Abstract
BackgroundThe X:IT intervention, conducted in 2010 to 2013, showed overall smoking preventive effect. However, parts of the intervention appeared less appealing to children from families with lower socioeconomic backgrounds. Therefore, the intervention components were modified and an evaluation of the amended intervention X:IT II is needed to show the effect of this revised intervention and whether children from different social backgrounds benefits equally from the current intervention.MethodsMain intervention components are smoke free schools, a curricular component, and parental involvement (smoke free agreements and talks about tobacco). Components have been revised from the first version; 1) previously, schools should be smoke free on the school ground and were encouraged to hide smoking so that it wasn’t visible to pupils from the school ground. Now they are encouraged to tighten the rules so that no pupils or teachers smoke during the school day, no matter where they are; 2) the specifically developed educational material (Up in Smoke) has been revised so that all materials are online and all texts has a ARI; 3) the parental involvement is now targeted multiple groups of parents, e.g. parents that are smokers, and parents of children that smoke. Language used is simpler and the website for parents presents very specific examples.X:IT is implemented in 46 Danish public schools from fall 2017 until summer 2020. Data is collected through electronic questionnaires to students and coordinators four times (fall 2017, spring/summer 2018, 2019 and 2020). Further, qualitative interviews and observations are conducted.DiscussionPrevalence of smoking among Danish adolescents is high compared to other Nordic countries and there is social inequality in smoking, leaving individuals from the lowest social backgrounds at higher risk. Although there has been an overall decline in smoking among Danish adolescents over the last decades, a recent levelling of this development indicates an urgent need for smoking prevention in Denmark. The X:IT intervention has the potential to prevent uptake of smoking among adolescents. However, there is a particular need for evaluating the effectiveness of the revised X:IT intervention, X:IT II, with focus on the effect across socioeconomic groups of adolescents.Trial registrationCurrent Controlled Trials ISRCTN31292019, date of registration 24/10/2017. Retrospectively registered.
Highlights
The X:IT intervention, conducted in 2010 to 2013, showed overall smoking preventive effect
We expect the revised version of the X:IT intervention to be successful in preventing smoking uptake in adolescents from high and low socioeconomic backgrounds
Smoking prevalence is higher among low socioeconomic positions (SEP) adolescents [1] and contributes to a large extent to the social inequality in health over the lifetime [5]
Summary
The X:IT intervention, conducted in 2010 to 2013, showed overall smoking preventive effect. Adolescents from low SEP seem less likely to quit smoking in adulthood [3]. Public health interventions to reduce risk behaviours (e.g. smoking) should aim at being effective across socioeconomic groups or at being more effective among individuals from low SEP [4]. Interventions themselves may generate or increase socioeconomic inequalities in health behaviours, e.g. in smoking [6]. This is problematic to the extent that interventions may be less effective or have counter-effects in the most at risk groups, often low SEP. It has been argued that interventions targeting individual aspects related to behavioral change are more likely to widen social inequalities compared to interventions targeting the environment, because the interventions targeting the individual directly require more effort and resources from each individual [8]
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