title: The Short-term Effects of ASPIRA: A Web-based, Multimedia Smoking Prevention Program for Adolescents in Romania: A Cluster Randomized Trial.
abstract: BACKGROUND
  Although web-based, multimedia smoking prevention programs have been tested in several high-income countries, their efficacy in Central and Eastern Europe is unknown. The aim of this trial was to assess the short-term effects of ASPIRA, among Romanian and Hungarian speaking ninth graders in Tirgu Mures, Romania. ASPIRA is the Romanian acronym for the translated and adapted version of ASPIRE, "A Smoking Prevention Interactive Experience," an evidence-based smoking prevention program originally developed to prevent tobacco use among high school students in the United States.
  
  
  METHODS
  Sixteen high schools in Tirgu Mures, Romania were randomized to receive five weekly sessions of the ASPIRA web-based, multimedia program or to a control condition. Socio-demographic data, psychosocial characteristics, and smoking behavior were collected from students at baseline and at 6 months. A hierarchical logistic regression analysis was conducted to test the efficacy of the intervention on smoking initiation and current smoking among 1369 students.
  
  
  RESULTS
  Never-smoker students in the intervention arm were 35% less likely to report smoking initiation 6 months after the baseline assessment (OR = 0.65, 95%CI: 0.44-0.97). Reduced smoking initiation was observed most notably among students who were exposed to at least 75% of the ASPIRA program. There was no statistically significant effect of the intervention on current tobacco use (OR = 0.80, 95%CI: 0.44-1.46).
  
  
  CONCLUSIONS
  ASPIRA, an adapted version of the evidence-based, multimedia ASPIRE program that was originally developed and tested in the United States may decrease smoking initiation among multi-ethnic adolescents in Central and Eastern Europe.
  
  
  CONCLUSIONS
  (1). Web-based, multimedia smoking prevention programs may be effective tools to prevent smoking initiation among multi-ethnic adolescent communities in Central and Eastern Europe. (2). The degree of exposure is critical, only high exposure to the multimedia smoking prevention program is associated with reduced smoking initiation.
authors.affiliation: Department of Hygiene, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania.
authors.forename: Valentin
authors.initials: V
authors.lastname: Nădăşan
authors.affiliation: Social Sciences and Health Policy, Cancer Prevention and Control, Wake Forest University Medical School, Medical Center Blvd., Winston-Salem, NC.
authors.forename: Kristie L
authors.initials: KL
authors.lastname: Foley
authors.affiliation: Institute of Public Health, Faculty of Medicine, Semmelweis University, Budapest,Hungary.
authors.forename: Melinda
authors.initials: M
authors.lastname: Pénzes
authors.affiliation: Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary.
authors.forename: Edit
authors.initials: E
authors.lastname: Paulik
authors.affiliation: Department of Pulmonology, University of Medicine and Pharmacy, Timişoara, Romania.
authors.forename: Ștefan
authors.initials: Ș
authors.lastname: Mihăicuţă
authors.affiliation: Department of Hygiene, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Ábrám
authors.affiliation: Department of Hygiene, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania.
authors.forename: Jozsef
authors.initials: J
authors.lastname: Bálint
authors.affiliation: Department of Hygiene, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania.
authors.forename: Monika
authors.initials: M
authors.lastname: Csibi
authors.affiliation: Institute of Psychology, Eötvös Loránd University, Budapest, Budapest,Hungary.
authors.forename: Robert
authors.initials: R
authors.lastname: Urbán
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D019212:Multimedia; D012383:Romania / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention / Q000379:methods / Q000706:statistics & numerical data