Adapting and Implementing a School-Based "Implementation Intentions" Program Within FRESHAIR4Life to Prevent Smoking...

Background: Most individuals develop smoking habits in adolescence, highlighting the need for a smoking prevention program targeted at this age group. The use of "Implementation Intentions" (If-Then plans) about how to refuse a cigarette combined with anti-smoking messages has been shown to be effective in the UK. However, there is a scarcity of data regarding school-based smoking prevention interventions among adolescents available to countries with high tobacco consumption rates, like Greece. Objectives: To describe the cultural adaptation procedure and the evaluation protocol for the school-based "Implementation Intentions" program aimed at reducing tobacco use susceptibility among Greek adolescents aged 13-16 in school settings. Methods: The present study is part of the EU-funded FRESHAIR4Life Program. We will use a mixed-methods approach with a pre- and post-intervention design in six conveniently selected secondary schools in Heraklion, Crete, Greece, to measure the intervention's Reach, Effectiveness, Adoption, Implementation, and Maintenance using the RE-AIM framework. The study plans to involve three Master Trainers (MTs), 20-25 school teachers (to be trained by the MTs), and approximately 480 students. Participating schools will receive the "Implementation Intentions" intervention, which is based on a goal-setting technique where individuals commit to perform a particular behavior when a specific context arises. The study will consist of five sequential phases: Phase I involves training three Master Trainers (MTs) using the International Primary Care Respiratory Group (IPCRG's) Teach-the-Teacher (TtT) curriculum, specifically focused on the implementation of our intervention. In Phase II, workshops will be held to co-create and culturally adapt the intervention. Phase III will involve teachers trained by MTs on delivering the intervention. In Phase IV, teachers will deliver the intervention among students in their schools. Data will be collected pre- and post-intervention through surveys, session logs, fidelity observations, feedback forms, and follow-up interviews or focus groups (Phase V). Quantitative data will be analyzed descriptively and by using paired t-tests and multiple linear regression analyses, while qualitative data will undergo thematic analysis. Discussion: The study protocol's potential benefits extend beyond educating Greek adolescents on the risks associated with smoking. Active participation will empower and motivate young people to make informed, healthy choices. We expect the results could help create more effective, context-specific interventions, support policy changes aimed at decreasing the prevalence of adolescent smoking in Crete, Greece, and potentially be used by other countries as well.