Employment, Social Affairs & Inclusion

Social Influence Decision-Making Smoking Prevention Programme

Evidence level:
Evidence of effectiveness:
? - 0 + ++
? - 0 + ++
Enduring impact:
? - 0 +


The Social Influence Decision-Making (SI-DM) smoking prevention programme was based upon the idea that attitudes, social influences and belief in one’s ability to abstain from smoking predict the intention to smoke, and ultimately smoking itself.  The programme aimed to educate adolescents and build skills in order to promote healthy attitudes and beliefs related to smoking.  

Practice category

  • Facilitating Positive Transitions to Adulthood
  • Helping Vulnerable Children

Recommendation pillar

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

Countries that have implemented practice

  • Netherlands

Age groups

  • Middle Childhood (age 6 to 12)
  • Teenagers (age 13 to 19)

Target groups

  • Children

Years in operation

  • 1990  - 2013

Scope of practice

  • Local level

Type of organisation implementing practice

  • City or Town Government

Rationale of practice

he SI+ programme was delivered over five weeks in once-weekly 45-minute sessions in small groups consisting of four or five students.  Information was delivered in a video format, and the content of the videos was subsequently discussed and processed in small-group activities. The groups were led by a peer from the same class of students.  Peer leaders were chosen by the students themselves and were assisted by classroom teachers. Teachers were trained for one hour by health educators prior to implementation, and peer leaders were trained using a training video. Both teachers and peer leaders had manuals guiding them in the curriculum. Lessons focused on pressures to smoke, dangers of smoking, skill-building to resist peer pressure to smoke, and healthy alternatives to smoking. The structure of each of the five sessions was as follows: 

  1. Introduction of the theme, presented on video
  2. Peer-led activity 
  3. Feedback on activity and continuation of the lesson on video
  4. Peer-led activity
  5. Feedback on activity
  6. Homework assignments 

The SI-DM programme also included explicit content to support adolescents’ decision-making processes.  That is, the first lesson in the programme discusses the decision-making process in order to encourage deliberate decision-making based on a weighing of the pros and cons.  Students are then asked to discuss a decision that they are considering, the pros and cons of that decision, and the finalization and implementation of that decision. 

In the study of SI-DM conducted in the Netherlands, researchers examined the effects of this SI-DM programme compared those effects to three variants of the SI programme –  a “core” SI programme with no decision-making component ( SI) (a programme which is also listed as an Emerging Practice on the EPIC site), the SI programme with boosters ( SI+) (also listed as an Emerging Practice on the EPIC site), and the SI-DM programme with boosters (SI-DM+) (this programme is not listed on the EPIC site due to a lack of positive outcomes).

Further detail on this study is provided below.

Mode of delivery

  • Group sessions

Delivery dosage

  • Frequency: Weekly
  • Duration: Less than 1 hour session

Location of practice

  • School based

Evidence of effectiveness

Evaluation 1

M. Dijkstra, I. Mesters, H. De Vries, G. van Breukelen, and G. S. Parcel. Effectiveness of a social influence approach and boosters to smoking prevention. Health Educ. Res. (1999) 14 (6): 791-802

In the Netherlands, 26 eighth and ninth grade classes were assigned to one of the four variants of the SI-DM programme, and 67 classes were assigned to the control condition. A questionnaire was distributed to students before the programme was implemented, then again immediately after the programme ended, then again six months after the programme ended.  The main outcome of interest was smoking behaviour.  

Summary of Results for Evaluation 1


Treatment Group

Control Group

Outcomes improved (statistically significant)

Change in the percentage of participants who were smokers between pre-test and follow-up

10.4 percentage point increase

14.9 percentage point increase

Outcomes with no effect


The SI-DM programme has only been tested in the Netherlands.

Practice Materials

  • Practice materials are not available 

Cost information

  • Implementation cost information is not available

Enduring impact

Follow-up outcomes beyond two years after the programme terminated were not measured in this evaluation, so we do not know whether this programme offers enduring impact.

Evaluation details

In the Netherlands, Dijkstra et al. (1999) invited 20 health districts in the Netherlands to participate in the intervention study.  15 districts agreed, and each of the 52 schools in those 15 districts were randomly assigned to receive one of the four variants of the SI intervention (the SI-DM intervention reviewed here, SI alone, SI+ and SI-DM+), or to serve as a control group.  Ultimately 4826 students participated in the trial.

The pre-test consisted of a questionnaire which was distributed prior to the programme implementation in October 1990.  The core SI and SI-DM programmes were implemented between October and December 1990, with the first booster delivered (for SI+ and SI-DM+) in September 1991.  The second booster was delivered in January of 1992, and the third in March 1992.  The follow-up questionnaire was distributed in April 1992, covering the same questions related to smoking behaviour that was covered in the pre-test questionnaire.

Issue to consider

In the study by Dijkstra et al. (1999), four variants of the SI programme were tested.  The SI+ programme was found to be effective at follow-up, but the SI programme without boosters was not. Interestingly, the SI-DM programme was found to be effective, but the SI-DM+ programme with boosters was not found to be effective. Thus the impact of boosters on the effectiveness of smoking prevention programmes in general remains unclear. 


M. Dijkstra, I. Mesters, H. De Vries, G. van Breukelen, and G. S. Parcel. Effectiveness of a social influence approach and boosters to smoking prevention. Health Educ. Res. (1999) 14 (6): 791-802

Last updated

December 2018

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