Peter Dalum - Academia.edu (original) (raw)

Papers by Peter Dalum

Preventive Medicine Reports, 2017

Preventive medicine, Jan 20, 2017

Sunbed use is associated with an increased risk for skin cancer and is particularly dangerous for... more Sunbed use is associated with an increased risk for skin cancer and is particularly dangerous for younger persons. The objective of this study was to assess how demographic factors, health-related behaviours and appearance-related factors are associated with sunbed use. Cross-sectional data from the Danish National Youth Study collected by the National Institute of Public Health during 2014 was used. A total of 64,382 students aged 15-25years were included in the present study. Multilevel logistic regression analyses were used to determine associations. Sunbed use during the past 12months was reported by 22% of students, with a higher proportion among females (29%) than males (12%). Factors associated with sunbed use were older age, studying at a vocational college or a higher preparatory examination school compared to upper secondary school, and lower parental education. Furthermore, being a smoker, been binge-drinking, longer duration of exercise and been dieting were also associa...

Health promotion practice, 2016

Objectives The objective of this project was to determine whether intervention mapping is a suita... more Objectives The objective of this project was to determine whether intervention mapping is a suitable strategy for developing an Internet- and text message-based smoking cessation intervention. Method We used the Intervention Mapping framework for planning health promotion programs. After a needs assessment, we identified important changeable determinants of cessation behavior, specified objectives for the intervention, selected theoretical methods for meeting our objectives, and operationalized change methods into practical intervention strategies. Results We found that "social cognitive theory," the "transtheoretical model/stages of change," "self-regulation theory," and "appreciative inquiry" were relevant theories for smoking cessation interventions. From these theories, we selected modeling/behavioral journalism, feedback, planning coping responses/if-then statements, gain frame/positive imaging, consciousness-raising, helping relationship...

Addiction, 2016

To compare the effectiveness of proactive telephone counselling, reactive telephone counselling a... more To compare the effectiveness of proactive telephone counselling, reactive telephone counselling and an internet- and text messages-based intervention with a self-help booklet for smoking cessation. A randomised controlled trial with equal allocation to four conditions: 1) Proactive telephone counselling (n=452), 2) Reactive telephone counselling (n=453), 3) Internet- and text-message-based intervention (n=453), 4) Self-help booklet (control) (n=452) SETTING: Denmark PARTICIPANTS: Smokers who had previously participated in two national health surveys were invited. Eligibility criteria were daily cigarette smoking, age ≥16 years, having a mobile phone and e-mail address. Primary outcome was prolonged abstinence to 12 months from the end of the intervention period. At 12-month follow-up higher prolonged abstinence was found in the proactive telephone counselling group compared with the booklet group (7.3% vs. 3.6%, OR=2.2 (95% CI 1.2-4.0)), There was no clear evidence of a difference in prolonged abstinence between the reactive telephone counselling group or the internet-based smoking cessation program and the booklet group: 1.8% vs. 3.6%, OR=0.8 (95% CI 0.6-1.2) and 5.3% vs. 3.6%, OR=1.6 (95% CI 0.8-3.0) respectively. In the proactive telephone counselling group, the cost per additional 12-month quitter compared with the booklet group was £644. Proactive telephone counselling was more effective than a self-help booklet in achieving prolonged abstinence for 12 months. No clear evidence of an effect of reactive telephone counselling or the internet- and text-message-based intervention was found compared with the self-help booklet. This article is protected by copyright. All rights reserved.

Tobacco control, Jan 16, 2014

A variety of smoking cessation aids are available; however, the majority of smokers quit unaided.... more A variety of smoking cessation aids are available; however, the majority of smokers quit unaided. We know little of the differences between users and non-users of cessation support. A cross-sectional study based on the Danish Health Examination Survey (DANHES) conducted in 2007-2008. In all, 6445 persons reporting quitting successfully within the last 5 years were included in analyses. Users and non-users of cessation aid (medical or behavioural support) were compared with regards to age, education, years smoked, tobacco amount, tobacco type and smoking-related disease using logistic regression analysis. Quitting unaided was reported by 63%. Adjusted analyses showed that men were more likely to quit unaided than women, and younger compared with older were more likely to quit unaided (eg, OR among women age 45-59 versus age 14-29 were 0.18, 95% CI 0.12 to 0.20). Additionally, those who had smoked for 15 years or more also had lower odds of quitting unaided. Smoking 15 or more grams o...

