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Aims: There are well-known gender differences in smoking, including the pattern of use and the effectiveness of smoking prevention programs. However, little is known about the differences between boys and girls in their attitudes towards smoking prevention interventions. This study explores gender differences in attitudes towards a school-based intervention to prevent smoking. Methods: We used data from the X:IT II intervention study conducted in 46 Danish elementary schools. Results: Compared to boys, girls were more positive towards smoke-free school time, both concerning rules for teachers smoking (odds ratio (OR) = 1.69, 95% confidence interval (CI): 1.35–2.12) and for students smoking (OR = 1.41, 95% CI: 1.13–1.76). No difference was observed in students signing the smoke-free agreement. However, a larger proportion of girls reported that the agreement was a good occasion to talk about smoking with their parents (OR = 1.36, 95% CI: 1.13–1.76). Girls were also more positive towards the smoke-free curriculum (OR = 1.52, 95% CI: 1.19–1.94). Conclusions: This study showed that girls were, overall, more positive towards the components of the smoking preventive intervention. Our findings highlight the importance of considering differences in intervention preferences for boys and girls in future health prevention initiatives.

The X:IT intervention, conducted in 2010 to 2013, showed overall smoking preventive effect. However, parts of the intervention appeared less appealing to children from families with lower socioeconomic backgrounds. Therefore, the intervention components were modified and an evaluation of the amended intervention X:IT II is needed to show the effect of this revised intervention and whether children from different social backgrounds benefits equally from the current intervention. Main intervention components are smoke free schools, a curricular component, and parental involvement (smoke free agreements and talks about tobacco). Components have been revised from the first version; 1) previously, schools should be smoke free on the school ground and were encouraged to hide smoking so that it wasn’t visible to pupils from the school ground. Now they are encouraged to tighten the rules so that no pupils or teachers smoke during the school day, no matter where they are; 2) the specifically developed educational material (Up in Smoke) has been revised so that all materials are online and all texts has a ARI; 3) the parental involvement is now targeted multiple groups of parents, e.g. parents that are smokers, and parents of children that smoke. Language used is simpler and the website for parents presents very specific examples. X:IT is implemented in 46 Danish public schools from fall 2017 until summer 2020. Data is collected through electronic questionnaires to students and coordinators four times (fall 2017, spring/summer 2018, 2019 and 2020). Further, qualitative interviews and observations are conducted. Prevalence of smoking among Danish adolescents is high compared to other Nordic countries and there is social inequality in smoking, leaving individuals from the lowest social backgrounds at higher risk. Although there has been an overall decline in smoking among Danish adolescents over the last decades, a recent levelling of this development indicates an urgent need for smoking prevention in Denmark. The X:IT intervention has the potential to prevent uptake of smoking among adolescents. However, there is a particular need for evaluating the effectiveness of the revised X:IT intervention, X:IT II, with focus on the effect across socioeconomic groups of adolescents. Current Controlled Trials ISRCTN31292019 , date of registration 24/10/2017. Retrospectively registered.

School organizational readiness to implement interventions may play an important role for the actual obtained implementation level, and knowledge about organizational readiness prior to intervention start can help pinpoint how to optimize support to the schools. In this study, we applied a novel heuristic, R = MC2 to assess school organizational readiness prior to implementation of a multicomponent smoking prevention program. Furthermore, we examined the association to actual implementation after the first year of study. We used questionnaire data from school coordinators at 40 schools in Denmark who had accepted to implement the multi-component smoking prevention intervention—X:IT II—in the school year 2017–2018 including three main components: (1) Rules on smoke-free school time, (2) A smoke-free curriculum, and (3) Parental involvement. On behalf of the school, a school coordinator answered a baseline questionnaire about the organizational readiness and a follow-up questionnaire about implementation of the three components after first year of study. Readiness was measured by summing aspects of motivation (relative advantage, compatibility, complexity, and priority), general capacity (culture, climate, and staff capacity), and innovation-specific capacity (knowledge, skills, and abilities). Based on school coordinators’ perceptions, almost all schools had good general capacity while the other two areas of readiness varied across schools; overall, 56.8% of schools (N = 25) had good motivation for implementing the X:IT II intervention and 61.3% (N = 27) had high innovation-specific capacity. Half of the schools had high overall readiness defined as high motivation and high innovation-specific capacity. Schools with high overall readiness implemented the rules on smoke-free school time, smoke-free curriculum, and parental involvement to a higher degree than schools with low overall readiness. All participating schools possessed sufficient levels of general capacity, e.g., a well-functioning organizational culture and sufficient staff capacity. High levels of motivation and innovation-specific capacity were positively associated with the schools’ actual implementation of the main intervention components. This way of conceptualizing and measuring organizational readiness may be useful in future studies, i.e., in studies where enhancing readiness is a main objective.

