Interventions for Prevention of Tobacco Smoking in School-Aged Children and Adolescents: A Systematic Review and Meta-Analysis.

Smoking is a major worldwide health concern and a leading cause of preventable diseases such as cancer and heart disease. Adolescence, marked by experimentation and risk-taking behaviors, is a critical developmental stage where tobacco smoking frequently begins. Early smoking is associated with an increased risk of health problems, reduced life expectancy, and lifetime addiction, making prevention during this stage imperative. Despite its urgency, evidence on effective non-pharmacological preventative techniques for this demographic remains limited. This systematic review and meta-analysis aimed to assess the components, efficacy, and potential negative consequences of behavior-based, non-pharmacological interventions. A systematic search of PubMed and the Cochrane Library was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria for randomized controlled trials (RCTs) published between 2014 and 2024. Eligible studies included school-aged children and evaluated smoking initiation or cessation as outcomes. Data from six RCTs involving 10,192 participants were analyzed using Review Manager (RevMan v5.4, The Cochrane Collaboration, Oxford, UK). Risk ratios (RR) with 95% confidence intervals (CI) and I² statistics were calculated to evaluate heterogeneity and intervention efficacy. Results showed that school-based educational programs significantly reduced smoking initiation rates at six months (RR = 0.38, 95% CI: 0.23-0.61, p < 0.001), though effects diminished at longer follow-up periods (12-36 months). Culturally tailored, peer-led interventions demonstrated moderate efficacy in improving attitudes toward smoking and reducing consumption. Combined interventions were the most effective overall, but variability in study design and follow-up durations limited generalizability. This research highlights the short-term effectiveness of school-based and culturally sensitive interventions in reducing adolescent tobacco use. Future research should prioritize long-term strategies that integrate digital tools, family, and community involvement to sustain behavioral changes and combat the global tobacco epidemic effectively.