Scandinavian Journal of Public Health, 2013

Background: A growing body of literature demonstrates internet-based smoking cessation interventi... more Background: A growing body of literature demonstrates internet-based smoking cessation interventions as a promising aid in helping people quit smoking. However, the underlying mechanisms of how these interventions influence the cessation process are still relatively unknown. Several studies have indicated blogging as a potential source in providing social support to users of internet-based smoking cessation interventions and thereby enhance their change of succeeding in quitting. Objective: The study aimed to investigate themes discussed on a blog in an internet-based smoking cessation intervention. In addition, we examined if blogging could provide social support for people in a smoking cessation process. Method: The study was based on messages posted from 1 January 2012 to 29 February 2012 on the blog of the internet-based smoking cessation programme DDSP, operated by the Danish Cancer Society. messages were coded according to themes using grounded Theory, and additionally data about bloggers were analyzed. Result: In total, 1663 messages were posted within the 2-month period, and we identified 16 themes. The majority of messages contained personal stories or experiences (53%), provided emotional support (34%) or congratulated other users (17%). The messages were found capable of supplying social support to members on the blog. In addition, we found that only a minority of users who viewed the blog participated actively in posting messages, and only a minority was highly active bloggers. Conclusions: The blog offers a unique platform for informal conversations about quitting smoking and is important in providing social support to people in a smoking cessation process.

Scandinavian Journal of Public Health, 2012

Background: There is a lack of effective smoking cessation interventions which have a high reach ... more Background: There is a lack of effective smoking cessation interventions which have a high reach among adolescent smokers. Method: We conducted a randomised controlled trial of an adolescent smoking cessation intervention for students aged 15−21 at 22 continuation schools in Denmark. The intervention was a minimal intervention based on events with short counselling and a range of self-help materials. Our 1-month follow up consisted of 514 baseline daily smokers and the 14-month follow up of 369 daily smokers. Results: We found positive short-term effects regarding smoking cessation (adjusted Or 4.50, 95% CI 1.20−16.86), self-efficacy (p=0.01), and intentions to quit (p=0.004). However, none of these effects were maintained at 1-year follow up. The intervention was successful in reaching more than half of all daily smokers in the target group with more than 30% receiving counselling at least once in the intervention period. Conclusions: This trial shows that a "minimal" intervention can produce short-term effects but that this approach is insufficient in producing long-term effects.

Scandinavian Journal of Public Health, 2012

Background: Danish youth has for years had the highest alcohol consumption in Europe, however rec... more Background: Danish youth has for years had the highest alcohol consumption in Europe, however recent surveys show that consumption levels have diminished slightly and that the age of first intoxication has been raised. Aim: To explore young moderate drinkers' attitudes, values, and behaviour in relation to alcohol consumption. Design, setting, and participants: Data consists of 10 individual semi-structured interviews with 16-17-year-old moderate drinkers attending high school in Copenhagen, Denmark. Results: The study shows that the respondents perceive drinking as a necessity for feeling included at parties, but also that they do not feel a need to drink large amounts of alcohol in order to feel this social inclusion. The study finds that respondents employ a number of different behavioural and cognitive strategies aimed at controlling their own and close friends' drinking behaviour, and that short-term negative social implications are of much greater concern than long-term health consequences. In addition, the study shows that parents have a limited direct influence in this group. Conclusions: The study identifies a group of young people who have clearly defined restrictions as to what they consider positive drinking behaviour. As parents and long-term health consequences only have an limited influence on the respondents' drinking behaviour, these elements should not have primary focus in future interventions. In stead, interventions should take into account the social dynamics involved in drinking and recognise that the social qualities surrounding alcohol weighs higher among this group of young people than the quantity of alcohol consumed.

Preventive Medicine, 2014

The aim was to compare the effectiveness of untailored text messages for smoking cessation to tai... more The aim was to compare the effectiveness of untailored text messages for smoking cessation to tailored text messages delivered at a higher frequency. From users of an internet-based smoking cessation program with optional text message support aged 15-25 years were consecutively randomized to versions of the program that offered either tailored or untailored text messages. Thirty-day point abstinence from smoking was measured self-reportedly at 12-months follow-up. Response rates were 36.3% and 38.1% in the tailored and untailored group, respectively. We analyzed the entire study population, as well as those opting for text messages (n ¼ 1619). In intention-to-treat analysis with multiple imputation of missing data, the odds ratio for 30-day point abstinence was 1.28 (95% CI 0.91-2.08) for the tailored compared with untailored messages. When restricting the analysis to those who had chosen to receive text messages, the corresponding odds ratio was 1.45 (95% CI 1.01-2.08). The higher long-term quit rates in the group receiving the tailored text messages compared with untailored text messages in the restricted analysis indicated that tailoring and higher frequency of text messages increases quit rates among young smokers.

