Background:
In Europe, smoking is very common among young people. Almost 2 out of 5 teens in Italy are ‘habitual smokers’ according to research carried out by ESPAD. That is the highest rate of all European countries. Education settings are optimal for implementing cigarette smoking prevention interventions for children and adolescents. Yet, traditional sit-desk interventions with an informative approach on smoking-related health hazards seem to be ineffective.

Objective:
To examine and evaluate the impact of drama techniques and social theatre developed by the Italian League against Cancer to enhance students’ learning experience on tobacco knowledge and health, facilitate critical thinking toward smoking-related attitudes, norms, and promote pre-adolescents’ self-reflection on identity.

Methods:
The University of Milano-Bicocca Department of Psychology conducted two separate studies in primary and secondary schools. Questionnaires were administered before and after drama interventions with the aim to assess critical thinking, learning experience on tobacco and health issues, self-efficacy beliefs, independent thinking, attitudes and cognitive representations associated to smoking behaviours. Students not involved in intervention projects were compared to the experimental group undergoing intervention. A total of 746 students were included in the first Primary School project ‘Agenti 00Sigarette’: 398 children aged 9 years were provided with a drama tobacco issue workshop, as opposed to 348 children of the control group who did not take part in the treatment. Both groups were followed over a period of 4 years. A total of 515 students were included in the Secondary School project ‘Specchio Riflesso’, 191 students aged 12 years were provided with the treatment, as opposed to 324 young students of the control group who did not take part in the treatment. These last two groups were followed over a period of two years.

Results:
Analyses of variance and t-test were performed to test differences pre-post drama intervention and to compare the intervention group with the control one. Students reported a higher knowledge about smoking and its harmful effects, compared to their fellow students who reported a greater number of wrong answers. Results attest the efficacy of drama methodology to diminish the attractiveness of cigarettes, and to promote higher assertiveness towards peer pressure and self-efficacy to express opinions.

Conclusions:
Drama and social theatre techniques can be an effective educational tool among pre-adolescents to promote health issues and maximize learning experience on health issues. Studies show the effectiveness of LILT project to contrast positive attitudes and emotions traditionally associated with cigarettes by promoting interpersonal self-efficacy beliefs and independent thinking.