Background: Non-smoking agreements has shown effective in preventing smoking among adolescents. However, to date, this is the first study to explore: 1) if adolescents who do or do not sign have specific characteristics, 2) adolescents’ attitudes towards signing and committing to these smoke-free agreements (SFA). Methods: This is explored by combining questionnaire and focus group data. The questionnaire data is gathered as part of the evaluation of X:IT study II; a smoking preventive intervention targeting adolescents in 7 th -9 th grade. In this paper data from second follow (8 th grade) up is used. Eight focus groups (N=43) were conducted with the adolescents in 8 th grade at two Danish secondary schools. Inspired by theory integration we draw from resistance theory to combine the results from the methods. Results: The questionnaire data showed that adolescents who were partaking in smoking or smoking-related behavior including current or ever smoked as well as have ever tried hash, snuff or electronic cigarettes to a less degree signed a SFA. Focus group analysis showed that even though the adolescents at the two schools emphasized a lack of attention to the SFA, the lack of attention was ascribed to different approaches to smoking and the SFA. In general, adolescents at one of the schools had no intention of smoking and thus willingly signed and committed. Whereas, adolescents at the other school expressed a greater resistance to signing as well as committing to the SFA. Instead, what seemed important for the adolescents at this school was a desire to act freely and appear with no strains, including possibility to smoke, which the SFA seemingly threated. Conclusion: Although non-smoking agreements, implemented in the school setting, have been effective in decreasing smoking among adolescents in other studies, our results suggest that the SFA may appeal differently to adolescents according to certain characteristics, while getting overall very little attention.

Objective To examine gender and socioeconomic differences in adolescents’ reasons for not smoking cigarettes using self-reported data from Danish 14-year-olds (N = 1,559) collected in 2018. χ2-tests were used to assess whether the proportion of students who rated 12 statements as important reasons for not smoking cigarettes differed according to gender and family occupational social class (OSC). Results More girls than boys stated that thinking the taste of cigarettes is disgusting, not being allowed to smoke by parents, knowing smoking is dangerous, not being allowed to smoke before the age of 18, not wanting to be addicted to smoking, and that smoking makes you smell bad were important reasons for choosing not to smoke cigarettes. More boys than girls reported exercising a lot and having a partner that does not smoke as important reasons for not smoking cigarettes. More students with a high OSC compared with a low OSC stated exercising a lot and that smoking makes you smell bad were important reasons. In conclusion, reasons for not smoking cigarettes differed substantially across gender and less according to socioeconomic position.

Objective: We examined whether schools participating in a school-based smoking prevention intervention (X:IT II) differed from other schools in Denmark. Methods: We used national data to compare schools in X:IT II (N = 46) to all other schools nationwide having a 7th grade (N = 1299). Using binary logistic regression analyses, we examined whether school characteristics and measures of pupils' well-being were associated with participation. Results: We found lower odds for participating in X:IT II among private schools compared to public schools (OR = .433, p = .026) and higher odds for participating among schools with many pupils reporting high social well-being (OR = 1.034, p = .023) and low well-being concerning support and inspiration (OR = 1.055, p = .019). Conclusions: Findings suggest that schools in X:IT II are representative in terms of pupil enrollment, proportion of pupils with foreign origin, organizational resources, average grades, academic well-being, and well-being concerning peace and order compared to schools nationwide. On the other hand, type of institution (private vs public), social well-being, and well-being concerning support and inspiration were significantly associated with participation in the intervention. These findings are relevant for guiding future interventions targeting health areas among school children and adolescents.

