The Short-term Effects of ASPIRA: A Web-based, Multimedia Smoking Prevention Program for Adolescents in Romania: A Cluster Randomized Trial

Abstract

IntroductionAlthough web-based, multimedia smoking prevention programs have been tested in several high-income countries, their efficacy in Central and Eastern Europe is unknown. The aim of this trial was to assess the short-term effects of ASPIRA, among Romanian and Hungarian speaking ninth graders in Tirgu Mures, Romania. ASPIRA is the Romanian acronym for the translated and adapted version of ASPIRE, “A Smoking Prevention Interactive Experience,” an evidence-based smoking prevention program originally developed to prevent tobacco use among high school students in the United States.MethodsSixteen high schools in Tirgu Mures, Romania were randomized to receive five weekly sessions of the ASPIRA web-based, multimedia program or to a control condition. Socio-demographic data, psychosocial characteristics, and smoking behavior were collected from students at baseline and at 6 months. A hierarchical logistic regression analysis was conducted to test the efficacy of the intervention on smoking initiation and current smoking among 1369 students.ResultsNever-smoker students in the intervention arm were 35% less likely to report smoking initiation 6 months after the baseline assessment (OR = 0.65, 95%CI: 0.44–0.97). Reduced smoking initiation was observed most notably among students who were exposed to at least 75% of the ASPIRA program. There was no statistically significant effect of the intervention on current tobacco use (OR = 0.80, 95%CI: 0.44–1.46).ConclusionsASPIRA, an adapted version of the evidence-based, multimedia ASPIRE program that was originally developed and tested in the United States may decrease smoking initiation among multi-ethnic adolescents in Central and Eastern Europe.Implications(1). Web-based, multimedia smoking prevention programs may be effective tools to prevent smoking initiation among multi-ethnic adolescent communities in Central and Eastern Europe. (2). The degree of exposure is critical, only high exposure to the multimedia smoking prevention program is associated with reduced smoking initiation.

Bidirectional associations of e-cigarette, conventional cigarette and waterpipe experimentation among adolescents: A cross-lagged model

“…The smoking prevention intervention had an impact only on conventional cigarette smoking (AOR=0.65, 95%CI: 0.43–0.98) as it was reported previously (Nădășan et al, 2017), but had no significant effect on either trying e-cigarettes (AOR=0.81, 95%CI: 0.60–1.11) or trying waterpipe (AOR=1.17, 95%CI: 0.65–2.11). Gender was associated with e-cigarette experimentation only at baseline.…”

“…The present study is the secondary analysis of the data collected in a school-based, cluster randomized controlled trial designed to test a web-based multimedia program to prevent the initiation of smoking among adolescents. Detailed description of the original study design is provided elsewhere (Nădășan et al, 2017).…”

Computer-Based Prevention and Intervention to Reduce Substance Use in Youth

“…Evident in Table 1 are disquietingly high rates of attrition (i.e., > 30%) in nine of the 26 studies [28, 31, 33, 36, 37, 39, 40, 41, 43, 45]. Small wonder that between-arm differences elude investigators when a good portion of the sample is not available for data collection.…”

School-based Smoking Prevention in Adolescents in Developing Countries: A Literature Review

“…School-based programs are a comprehensive strategy that is generally accepted to limit tobacco use among children and adolescents. It is an implementation of the program with a health education curriculum taught by teachers or trained professionals [19]. The purpose of this program is to minimize the intention and initiation to smoke, increase student awareness and knowledge about smoking, increase understanding of the effects of cigarette smoke on those around him, teach and practice the skills to reject cigarettes, and develop positive attitudes towards students toward smoking [7].…”