Child–adult contract for prevention of tobacco use: "as-treated" analysis of a cluster randomized controlled trial (the TOPAS study) at 3-year follow-up

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Beeres, Dorien TeclaDepartment of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Sweden; Department of Public Health, Erasmus MC, Rotterdam, Netherlands (author)

Child–adult contract for prevention of tobacco use : "as-treated" analysis of a cluster randomized controlled trial (the TOPAS study) at 3-year follow-up

Article/chapterEnglish2024

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Springer Nature,2024
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LIBRIS-ID:oai:DiVA.org:umu-215924
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-215924URI
https://doi.org/10.1007/s11121-023-01598-yDOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:154038383URI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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To estimate the effect of a 3-year commitment to remain tobacco free on tobacco uptake among high school students in Sweden. The commitment is developed in the form of a contract between a child and a significant adult, constituting the core component of Tobacco-free Duo (T-Duo), a Swedish school-based tobacco prevention program. Secondary analysis of data from a cluster randomized controlled trial. Participants were 586 students in high schools assigned to the intervention arm of T-Duo. At inception, participants attended grade 7 (i.e., age 12–13). Only students who were tobacco naïve at baseline for the respective outcome and participated in all follow-ups were included. The exposure was defined as signing a 3-year contract with a significant adult, categorized as “stable contract” (3 years contract with the same contract partner), “unstable” (signed a contract sometime during follow-up but this was not sustained over time and/or with the same partner), and “no contract” at all during the intervention period. The primary outcome was having never tried cigarette smoking at the end of grade 9. Exposure and outcomes were self-reported in yearly questionnaires. Of 586 students, 321 (55%) held a stable contract, 204 (35%) an unstable contract, and 61 (10%) did not sign a contract at all. At the end of grade 9 (age 15–16), the relative risk (RR) to remain cigarette free was 1.11 (95% CI 1.00–1.22) (Number Needed to Treat = 10) among students in any type of contract compared to students that did not write a contract at all. The RRs for remaining tobacco free (secondary outcomes) ranged from 1.07 (0.98–1.16) for regular snus use to 1.16 (1.00–1.35) for any type of tobacco use. A commitment to remain tobacco free through a child–adult contract seems to exert a preventive effect on the uptake of tobacco use among Swedish adolescents over 3 school years. The current findings apply to a selected sample of both schools and students.Registration: Current Controlled Trials ISRCTN52858080 Date: January 4, 2019, retrospectively registered.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Public Health, Global Health, Social Medicine and Epidemiology hsv//eng
Adolescence
As-treated analysis
School-based prevention
Tobacco use

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Pulkki-Brännström, Anni-MariaUmeå universitet,Institutionen för epidemiologi och global hälsa(Swepub:umu)anpu0004 (author)
Nilsson, Maria,1957-Umeå universitet,Institutionen för epidemiologi och global hälsa(Swepub:umu)mani0057 (author)
Galanti, Maria RosariaKarolinska Institutet (author)
Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Sweden; Department of Public Health, Erasmus MC, Rotterdam, NetherlandsInstitutionen för epidemiologi och global hälsa (creator_code:org_t)

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In:Prevention Science: Springer Nature25, s. 175-1921389-49861573-6695

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