Long-Term Effects of a Home-Based Smoking Prevention Program On Smoking Initiation: A Cluster Randomized Controlled Trial

During adolescence smoking increases rapidly from 4% at age 10 to 44% at age 14. Therefore, prevention of children at an early age is pivotal. It is important to involve parents in smoking prevention, because they can affect their children’s smoking through parenting practices. Last year we presented the short term effect of the Smoke-free Kids program at the SPR. This year we will focus us on the long-term effects. The aim is to evaluate the long-term effects (i.e., 36 months) of a Dutch homed-based smoking prevention program called ‘Smoke-free kids” on smoking initiation in children aged 9-11 years old and the moderating effect of parental smoking, Social Economic Status, and asthma. A Cluster randomized controlled trial using intervention and control condition. Children were recruited via elementary schools; however the program itself was conducted at home. A total of 1,398 children aged 9-11 years old (mean age = 10.11; SD = .78) were randomly assigned to the intervention (n = 684) or control condition (n = 714). Intention-to-treat analyses were conducted on 1,398 children and completers-only analyses on 1,238 children. The dropout was 11.4% over 36 months. Once every four weeks over a period of five months, mothers and children in the intervention condition received printed activity modules with separate communication sheets for the mother. These modules were designed to gradually increase parental skills and comfort level in communicating with children about smoking, addiction, and expectations regarding abstinence. The control condition received a fact-based program. The factsheets provided information on youth smoking and focuses parents’ attention on macro-level variables relevant to youth smoking. The main outcome was initiation of smoking (first instance of puffing on a cigarette) at 36 months after baseline measurement Results showed that in the intervention condition 10.8% of the children started smoking compared with 12% in the control condition at 36 months follow-up. However, the difference between the two groups was not significant (OR = 90, 95% CI = .63-1.27, p = .54). Also no moderating effects of SES, parental smoking, and asthma were found. In conclusion, there is a small difference between the two conditions of the Smoke-free Kids program; however the results were not significant. Longer follow-ups are needed.

Trial registration: NTR1465