Objective The aim of this paper was to examine smoking-specific norms and practices to understand the meaning of social context for young adolescent’s perception of tobacco use. The analysis of the social context was informed by the Collective Lifestyle framework and draws on concepts like place-based smoking, structure and agency. Methods This paper draws from an ethnographic study of smoking-specific norms and practices. We conducted eight focus group interviews with a total of 44 adolescents and 28 days of field observations among grade 8 students at two Danish schools. Results Our analysis suggests that adolescents’ smoking-related practices and hence meaning of smoking differs according to the social context they engage in. The social context contributes to the way adolescents smoking unfold in specific places by specific groups of adolescents. Herby suggesting that smoking becomes an object contributing to social exclusion. Conclusions Future interventions and tobacco control initiatives targeting young adolescents should consider the meaning of the social context for creating places to practice smoking.

Objective Over the last decades, numerous school-based smoking prevention programs have been launched internationally. However, there has been limited research on the differential effect of sex in response to the implementation of school-based smoking prevention interventions. The aim of this study was to examine sex differences in the attitudes towards a school-based smoking prevention intervention. Specifically, the research questions explore whether there are sex differences in the attitudes towards the three main components; 1) Smoke-free school grounds 2) Smoke-free curriculum, and 3) Smoke-free agreement. Methods We used data from the X:IT II intervention study with 46 elementary schools collected in 2017-2018. The X:IT II intervention is a school-based multicomponent smoking prevention intervention targeted all students attending grade 7 to 9 (13- to 15-year-olds). Data were collected by electronic questionnaires completed by students at first follow-up. Results We found that compared to boys, girls were significantly more positive towards the implementation of smoke-free school grounds, both concerning teachers smoking (66 % vs. 53.5 %) and students smoking (61.3 % vs. 51.9 %) and toward the smoke-free curriculum (79.5 % vs. 71.9 %). No statistically significant differences between boys and girls could be observed in the proportion of students signing the smoke-free agreement, nor in their attitudes towards the agreement. Conclusions This study showed that there were, to some extent, sex differences in the attitudes towards components in the X:IT II intervention study. Our findings highlight the importance of considering sex differences in future health prevention initiatives.

Several established school smoking prevention initiatives involve restrictions on places to smoke. The focus on tobacco control in schools is due to the risk of smoking initiation during adolescence and the perception of this life stage as a period of time when health behavior is established. Hence, this period of time is considered to be ideal for health-promoting initiatives. This paper is part of an ethnographic study on adolescents&rsquo, perceptions of tobacco use. Focus groups and field observations were used to explore adolescents&rsquo, smoking-related practices related to smoking bans at schools. The findings show that smoking, as a place-based practice, is influenced by locally embedded rules and carries social implications resulting in a distinction between smokers and non-smokers. The distinction between smokers and non-smokers contributes to the retention of a stereotypical view of smokers and, moreover, stigmatizes smokers. According to this, restrictions on places to smoke within the school should be considered carefully in order to avoid stigma or ethical issues.

Background The aims of antenatal education are broad and encompass outcomes related to pregnancy, birth, and parenthood. Both form and content of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups, with participation of a small number of participants, may differ from the effect of other forms of antenatal education due to, for example, group dynamic. The objective of this systematic review is to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes. Methods Bibliographic databases (Medline, EMBASE, CENTRAL, CINAHL, Web of Science, and PsycINFO) were searched. We included randomized and quasi-randomized trials irrespective of language, publication year, publication type, and publication status. Only trials carried out in the Western world were considered in this review. Studies were assessed for bias using the Cochrane risk of bias tool. Results are presented as structured summaries of the included trials and as forest plots. Results We identified 5,708 records. Of these, 17 studies met inclusion criteria. Studies varied greatly in content of the experimental and control condition. All outcomes were only reported in a single or a few trials, leading to limited or uncertain confidence in effect estimates. Given the heterogeneity in interventions and outcomes and also the high risk of bias of studies, we are unable to draw definitive conclusions as to the impact of small group antenatal education on obstetric and psycho-social outcomes. Conclusions Insufficient evidence exists as to whether antenatal education in small classes is effective in regard to obstetric and psycho-social outcomes. We recommend updating this review following the emergence of well-conducted randomized controlled trials with a low risk of bias. Systematic review registration PROSPERO CRD42013004319 Electronic supplementary material The online version of this article (doi:10.1186/s13643-015-0010-x) contains supplementary material, which is available to authorized users.