Assessing Differences in the Implementation of Smoke-Free Contracts—A Cross-Sectional Analysis from the School Randomized Controlled Trial X:IT

Abstract

Objective: The X:IT study is a school-based smoking preventive intervention that has previously been evaluated in a large randomized controlled trial (RCT) with good effects. However, the actual effect for participating students depends on the individual implementation. The aim of this study was to examine the implementation of smoke-free contract, which is one of the three main intervention components. Specifically, we examined whether it was implemented equally across family occupational social class (OSC), separately for boys and girls, the joint effect of OSC and gender, and the participants’ own reasons for not signing a contract. Results: Overall, the smoke-free contract was well implemented; 81.8% of pupils (total N = 2.015) signed a contract (girls 85.1, boys 78.6%). We found a social gradient among girls; more than 90% were in OSC group I vs. 75% in group VI. Among boys, however, we found no difference across OSC. Boys in all the OSC groups had about half the odds (i.e., medium OSC boys: OR = 0.48 (95% CI: 0.32–0.72) of having a smoke-free contract compared to girls from a high OSC. Conclusion: future interventions should include initiatives to involve families from all OSC groups and allow for different preferences among boys and girls.

Child–Adult Contract for Prevention of Tobacco Use: “As-Treated” Analysis of a Cluster Randomized Controlled Trial (the TOPAS Study) at 3-Year Follow-Up

“…This shows that smokers were less likely to enter a stable 3-year contract. A Danish study also reported that students who smoked cigarettes were less likely to enter a contract in the first place (Bast et al, 2021 ). However, most of the questioned participants stated that the reason for not signing a contract was because they were never invited to sign a contract, alternatively that there was no specific reason (“I just didn’t do it”) (Bast et al, 2021 ).…”

“…A Danish study also reported that students who smoked cigarettes were less likely to enter a contract in the first place (Bast et al, 2021 ). However, most of the questioned participants stated that the reason for not signing a contract was because they were never invited to sign a contract, alternatively that there was no specific reason (“I just didn’t do it”) (Bast et al, 2021 ). Both in our study and in the Danish study, girls were more likely to be in a (stable) contract, while in Sweden, the smoking prevalence is higher among girls compared to boys (Bast et al, 2021 ; Beeres et al, 2022 ).…”

“…However, most of the questioned participants stated that the reason for not signing a contract was because they were never invited to sign a contract, alternatively that there was no specific reason (“I just didn’t do it”) (Bast et al, 2021 ). Both in our study and in the Danish study, girls were more likely to be in a (stable) contract, while in Sweden, the smoking prevalence is higher among girls compared to boys (Bast et al, 2021 ; Beeres et al, 2022 ). Multiple unknown factors other than tobacco use and gender might have affected the probability to enter and remain in a contract, but studies are rare, and apart from this single Danish study, factors related to participation in such a contract are largely unexplored (Bast et al, 2021 ).…”

“…Despite recommendations to evaluate individual components, there are very few studies that assessed the effect of the core component of SFC, i.e., the agreement between students within a class to remain tobacco free for a set time period (Bast et al, 2021 ). A Danish study assessed predictors for participation in the contract (Bast et al, 2021 ).…”

Effects of a Patient-Centered Intervention to Reduce Alcohol Use Among Youth With Chronic Medical Conditions

“…For the trial, we tested the effects of viewing the intervention on YCMC drinking behaviors (primary dependent variable), impacts on knowledge regarding the effects of alcohol on their disease and its management, and YCMC perceptions about the riskiness of drinking (putative intermediary variables). We also explored gender-based subgroup effects, given the potential that males and females might respond differently to the intervention [19,20]. All participants completed baseline and 6-month followup surveys; participants in the intervention arm also reported about knowledge and perceived risk of alcohol use immediately after viewing the intervention.…”