Patient Education and Counseling, 2008

Objective: To explore the smoking cessation process of adolescents and their attitudes and belief... more Objective: To explore the smoking cessation process of adolescents and their attitudes and beliefs towards smoking cessation and cessation interventions. Method: Focus group discussions and individual interviews during April-May 2004 with 26 persons aged 15-21 years who all initiated a quit attempt on 1 January 2004. Results: The approach towards all stages of the youth smoking cessation process varied greatly among both successful and unsuccessful quitters. Apart from 'commitment' or the amount of energy put into a cessation attempt, there were no differences in the way successful and unsuccessful quitters approached the quit attempt. 'Smoking friends' and 'social support' were important for maintaining cessation. Further, participants had negative attitudes towards formalized smoking cessation interventions. Conclusion: There are many approaches to the smoking cessation process. Whether an attempt is successful depends more on individual conditions and the amount of commitment invested in the attempt than on the specific cessation strategy used. Practice Implications: Future adolescent smoking cessation interventions should be flexible regarding both structure and content and should focus on the individual learning process, rather than adhering to rigid cessation strategies. ß

Health Informatics Journal, 2013

This study aimed to investigate how users perceive the different elements of an internet based sm... more This study aimed to investigate how users perceive the different elements of an internet based smoking cessation intervention and to see if the program meet needs and expectations of people in a smoking cessation process. Nine semi-structured interviews were conducted in February 2010. Participants were recruited via the homepage of the smoking cessation program Dit Digitale Stopprogram (Your Digital Quit Program) operated by the Danish Cancer Society. The main result was that participants established a relationship to the program which influenced their smoking cessation process. Participants perceived the program as caring and found it supportive. However, the program also created feelings of frustration, disappointment and anger. Some participants in the last phase of cessation experienced text messages from the program as smoking cues. The study concluded that individual interpretations of the different elements in an Internet-based smoking cessation intervention can have both positive and negative impact on the smoking cessation process of participants.

Health Education Research, 2014

The aim was to compare the effectiveness of untailored text messages for smoking cessation to tai... more The aim was to compare the effectiveness of untailored text messages for smoking cessation to tailored text messages delivered at a higher frequency. From users of an internet-based smoking cessation program with optional text message support aged 15-25 years were consecutively randomized to versions of the program that offered either tailored or untailored text messages. Thirty-day point abstinence from smoking was measured self-reportedly at 12-months follow-up. Response rates were 36.3% and 38.1% in the tailored and untailored group, respectively. We analyzed the entire study population, as well as those opting for text messages (n ¼ 1619). In intention-to-treat analysis with multiple imputation of missing data, the odds ratio for 30-day point abstinence was 1.28 (95% CI 0.91-2.08) for the tailored compared with untailored messages. When restricting the analysis to those who had chosen to receive text messages, the corresponding odds ratio was 1.45 (95% CI 1.01-2.08). The higher long-term quit rates in the group receiving the tailored text messages compared with untailored text messages in the restricted analysis indicated that tailoring and higher frequency of text messages increases quit rates among young smokers.

Health Education Research, 2012

The objective of this project was to develop a theory-and evidence-based adolescent smoking cessa... more The objective of this project was to develop a theory-and evidence-based adolescent smoking cessation intervention using both new and existing materials. We used the Intervention Mapping framework for planning health promotion programmes. Based on a needs assessment, we identified important and changeable determinants of cessation behaviour, specified change objectives for the intervention programme, selected theoretical change methods for accomplishing intervention objectives and finally operationalized change methods into practical intervention strategies. We found that guided practice, modelling, self-monitoring, coping planning, consciousness raising, dramatic relief and decisional balance were suitable methods for adolescent smoking cessation. We selected behavioural journalism, guided practice and Motivational Interviewing as strategies in our intervention. Intervention Mapping helped us to develop as systematic adolescent smoking cessation intervention with a clear link between behavioural goals, theoretical methods, practical strategies and materials and with a strong focus on implementation and recruitment. This paper does not present evaluation data.

