title: Effect of a sport-for-health intervention (SmokeFree Sports) on smoking-related intentions and cognitions among 9-10 year old primary school children: a controlled trial.
abstract: Preventing children from smoking is a public health priority. This study evaluated the effects of a sport-for-health smoking prevention programme (SmokeFree Sports) on smoking-related intentions and cognitions among primary school children from deprived communities.
  
  
  
  A non-randomised-controlled trial targeted 9-10 year old children from Merseyside, North-West England. 32 primary schools received a programme of sport-for-health activities over 7 months; 11 comparison schools followed usual routines. Data were collected pre-intervention (T0), and at 8 months (T1) and one year post-intervention (T2). Smoking-related intentions and cognitions were assessed using an online questionnaire. Intervention effects were analysed using multi-level modelling (school, student), adjusted for baseline values and potential confounders. Mixed-sex focus groups (n = 18) were conducted at T1.
  
  
  
  961 children completed all assessments and were included in the final analyses. There were no significant differences between the two study groups for non-smoking intentions (T1: β = 0.02, 95 % CI = -0.08-0.12; T2: β = 0.08, 95 % CI = -0.02-0.17) or for cigarette refusal self-efficacy (T1: β = 0.28, 95 % CI = -0.11-0.67; T2: β = 0.23, 95 % CI = -0.07-0.52). At T1 there was a positive intervention effect for cigarette refusal self-efficacy in girls (β = 0.72, 95 % CI = 0.21-1.23). Intervention participants were more likely to 'definitely' believe that: 'it is not safe to smoke for a year or two as long as you quit after that' (RR = 1.19, 95 % CI = 1.07-1.33), 'it is difficult to quit smoking once started' (RR = 1.56, 95 % CI = 1.38-1.76), 'smoke from other peoples' cigarettes is harmful' (RR = 1.19, 95 % CI = 1.20-2.08), 'smoking affects sports performance' (RR = 1.73, 95 % CI = 1.59-1.88) and 'smoking makes 'no difference' to weight' (RR = 2.13, 95 % CI = 1.86-2.44). At T2, significant between-group differences remained just for 'smoking affects sports performance' (RR = 1.57, 95 % CI = 1.43-1.72). Focus groups showed that SFS made children determined to remain smoke free and that the interactive activities aided children's understanding of smoking harms.
  
  
  
  SFS demonstrated short-term positive effects on smoking attitudes among children, and cigarette refusal self-efficacy among girls. Although no effects were observed for non-smoking intentions, children said that SFS made them more determined not to smoke. Most children had strong intentions not to smoke; therefore, smoking prevention programmes should perhaps target early adolescents, who are closer to the age of smoking onset.
authors.affiliation: Centre for Public Health, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2AT, UK. c.e.mcgee@ljmu.ac.uk.
authors.forename: Ciara E
authors.initials: CE
authors.lastname: McGee
authors.affiliation: Centre for Health Promotion Research, Leeds Beckett University, Calverley Building, City Campus, Leeds, LS1 3HE, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Trigwell
authors.affiliation: Department of Sport and Physical Activity, Edge Hill University, St. Helens Road, Ormskirk, Lancashire, L39 4QP, UK.|Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Fairclough
authors.affiliation: Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 62 Great Crosshall Street, Liverpool, L3 2AT, UK.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Murphy
authors.affiliation: Centre for Public Health, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2AT, UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: Porcellato
authors.affiliation: Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Ussher
authors.affiliation: Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 62 Great Crosshall Street, Liverpool, L3 2AT, UK.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Foweather
mesh_terms: D002648:Child; D002662:Child Health Services; D004739:England; D005260:Female; D017144:Focus Groups; D006801:Humans; D033182:Intention; D008297:Male; D012572:School Health Services; D012574:Schools; D000074606:Smoking Prevention; D013177:Sports; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Children; Intervention; Prevention; School-based; Smoking