach me that!’Urban youth activism programs as transformative sites for critical adolescent learning. Journal of Youth Studies, 1-20. https://doi.org/10.1080/13676261.2020.1784400.
Chen, L., Chen, Y., Hao, Y., Gu, J., Guo, Y., & Ling, W. (2014). Effectiveness of school-based smoking intervention in middle school students of Linzhi Tibetan and Guangzhou Han ethnicity in China. Addictive Behaviors, 39(1), 189–195. http://dx.doi.org/10.1016/j.addbeh.2013.09.026
Darcy, C. (2020). Precarious positions of understanding: the illicit drug landscape and drug education in Ireland. Irish Educational Studies, 1-13. https://doi.org/10.1080/03323315.2020.1779111
Heris, C. L., Chamberlain, C., Gubhaju, L., Thomas, D. P., & Eades, S. J. (2019). Factors influencing smoking among indigenous adolescents aged 10–24 years living in Australia, New Zealand, Canada, and the United States: A systematic review. Nicotine & Tobacco Research. https://doi.org/10.1093/ntr/ntz219.
Lussier, P., & McCuish, E. (2020). A developmental life‐course view of sexual offending: Taking stock of research on the life‐course development of antisocial and criminal behavior. The Wiley Handbook of What Works with Sexual Offenders: Contemporary Perspectives in Theory, Assessment, Treatment, and Prevention, 39-70. https://doi.org/10.1002/9781119439325.ch3.
Mahmood, N., S. O., Al-Tawil, N., & ⨯ Tariq Al-Hadithi. (2018). Impact of an education intervention on knowledge of high school students concerning substance use in Kurdistan region-Iraq: A quasi-experimental study. PLoS One, 13(10) http://dx.doi.org/10.1371/journal.pone.0206063
Nurcan, B. & Türkan, G. (2018). Evaluation of effectiveness of peer education on smoking behavior among high school students. Saudi Medical Journal, 39(1), 74-80. http://dx.doi.org/10.15537/smj.2018.1.21774
Orsini, M.M., Wyrick, D.L., Hansen, W.B., O’Sullivan, R.G., Hallfors, D., Steckler, A.B. & Ridenour, T.A. (2019). Evaluation of an infused alcohol and drug prevention programme. Health Education, 119(3), 230-243. https://doi.org/10.1108/HE-07-2018-0035
Scells, H., Zuccon, G., & Koopman, B. (2019). Automatic Boolean query refinement for systematic review literature search. In The World Wide Web Conference, 1646-1656. https://doi.org/10.1145/3308558.3313544.
Shackleton, N., Jamal, F., Viner, R. M., Dickson, K., Patton, G., & Bonell, C. (2016). School-based interventions going beyond health education to promote adolescent health: systematic review of reviews. Journal of Adolescent Health, 58(4), 382-396. https://doi.org/10.1016/j.jadohealth.2015.12.017.
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