BMC Public Health, 2014

Background: Adolescent smoking is still highly prevalent in Denmark. One in four 13-year olds ind... more Background: Adolescent smoking is still highly prevalent in Denmark. One in four 13-year olds indicates that they have tried to smoke, and one in four 15-year olds answer that they smoke regularly. Smoking is more prevalent in socioeconomically disadvantaged populations in Denmark as well as in most Western countries. Previous school-based programs to prevent smoking have shown contrasting results internationally. In Denmark, previous programs have shown limited or no effect. This indicates a need for developing a well-designed, comprehensive, and multi-component intervention aimed at Danish schools with careful implementation and thorough evaluation. This paper describes X:IT, a study including 1) the development of a 3-year school-based multi-component intervention and 2) the randomized trial investigating the effect of the intervention. The study aims at reducing the prevalence of smoking among 13 to 15-year olds by 25%. Methods/Design: The X:IT study is based on the Theory of Triadic Influences. The theory organizes factors influencing adolescent smoking into three streams: cultural environment, social situation, and personal factors. We added a fourth stream, the community aspects. The X:IT program comprises three main components: 1) smoke-free school premises, 2) parental involvement including smoke-free dialogues and smoke-free contracts between students and parents, and 3) a curricular component. The study encompasses process-and effect-evaluations as well as health economic analyses. Ninety-four schools in 17 municipalities were randomly allocated to the intervention (51 schools) or control (43 schools) group. At baseline in September 2010, 4,468 year 7 students were eligible of which 4,167 answered the baseline questionnaire (response rate = 93.3%). Discussion: The X:IT study is a large, randomized controlled trial evaluating the effect of an intervention, based on components proven to be efficient in other Nordic settings. The X:IT study directs students, their parents, and smoking prevention policies at the schools. These elements have proven to be effective tools in preventing smoking among adolescents. Program implementation is thoroughly evaluated to be able to add to the current knowledge of the importance of implementation. X:IT creates the basis for thorough effect and process evaluation, focusing on various social groups. Trial registration: Current Controlled Trials ISRCTN77415416.

Preventive Medicine Reports, 2017

Preventive medicine, Jan 20, 2017

Sunbed use is associated with an increased risk for skin cancer and is particularly dangerous for... more Sunbed use is associated with an increased risk for skin cancer and is particularly dangerous for younger persons. The objective of this study was to assess how demographic factors, health-related behaviours and appearance-related factors are associated with sunbed use. Cross-sectional data from the Danish National Youth Study collected by the National Institute of Public Health during 2014 was used. A total of 64,382 students aged 15-25years were included in the present study. Multilevel logistic regression analyses were used to determine associations. Sunbed use during the past 12months was reported by 22% of students, with a higher proportion among females (29%) than males (12%). Factors associated with sunbed use were older age, studying at a vocational college or a higher preparatory examination school compared to upper secondary school, and lower parental education. Furthermore, being a smoker, been binge-drinking, longer duration of exercise and been dieting were also associa...

Health promotion practice, 2016

Objectives The objective of this project was to determine whether intervention mapping is a suita... more Objectives The objective of this project was to determine whether intervention mapping is a suitable strategy for developing an Internet- and text message-based smoking cessation intervention. Method We used the Intervention Mapping framework for planning health promotion programs. After a needs assessment, we identified important changeable determinants of cessation behavior, specified objectives for the intervention, selected theoretical methods for meeting our objectives, and operationalized change methods into practical intervention strategies. Results We found that "social cognitive theory," the "transtheoretical model/stages of change," "self-regulation theory," and "appreciative inquiry" were relevant theories for smoking cessation interventions. From these theories, we selected modeling/behavioral journalism, feedback, planning coping responses/if-then statements, gain frame/positive imaging, consciousness-raising, helping relationship...

