title: A Web-based, computer-tailored smoking prevention program to prevent children from starting to smoke after transferring to secondary school: randomized controlled trial.
abstract: BACKGROUND
  Smoking prevalence rates among Dutch children increase rapidly after they transit to secondary school, in particular among children with a low socioeconomic status (SES). Web-based, computer-tailored programs supplemented with prompt messages may be able to empower children to prevent them from starting to smoke when they transit to secondary school.
  
  
  OBJECTIVE
  The main aim of this study is to evaluate whether computer-tailored feedback messages, with and without prompt messages, are effective in decreasing children's smoking intentions and smoking behavior after 12 and 25 months of follow-up.
  
  
  METHODS
  Data were gathered at baseline (T0), and after 12 months (T1) and 25 months (T2) of follow-up of a smoking prevention intervention program called Fun without Smokes. A total of 162 schools were randomly allocated to a no-intervention control group, an intervention prompt group, or an intervention no-prompt group. A total of 3213 children aged 10 to 12 years old participated in the study and completed a Web-based questionnaire assessing their smoking intention, smoking behavior, and sociocognitive factors, such as attitude, social influence, and self-efficacy, related to smoking. After completion, children in the intervention groups received computer-tailored feedback messages in their own email inbox and those messages could be accessed on the intervention website. Children in the prompt group received prompt messages, via email and short message service (SMS) text messaging, to stimulate them to reuse the intervention website with nonsmoking content. Multilevel logistic regression analyses were performed using multiple imputations to assess the program effects on smoking intention and smoking behavior at T1 and T2.
  
  
  RESULTS
  A total of 3213 children participated in the Fun without Smokes study at T0. Between T0 and T1 a total of 1067 children out of the original 3213 (33.21%) dropped out of the study. Between T0 and T2 the number of children that did not participate in the final measurement was 1730 out of the original 3213 (53.84%). No significant program effects were observed for any of the intervention groups compared to the control group at T1 for the intention to engage in smoking-prompt, OR 0.67 (95% CI 0.30-1.50), no-prompt, OR 0.76 (95% CI 0.34-1.67)-or for smoking behavior-prompt, OR 1.13 (95% CI 0.13-9.98), no-prompt, OR 0.50 (95% CI 0.04-5.59). Similar nonsignificant program effects were found at T2 for the intention to start smoking-prompt, OR 0.78 (95% CI 0.26-2.32), no-prompt, OR 1.31 (95% CI 0.45-3.82)-and smoking behavior-prompt, OR 0.53 (95% CI 0.12-2.47), no-prompt, OR 1.01 (95% CI 0.24-4.21).
  
  
  CONCLUSIONS
  This study showed that the Web-based, computer-tailored feedback messages with and without prompt messages were not effective in modifying children's smoking intentions and smoking behavior as compared to no information. Future smoking prevention interventions are recommended to start closer to the age of actual smoking uptake. Furthermore, future studies on Web-based, computer-tailored smoking prevention programs should focus on assessing and controlling exposure to the educational content and the response to the prompt messages.
  
  
  BACKGROUND
  Netherlands Trial Register NTR3116; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3116 (Archived by WebCite at http://www.webcitation.org/6O0wQYuPI).
authors.affiliation: Maastricht University, Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht, Netherlands. p.cremers@maastrichtuniversity.nl.
authors.forename: Henricus-Paul
authors.identifier: http://orcid.org/0000-0002-5551-0214
authors.initials: HP
authors.lastname: Cremers
authors.forename: Liesbeth
authors.identifier: http://orcid.org/0000-0002-5719-7647
authors.initials: L
authors.lastname: Mercken
authors.forename: Math
authors.identifier: http://orcid.org/0000-0002-2229-1131
authors.initials: M
authors.lastname: Candel
authors.forename: Hein
authors.identifier: http://orcid.org/0000-0002-3640-2517
authors.initials: H
authors.lastname: de Vries
authors.forename: Anke
authors.identifier: http://orcid.org/0000-0002-4350-5821
authors.initials: A
authors.lastname: Oenema
mesh_terms: D002648:Child; D002652:Child Behavior; D003201:Computers; D034742:Electronic Mail; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008297:Male; D009426:Netherlands; D012574:Schools; D020377:Self Efficacy; D012907:Smoking / Q000523:psychology; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D060145:Text Messaging
keywords: Web-based intervention; computer-tailoring; primary school children; prompts; smoking prevention