Effectiveness and cost-effectiveness of repeated implementation intention formation on adolescent smoking initiation: A cluster randomized controlled trial.

Abstract

Objective: Forming implementation intentions (if–then plans) about how to refuse cigarette offers plus antismoking messages was tested for reducing adolescent smoking. Method: Cluster randomized controlled trial with schools randomized (1:1) to receive implementation intention intervention and messages targeting not smoking (intervention) or completing homework (control). Adolescents (11–12 years at baseline) formed implementation intentions and read messages on 8 occasions over 4 years meaning masking treatment allocation was not possible. Outcomes were: follow-up (48 months) ever smoking, any smoking in last 30 days, regular smoking, and breath carbon monoxide levels. Analyses excluded baseline ever smokers, controlled for clustering by schools and examined effects of controlling for demographic variables. Economic evaluation (incremental cost effectiveness ratio; ICER) was conducted. Trial is registered (ISRCTN27596806). Results: Schools were randomly allocated (September–October 2012) to intervention ( n = 25) or control ( n = 23). At follow-up, among 6,155 baseline never smokers from 45 retained schools, ever smoking was significantly lower (RR = 0.83, 95% CI [0.71, 0.97], p = .016) in intervention (29.3%) compared with control (35.8%) and remained so controlling for demographics. Similar patterns observed for any smoking in last 30 days. Less consistent effects were observed for regular smoking and breath carbon monoxide levels. Economic analysis yielded an ICER of $134 per ever smoker avoided at age 15–16 years. Conclusions: This pragmatic trial supports the use of repeated implementation intentions about how to refuse the offer of a cigarette plus antismoking messages as an effective and cost-effective intervention to reduce smoking initiation in adolescents.

Cognitive-Affective Inconsistency and Ambivalence: Impact on the Overall Attitude–Behavior Relationship

“…Study 2 focused on smoking initiation in adolescents. The current data have not been previously reported but are part of a larger randomized controlled trial testing implementation intentions as an intervention to reduce smoking initiation (Conner et al, 2013(Conner et al, , 2019 The current analyses control for intervention condition which did not moderate any of the relationships reported. A number of measures not reported here were also included (e.g., intentions; normative beliefs; perceived behavioral control).…”

Evidence that an intervention weakens the relationship between adolescent electronic cigarette use and tobacco smoking: a 24-month prospective study

“… 18 19 This intervention significantly reduced ever smoking and any recent tobacco use but had mixed effects on regular smoking and breath carbon monoxide. 19 Here, we analysed data from adolescents who were never smokers and either ever or never users of e-cigarettes at age 14. The focus was on predicting smoking at age 16 (24 months later).…”

The role of neuropsychological mechanisms in implementation intentions to reduce alcohol consumption among heavy drinkers: a randomized trial

“…Secondly, alcohol consumption was only followed up for a period of 1 month. Although implementation intentions have previously shown effects on other addictive behaviours that have lasted much longer (Conner et al, 2018;Conner & Higgins, 2010), future research should establish whether the effects found in this study would be sustained for similar lengths of time in heavy drinkers.…”

“…One suggestion for this would be a similar design to present study, but instead using an alcohol-relevant IAT with lexical stimuli drawn from the volitional helpsheet. This is especially important when considering that implementation intentions have been effective at enacting behaviour change that can last months, and even years (Conner et al, 2018;Conner & Higgins, 2010). Recently it has also been proven that implementation intentions can overcome the effects of habits outside of the laboratory (Epton & Armitage, 2017), which would be particularly useful in preventing more serious addictive disorders from developing.…”

“…There was a significant condition 9 time interaction, F(1, 91) = 3.95, p = 0.048, d = 0.47. Mean difference between groups at the 1 month follow-up was 5.65 units per week [95%CI 0.15,11.19], p = 0.048 to be tailored, which has been successfully done for other patterns of drinking Armitage, 2008Armitage, , 2015Conner et al, 2018). If these considerations were taken into account, there is the possibility that similar effects could be found in a clinically dependant population.…”