Addiction, 2016

To compare the effectiveness of proactive telephone counselling, reactive telephone counselling a... more To compare the effectiveness of proactive telephone counselling, reactive telephone counselling and an internet- and text messages-based intervention with a self-help booklet for smoking cessation. A randomised controlled trial with equal allocation to four conditions: 1) Proactive telephone counselling (n=452), 2) Reactive telephone counselling (n=453), 3) Internet- and text-message-based intervention (n=453), 4) Self-help booklet (control) (n=452) SETTING: Denmark PARTICIPANTS: Smokers who had previously participated in two national health surveys were invited. Eligibility criteria were daily cigarette smoking, age ≥16 years, having a mobile phone and e-mail address. Primary outcome was prolonged abstinence to 12 months from the end of the intervention period. At 12-month follow-up higher prolonged abstinence was found in the proactive telephone counselling group compared with the booklet group (7.3% vs. 3.6%, OR=2.2 (95% CI 1.2-4.0)), There was no clear evidence of a difference in prolonged abstinence between the reactive telephone counselling group or the internet-based smoking cessation program and the booklet group: 1.8% vs. 3.6%, OR=0.8 (95% CI 0.6-1.2) and 5.3% vs. 3.6%, OR=1.6 (95% CI 0.8-3.0) respectively. In the proactive telephone counselling group, the cost per additional 12-month quitter compared with the booklet group was £644. Proactive telephone counselling was more effective than a self-help booklet in achieving prolonged abstinence for 12 months. No clear evidence of an effect of reactive telephone counselling or the internet- and text-message-based intervention was found compared with the self-help booklet. This article is protected by copyright. All rights reserved.

Tobacco control, Jan 16, 2014

A variety of smoking cessation aids are available; however, the majority of smokers quit unaided.... more A variety of smoking cessation aids are available; however, the majority of smokers quit unaided. We know little of the differences between users and non-users of cessation support. A cross-sectional study based on the Danish Health Examination Survey (DANHES) conducted in 2007-2008. In all, 6445 persons reporting quitting successfully within the last 5 years were included in analyses. Users and non-users of cessation aid (medical or behavioural support) were compared with regards to age, education, years smoked, tobacco amount, tobacco type and smoking-related disease using logistic regression analysis. Quitting unaided was reported by 63%. Adjusted analyses showed that men were more likely to quit unaided than women, and younger compared with older were more likely to quit unaided (eg, OR among women age 45-59 versus age 14-29 were 0.18, 95% CI 0.12 to 0.20). Additionally, those who had smoked for 15 years or more also had lower odds of quitting unaided. Smoking 15 or more grams o...

Scandinavian Journal of Public Health, 2013

Background: A growing body of literature demonstrates internet-based smoking cessation interventi... more Background: A growing body of literature demonstrates internet-based smoking cessation interventions as a promising aid in helping people quit smoking. However, the underlying mechanisms of how these interventions influence the cessation process are still relatively unknown. Several studies have indicated blogging as a potential source in providing social support to users of internet-based smoking cessation interventions and thereby enhance their change of succeeding in quitting. Objective: The study aimed to investigate themes discussed on a blog in an internet-based smoking cessation intervention. In addition, we examined if blogging could provide social support for people in a smoking cessation process. Method: The study was based on messages posted from 1 January 2012 to 29 February 2012 on the blog of the internet-based smoking cessation programme DDSP, operated by the Danish Cancer Society. messages were coded according to themes using grounded Theory, and additionally data about bloggers were analyzed. Result: In total, 1663 messages were posted within the 2-month period, and we identified 16 themes. The majority of messages contained personal stories or experiences (53%), provided emotional support (34%) or congratulated other users (17%). The messages were found capable of supplying social support to members on the blog. In addition, we found that only a minority of users who viewed the blog participated actively in posting messages, and only a minority was highly active bloggers. Conclusions: The blog offers a unique platform for informal conversations about quitting smoking and is important in providing social support to people in a smoking cessation process.

Scandinavian Journal of Public Health, 2012

Background: There is a lack of effective smoking cessation interventions which have a high reach ... more Background: There is a lack of effective smoking cessation interventions which have a high reach among adolescent smokers. Method: We conducted a randomised controlled trial of an adolescent smoking cessation intervention for students aged 15−21 at 22 continuation schools in Denmark. The intervention was a minimal intervention based on events with short counselling and a range of self-help materials. Our 1-month follow up consisted of 514 baseline daily smokers and the 14-month follow up of 369 daily smokers. Results: We found positive short-term effects regarding smoking cessation (adjusted Or 4.50, 95% CI 1.20−16.86), self-efficacy (p=0.01), and intentions to quit (p=0.004). However, none of these effects were maintained at 1-year follow up. The intervention was successful in reaching more than half of all daily smokers in the target group with more than 30% receiving counselling at least once in the intervention period. Conclusions: This trial shows that a "minimal" intervention can produce short-term effects but that this approach is insufficient in producing long-term effects.

