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In 2002, TeenNet began a randomized control trial (RCT) of its web-based youth smoking prevention and cessation resource (Smoking Zine). This is the largest known randomized trial of an e-health intervention for behavior change and among the largest study investigating adolescent smoking cessation involving more than 1400 adolescents (smoking and non-smoking) from participating Toronto-area high schools. Data analysis is currently underway.

Participants in the study were randomly assigned to complete either the Smoking Zine [283A] or a website evaluation [276B] task that teaches youth how to critically appraise information on the Internet. Data has been collected at baseline, post-intervention, three and six month follow-up.

KEY FINDINGS

Overall, The Smoking Zine had greater influence with boys than girls and with students in grade 10 more than other grades at reducing smoking-related intentions and behaviours. For non-smokers:

• All boys in all grades and all grade 10 girls who completed the Smoking Zine lowered their intention to smoke throughout the entire six-month study, compared with those in the control group.
• Girls in grades 9 and 11 lowered their intention immediately after completing the Smoking Zine, but did not have lower intentions at three or six-month follow-up compared to the control group.
• All boys in all grades who completed the Smoking Zine reported lower cigarette consumption than the control group at three-month follow-up and boys in grade 10 maintained this lower level of cigarette consumption throughout the entire study period.

• Grade 9 boys who completed the Smoking Zine lowered their intention to smoke immediately afterwards, but did not maintain this lower intention relative to the control group at follow-up.
• Boys in the Smoking Zine condition reported higher levels of cigarette use at three months than their counterparts in the control group, but not at six-months.
• Both boys and girls in the Smoking Zine group reported lower resistance to smoking post-intervention, however resistance scores were comparable to the control group at three and six month follow-up.

Thus, The Smoking Zine in this study was more effective as a prevention tool for non-smokers than as a cessation resource for smokers. However, because of constraining use of the Smoking Zine to one class session, most smokers did not have time to complete the fifth phase of the intervention that involves developing a quit plan.

IMPLICATIONS

The Internet has potential for reaching large numbers of youth at a very low cost. The 24/7 availability of the website with its ability to be combined with a single-session classroom intervention suggests that the Smoking Zine can help prevent thousands of Ontario students from starting to smoke if it is routinely implemented in schools across the province. Combined with a short discussion with teachers or health practitioners, the Smoking Zine can complement the secondary school health curriculum and community-based health promotion programming.

Study Workbooks:
Smoking Zine Booklet [283A] | Website Evaluation [276B]

Principal Investigator: Dr. Harvey Skinner

Co-investigator: Dr Eudice Goldberg

Partners: Toronto Public Health, YMCA Youth Substance Abuse Program (YSAP)

Funders: Canadian Institutes for Health Research (CIHR) and Ministry of Health and Long Term Care

More information:
Cameron Norman, MA, (PhD-C)
416.209.6740

Oonagh Maley, MISt,
416.978.7543