Study protocol of the X:IT II - a school-based smoking preventive intervention

Background: 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. Methods: 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. Discussion: 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. Trial registration: Current Controlled Trials ISRCTN31292019, date of registration 24/10/2017. Retrospectively registered.