Scandinavian Journal of Public Health, 2012

Background: Danish youth has for years had the highest alcohol consumption in Europe, however rec... more Background: Danish youth has for years had the highest alcohol consumption in Europe, however recent surveys show that consumption levels have diminished slightly and that the age of first intoxication has been raised. Aim: To explore young moderate drinkers' attitudes, values, and behaviour in relation to alcohol consumption. Design, setting, and participants: Data consists of 10 individual semi-structured interviews with 16-17-year-old moderate drinkers attending high school in Copenhagen, Denmark. Results: The study shows that the respondents perceive drinking as a necessity for feeling included at parties, but also that they do not feel a need to drink large amounts of alcohol in order to feel this social inclusion. The study finds that respondents employ a number of different behavioural and cognitive strategies aimed at controlling their own and close friends' drinking behaviour, and that short-term negative social implications are of much greater concern than long-term health consequences. In addition, the study shows that parents have a limited direct influence in this group. Conclusions: The study identifies a group of young people who have clearly defined restrictions as to what they consider positive drinking behaviour. As parents and long-term health consequences only have an limited influence on the respondents' drinking behaviour, these elements should not have primary focus in future interventions. In stead, interventions should take into account the social dynamics involved in drinking and recognise that the social qualities surrounding alcohol weighs higher among this group of young people than the quantity of alcohol consumed.

Preventive Medicine, 2014

The aim was to compare the effectiveness of untailored text messages for smoking cessation to tai... more The aim was to compare the effectiveness of untailored text messages for smoking cessation to tailored text messages delivered at a higher frequency. From users of an internet-based smoking cessation program with optional text message support aged 15-25 years were consecutively randomized to versions of the program that offered either tailored or untailored text messages. Thirty-day point abstinence from smoking was measured self-reportedly at 12-months follow-up. Response rates were 36.3% and 38.1% in the tailored and untailored group, respectively. We analyzed the entire study population, as well as those opting for text messages (n ¼ 1619). In intention-to-treat analysis with multiple imputation of missing data, the odds ratio for 30-day point abstinence was 1.28 (95% CI 0.91-2.08) for the tailored compared with untailored messages. When restricting the analysis to those who had chosen to receive text messages, the corresponding odds ratio was 1.45 (95% CI 1.01-2.08). The higher long-term quit rates in the group receiving the tailored text messages compared with untailored text messages in the restricted analysis indicated that tailoring and higher frequency of text messages increases quit rates among young smokers.

Patient Education and Counseling, 2008

Objective: To explore the smoking cessation process of adolescents and their attitudes and belief... more Objective: To explore the smoking cessation process of adolescents and their attitudes and beliefs towards smoking cessation and cessation interventions. Method: Focus group discussions and individual interviews during April-May 2004 with 26 persons aged 15-21 years who all initiated a quit attempt on 1 January 2004. Results: The approach towards all stages of the youth smoking cessation process varied greatly among both successful and unsuccessful quitters. Apart from 'commitment' or the amount of energy put into a cessation attempt, there were no differences in the way successful and unsuccessful quitters approached the quit attempt. 'Smoking friends' and 'social support' were important for maintaining cessation. Further, participants had negative attitudes towards formalized smoking cessation interventions. Conclusion: There are many approaches to the smoking cessation process. Whether an attempt is successful depends more on individual conditions and the amount of commitment invested in the attempt than on the specific cessation strategy used. Practice Implications: Future adolescent smoking cessation interventions should be flexible regarding both structure and content and should focus on the individual learning process, rather than adhering to rigid cessation strategies. ß

Health Informatics Journal, 2013

This study aimed to investigate how users perceive the different elements of an internet based sm... more This study aimed to investigate how users perceive the different elements of an internet based smoking cessation intervention and to see if the program meet needs and expectations of people in a smoking cessation process. Nine semi-structured interviews were conducted in February 2010. Participants were recruited via the homepage of the smoking cessation program Dit Digitale Stopprogram (Your Digital Quit Program) operated by the Danish Cancer Society. The main result was that participants established a relationship to the program which influenced their smoking cessation process. Participants perceived the program as caring and found it supportive. However, the program also created feelings of frustration, disappointment and anger. Some participants in the last phase of cessation experienced text messages from the program as smoking cues. The study concluded that individual interpretations of the different elements in an Internet-based smoking cessation intervention can have both positive and negative impact on the smoking cessation process of participants.

