Evaluación de la efectividad de la intervención KickAsh! en la prevención del tabaquismo en adolescentes vulnerables...

Adolescents experiencing societal vulnerability are at heightened risk of smoking uptake, exacerbating health disparities. To address this, the KickAsh!-intervention was co-created with adolescents and youth workers in Flanders, Belgium, using the intervention mapping protocol (IMP), aiming to prevent smoking uptake among 10- to 16-year-olds, particularly those from disadvantaged backgrounds. This study evaluates its effectiveness on adolescents' smoking initiation behaviour and related determinants: smoking intention, attitude, self-efficacy beliefs, coping planning, perceived subjective norms, perceived social pressure, risk perception, and perceived smoking behaviour of peers and youth workers. A non-randomized cluster-controlled trial was conducted across 23 youth social work organizations, with 12 implementing the intervention over four months. Co-creation organizations were pre-assigned to the intervention group. Data were collected via questionnaires at baseline, post-intervention, and seven-month follow-up (total N = 670; mean age = 12.85 years, SD = 2.40; 63.2% boys). Generalized linear mixed models (GLMMs) in R were used to analyse intervention effects. A significant intervention effect was found for coping planning at post-test (B = 0.57, SE = 0.28, P = .04) and follow-up (B = 1.32, SE = 0.29, P < .001), with intervention participants showing an increase in preparing strategies to resist smoking. No significant effects were observed for smoking initiation behaviour or other determinants. This study found that combining co-creation with the IMP to develop a smoking prevention intervention yielded limited effects. High anti-smoking baseline levels and irregular adolescent attendance may have limited impact, highlighting challenges for implementing and evaluating interventions in youth social work settings.