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Effectiveness and cost-effectiveness of repeated implementation intention formation on adolescent smoking initiation: A cluster randomized controlled trial.

Mark Conner; Sarah Grogan; Robert West; Ruth Simms-Ellis; Keira Scholtens; Bianca Sykes-Muskett; Lisa Cowap; Rebecca Lawton; Christopher J. Armitage; David Meads; Laetitia Schmitt; Carole Torgerson; Kamran Siddiqi

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Title: Effectiveness and cost-effectiveness of repeated implementation intention formation on adolescent smoking initiation: A cluster randomized controlled trial.
Author: Mark Conner; Sarah Grogan; Robert West; Ruth Simms-Ellis; Keira Scholtens; Bianca Sykes-Muskett; Lisa Cowap; Rebecca Lawton; Christopher J. Armitage; David Meads; Laetitia Schmitt; Carole Torgerson; Kamran Siddiqi
Source: Journal of Consulting and Clinical Psychology · DOI 10.1037/ccp0000387 Published 2019-03-07 · Open source record
License: CC BY 3.0 deed

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Objective: Forming implementation intentions (if–then plans) about how to refuse cigarette offers plus antismoking messages was tested for reducing adolescent smoking. Method: Cluster randomized controlled trial with schools randomized (1:1) to receive implementation intention intervention and messages targeting not smoking (intervention) or completing homework (control). Adolescents (11–12 years at baseline) formed implementation intentions and read messages on 8 occasions over 4 years meaning masking treatment allocation was not possible. Outcomes were: follow-up (48 months) ever smoking, any smoking in last 30 days, regular smoking, and breath carbon monoxide levels. Analyses excluded baseline ever smokers, controlled for clustering by schools and examined effects of controlling for demographic variables. Economic evaluation (incremental cost effectiveness ratio; ICER) was conducted. Trial is registered (ISRCTN27596806). Results: Schools were randomly allocated (September–October 2012) to intervention (n = 25) or control (n = 23). At follow-up, among 6,155 baseline never smokers from 45 retained schools, ever smoking was significantly lower (RR = 0.83, 95% CI [0.71, 0.97], p = .016) in intervention (29.3%) compared with control (35.8%) and remained so controlling for demographics. Similar patterns observed for any smoking in last 30 days. Less consistent effects were observed for regular smoking and breath carbon monoxide levels. Economic analysis yielded an ICER of $134 per ever smoker avoided at age 15–16 years. Conclusions: This pragmatic trial supports the use of repeated implementation intentions about how to refuse the offer of a cigarette plus antismoking messages as an effective and cost-effective intervention to reduce smoking initiation in adolescents. What is the public health significance of this article? This study suggests that getting adolescents to read anti-smoking messages and form implementation intentions about how to refuse the offer of a cigarette in classroom time reduces smoking initiation. Such a classroom-based intervention is an effective and cost-effective way to reduce smoking initiation in adolescents and is readily scalable.

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Original journal: Journal of Consulting and Clinical Psychology
Published: 2019-03-07
DOI: 10.1037/ccp0000387
Open record: PMC6474716

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