Health Education Research, 2014

The aim was to compare the effectiveness of untailored text messages for smoking cessation to tai... more The aim was to compare the effectiveness of untailored text messages for smoking cessation to tailored text messages delivered at a higher frequency. From users of an internet-based smoking cessation program with optional text message support aged 15-25 years were consecutively randomized to versions of the program that offered either tailored or untailored text messages. Thirty-day point abstinence from smoking was measured self-reportedly at 12-months follow-up. Response rates were 36.3% and 38.1% in the tailored and untailored group, respectively. We analyzed the entire study population, as well as those opting for text messages (n ¼ 1619). In intention-to-treat analysis with multiple imputation of missing data, the odds ratio for 30-day point abstinence was 1.28 (95% CI 0.91-2.08) for the tailored compared with untailored messages. When restricting the analysis to those who had chosen to receive text messages, the corresponding odds ratio was 1.45 (95% CI 1.01-2.08). The higher long-term quit rates in the group receiving the tailored text messages compared with untailored text messages in the restricted analysis indicated that tailoring and higher frequency of text messages increases quit rates among young smokers.

Health Education Research, 2012

The objective of this project was to develop a theory-and evidence-based adolescent smoking cessa... more The objective of this project was to develop a theory-and evidence-based adolescent smoking cessation intervention using both new and existing materials. We used the Intervention Mapping framework for planning health promotion programmes. Based on a needs assessment, we identified important and changeable determinants of cessation behaviour, specified change objectives for the intervention programme, selected theoretical change methods for accomplishing intervention objectives and finally operationalized change methods into practical intervention strategies. We found that guided practice, modelling, self-monitoring, coping planning, consciousness raising, dramatic relief and decisional balance were suitable methods for adolescent smoking cessation. We selected behavioural journalism, guided practice and Motivational Interviewing as strategies in our intervention. Intervention Mapping helped us to develop as systematic adolescent smoking cessation intervention with a clear link between behavioural goals, theoretical methods, practical strategies and materials and with a strong focus on implementation and recruitment. This paper does not present evaluation data.

BMC Public Health, 2014

Background: Adolescent smoking is still highly prevalent in Denmark. One in four 13-year olds ind... more Background: Adolescent smoking is still highly prevalent in Denmark. One in four 13-year olds indicates that they have tried to smoke, and one in four 15-year olds answer that they smoke regularly. Smoking is more prevalent in socioeconomically disadvantaged populations in Denmark as well as in most Western countries. Previous school-based programs to prevent smoking have shown contrasting results internationally. In Denmark, previous programs have shown limited or no effect. This indicates a need for developing a well-designed, comprehensive, and multi-component intervention aimed at Danish schools with careful implementation and thorough evaluation. This paper describes X:IT, a study including 1) the development of a 3-year school-based multi-component intervention and 2) the randomized trial investigating the effect of the intervention. The study aims at reducing the prevalence of smoking among 13 to 15-year olds by 25%. Methods/Design: The X:IT study is based on the Theory of Triadic Influences. The theory organizes factors influencing adolescent smoking into three streams: cultural environment, social situation, and personal factors. We added a fourth stream, the community aspects. The X:IT program comprises three main components: 1) smoke-free school premises, 2) parental involvement including smoke-free dialogues and smoke-free contracts between students and parents, and 3) a curricular component. The study encompasses process-and effect-evaluations as well as health economic analyses. Ninety-four schools in 17 municipalities were randomly allocated to the intervention (51 schools) or control (43 schools) group. At baseline in September 2010, 4,468 year 7 students were eligible of which 4,167 answered the baseline questionnaire (response rate = 93.3%). Discussion: The X:IT study is a large, randomized controlled trial evaluating the effect of an intervention, based on components proven to be efficient in other Nordic settings. The X:IT study directs students, their parents, and smoking prevention policies at the schools. These elements have proven to be effective tools in preventing smoking among adolescents. Program implementation is thoroughly evaluated to be able to add to the current knowledge of the importance of implementation. X:IT creates the basis for thorough effect and process evaluation, focusing on various social groups. Trial registration: Current Controlled Trials ISRCTN77415416.