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Biochemical validation may not be necessary or advisable in studies like the current study using Internet data collection without face-to-face contact [ 53 ].

In their review of tobacco cessation interventions for young people, Grimshaw and Stanton [ 54 ] noted that biochemical validation can affect recruitment and retention, and may not be a very sensitive measure of change in smoking behavior for irregular smokers.

For these reasons, logistical constraints, and the fact that we promised anonymity, we did not perform biochemical verification.

When confidentiality and anonymity are assured, adolescent self-reported smoking will lead to similar results as obtained by biochemical validation [ 55 , 56 ].

Hence, in the present study, the respondents were guaranteed confidentiality and were informed of the exclusion of their names and email addresses from the remaining answers [ 57 ].

Most often, however, reasons for non-participation mentioned were lack of time and lack of interest, which is often the case in many schools in the Netherlands, since health promotion is not integrated into the Dutch school curriculum [ 10 , 58 , 59 ].

This clearly implies a need for health promoting policies to outline the need for adoption of evidence-based smoking prevention programs.

Third, we experienced high but equal loss to follow-up in both the experimental and control condition. High attrition is a well-known feature of many studies of eHealth interventions [ 60 , 61 ] and may be a threat to internal validity.

In the current study, attrition risk may have been elevated because participants had to complete the follow-up questionnaire in their spare time, as compared to it being an activity at school [ 62 ].

Attrition analyses showed that dropout was selective. Dropout was higher among lower educated and older students and adolescents with a higher intention to start smoking.

Since intention is an immediate antecedent of behavior [ 63 ], caution is warranted in generalizing the findings. Handling dropout was performed using multiple imputation, thus preserving as many cases for analysis on the intervention effects as possible.

Multiple imputation is considered the best method for imputing missing values [ 49 ], provided the missing values are missing at random. The current study did not allow time for qualitative assessment of missingness due to dropout, as we promised anonymity.

The most likely explanation for non-participation, as voiced by their teachers, is that the students had a lack of interest in participating in a study, rather than reasons relating to their smoking behavior.

It is important to gain insight into predictors of dropout and examine strategies to enhance engagement with Web-based interventions over time and reduce the excessive rates of attrition.

Web 2. Web-based computer-tailored interventions are a promising way of preventing smoking initiation among adolescents for at least 6 months, in particular among the age cohort of years.

The findings of the present study illustrate the need for smoking prevention programs beyond the year age group that is traditionally targeted by these programs.

Long-term assessment is needed to determine if the preventive effect of Web-based computer-tailored interventions is sustained in the years following program delivery.

This study was supported by grants from the Dutch Ministry of Health, Welfare and Sport. CONSORT-EHEALTH checklist V1. Conflicts of Interest: Conflicts of Interest: Hein de Vries is scientific director of Vision2Health, a company that licenses evidence-based innovative computer-tailored health communication tools.

National Center for Biotechnology Information , U. National Library of Medicine Rockville Pike , Bethesda MD , USA.

NCBI Skip to main content Skip to navigation Resources How To About NCBI Accesskeys My NCBI Sign in to NCBI Sign Out. PMC US National Library of Medicine National Institutes of Health.

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Journal List J Med Internet Res v. J Med Internet Res. Published online Mar PMCID: PMC Reviewed by Nanhua Zhang and Kelvin Choi.

Sanne de Josselin de Jong , MSc, 1, 2 3 Math Candel , PhD, 4 Dewi Segaar , PhD, 3 Henricus-Paul Cremers , MSc, 1 and Hein de Vries , PhD 1 1 School for Public Health and Primary Care CAPHRI , Department of Health Promotion, Maastricht University, Maastricht, Netherlands.

Sanne de Josselin de Jong, Trimbos Institute Netherlands Institute of Mental Health and Addiction , Da Costakade 45, PO Box , Utrecht, AS, Netherlands, Phone: 31 30 , Fax: 31 30 , Email: ln.

Sanne de Josselin de Jong 1 School for Public Health and Primary Care CAPHRI , Department of Health Promotion, Maastricht University, Maastricht, Netherlands 2 Trimbos Institute Netherlands Institute of Mental Health and Addiction , Utrecht, Netherlands 3 STIVORO Dutch Expert Centre on Tobacco Control, Den Haag, Netherlands Find articles by Sanne de Josselin de Jong.

Math Candel 4 School for Public Health and Primary Care CAPHRI , Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands Find articles by Math Candel.

Dewi Segaar 3 STIVORO Dutch Expert Centre on Tobacco Control, Den Haag, Netherlands Find articles by Dewi Segaar.

Henricus-Paul Cremers 1 School for Public Health and Primary Care CAPHRI , Department of Health Promotion, Maastricht University, Maastricht, Netherlands Find articles by Henricus-Paul Cremers.

Hein de Vries 1 School for Public Health and Primary Care CAPHRI , Department of Health Promotion, Maastricht University, Maastricht, Netherlands Find articles by Hein de Vries.

Author information Article notes Copyright and License information Disclaimer. Corresponding author. Corresponding Author: Sanne de Josselin de Jong ln.

Received Dec 4; Revisions requested Jun 14; Revised Jan 29; Accepted Feb This article has been cited by other articles in PMC.

Abstract Background Preventing smoking initiation among adolescents is crucial to reducing tobacco-caused death and disease.

Objective The intent of the study was to describe the intervention characteristics and to show the effectiveness and results of a randomized controlled trial.

Methods The intervention consisted of a questionnaire and fully automated computer-tailored feedback on intention to start smoking and motivational determinants.

Results Smoking initiation among students aged years was borderline significantly lower in the experimental condition as compared to the control condition 6 months after baseline OR 0.

Conclusions The findings of this study suggest that computer-tailored smoking prevention programs are a promising way of preventing smoking initiation among adolescents for at least 6 months, in particular among the age cohort of years.

Keywords: computer tailoring, Web-based intervention, Internet, smoking prevention, smoking initiation, adolescents, randomized controlled trial.

Introduction Background Of every three young smokers, one will die as a result of their tobacco use [ 1 ].

Objectives The main aim of this paper is to describe the intervention characteristics and to show the results of the randomized controlled trial on its effectiveness for the prevention of smoking among Dutch adolescents.

Methods Design Intervention effectiveness was studied by means of a cluster randomized controlled trial and encompassed the implementation of Smoke Alert in the experimental condition at school.

Participants and Procedure Participants in the present study were students from secondary schools in the Netherlands. Intervention The Smoke Alert program was based on the I-Change Model, or the Integrated Model for exploring motivational and behavioral change [ 38 , 39 ].

Open in a separate window. Figure 1. Table 1 Examples of feedback messages [ 36 ]. That would be a pity. Attitude feedback Your answers show that you see a lot of advantages of smoking.

That can make it difficult to remain a non-smoker. Social influence feedback Almost none of your friends smoke. However, you mentioned about half of the people around you smoke.

Maybe you feel like smoking is normal. Most people in the Netherlands do not smoke. Did you know that almost three-quarters of Dutch citizens do not smoke?

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Pascha's founder, Hermann Müller, was sentenced to 3 years in prison on 4 September This was for tax evasion in one of his brothels in Munich.

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The Pascha filed for bankruptcy in early September Prostitution was outlawed in the state of North Rhine-Westphalia from the beginning of the COVID outbreak , which led to authorities repeatedly renewing fortnightly closure orders.

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