The implementation of 'Leuk Zonder Peuk', a smoking prevention program for primary school children

Smoking is a leading cause of morbidity and mortality. Tobacco use represents a
major health risk and is a preventable cause of many chronic diseases,
including coronary heart disease and various types of cancers. It is known from
previous studies the earlier people start to smoke the more likely they will
become regular smokers.
Especially the transition from primary school to secondary school is a period
of risk to start smoking. In this period youngsters experience pressure and
stress, and want to belong to a group. If someone offers them a cigarette they
need positive attitudes, self-efficacy and skills to refuse that cigarette.
The present study will include primary school students from group 7 and will
follow them to the first class of the secondary school. With computer tailored
feedback we will give the youngsters (in the experimental group) information
about their own attitudes, self-efficacy and social norms helping them not to
start (experimenting with) smoking. Computer tailored feedback has shown to be
effective in reaching adolescents, also in smoking prevention trials.
Furthermore, we will test the efficacy of a proactive approach using prompts in
order to maintain interest and attention of the pupils. Several studies suggest
that the utilization of a proactive approach will yield higher participation
rates.

The main goal of this study is to examine the effectiveness of a smoking
prevention program for primary school children. The program should provide the
pupils with attitudes, knowledge and skills to refuse cigarettes when they make
the transition to secondary school.
In the intervention trial our goal is to assess what the effects of providing
prompts will be on the intensity of use of Leuk Zonder Peuk in primary school
children.

The design of the study is a Randomized Control Trial (RCT) with three equal
groups (two experimental groups and one control group). The control group
receives no tailored feedback reports. Both experimental groups will be
compared with the control group and mutually (proactive group will be compared
with the reactive group). One experimental group will be approach proactively
to revisit a website, read their previous advices and get new advices. The
other experimental group will not be stimulated to revisit the website.

Pupils in the proactive group receive three tailored feedback reports based on
their answers in the online questionnaire. We will provide prompts to the
pupils to encourage them to revisit the Leuk Zonder Peuk website. To prompt the
pupils to (re)visit the web page we will use e-mails and SMS text messages.

Pupils in the reactive group will receive three tailored feedback reports,
similar to those in the proactive group. Students in the reactive group are
free to (re)visit the Leuk Zonder Peuk website, but they will not be prompted.

Students in the control group will not receive tailored feedback reports and
will not be prompted to (re)visit the Leuk Zonder Peuk website. They only have
to fill out the online questionnaire at the three measurement periods. Between
the measurement periods they will not have access to the website of Leuk Zonder
Peuk.

The computer tailored intervention will consist of three groups: one control
group and two experimental groups. All participants will fill out an online
questionnaire regarding their attitudes, self-efficacy and other factors
related to smoking. While the control group receives nothing, the two
experimental groups will receive computer tailored feedback reports based on
the answers they filled out in the online questionnaire. The difference between
these two groups is that one group will be proactively prompted (via sms and
e-mail) to revisit the website (prompt group), with information about smoking,
whereas the other group will not be prompted (non-prompt group).

Participation in this study is voluntary and without any risk. The
well-intentioned personal advices will only lead to positive health effects,
when followed correctly. We will guarantee full confidentiality to our
participants. The data will only be available to the researchers of Leuk Zonder
Peuk.