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Evaluating the KickAsh!-intervention’s effectiveness in preventing smoking among vulnerable Flemish adolescents : a non-randomized cluster-controlled trial

Dr. Kenji Leta (UGent) , Emelien Lauwerier (UGent) , Sara Willems (UGent) , Babette Demeester (UGent) , Veerle Van Oeckel (UGent) and Maïté Verloigne (UGent)
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Abstract
Adolescents experiencing societal vulnerability are at heightened risk of smoking uptake, exacerbating health disparities. To address this, the KickAsh!-intervention was co-created with adolescents and youth workers in Flanders, Belgium, using the intervention mapping protocol (IMP), aiming to prevent smoking uptake among 10- to 16-year-olds, particularly those from disadvantaged backgrounds. This study evaluates its effectiveness on adolescents’ smoking initiation behaviour and related determinants: smoking intention, attitude, self-efficacy beliefs, coping planning, perceived subjective norms, perceived social pressure, risk perception, and perceived smoking behaviour of peers and youth workers. A non-randomized cluster-controlled trial was conducted across 23 youth social work organizations, with 12 implementing the intervention over four months. Co-creation organizations were pre-assigned to the intervention group. Data were collected via questionnaires at baseline, post-intervention, and seven-month follow-up (total N = 670; mean age = 12.85 years, SD = 2.40; 63.2% boys). Generalized linear mixed models (GLMMs) in R were used to analyse intervention effects. A significant intervention effect was found for coping planning at post-test (B = 0.57, SE = 0.28, P = .04) and follow-up (B = 1.32, SE = 0.29, P < .001), with intervention participants showing an increase in preparing strategies to resist smoking. No significant effects were observed for smoking initiation behaviour or other determinants. This study found that combining co-creation with the IMP to develop a smoking prevention intervention yielded limited effects. High anti-smoking baseline levels and irregular adolescent attendance may have limited impact, highlighting challenges for implementing and evaluating interventions in youth social work settings.
Keywords
smoking prevention, socially vulnerable adolescents, co-creation, youth social work, health inequalities, SOCIOECONOMIC-STATUS, CIGARETTE-SMOKING, RISK-FACTORS, TOBACCO USE, INITIATION, FRAMEWORK, CHILDREN, MODEL, DETERMINANTS, CESSATION

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MLA
Leta, Dr. Kenji, et al. “Evaluating the KickAsh!-Intervention’s Effectiveness in Preventing Smoking among Vulnerable Flemish Adolescents : A Non-Randomized Cluster-Controlled Trial.” HEALTH PROMOTION INTERNATIONAL, vol. 41, no. 1, 2026, doi:10.1093/heapro/daag022.
APA
Leta, Dr. K., Lauwerier, E., Willems, S., Demeester, B., Van Oeckel, V., & Verloigne, M. (2026). Evaluating the KickAsh!-intervention’s effectiveness in preventing smoking among vulnerable Flemish adolescents : a non-randomized cluster-controlled trial. HEALTH PROMOTION INTERNATIONAL, 41(1). https://doi.org/10.1093/heapro/daag022
Chicago author-date
Leta, Dr. Kenji, Emelien Lauwerier, Sara Willems, Babette Demeester, Veerle Van Oeckel, and Maïté Verloigne. 2026. “Evaluating the KickAsh!-Intervention’s Effectiveness in Preventing Smoking among Vulnerable Flemish Adolescents : A Non-Randomized Cluster-Controlled Trial.” HEALTH PROMOTION INTERNATIONAL 41 (1). https://doi.org/10.1093/heapro/daag022.
Chicago author-date (all authors)
Leta, Dr. Kenji, Emelien Lauwerier, Sara Willems, Babette Demeester, Veerle Van Oeckel, and Maïté Verloigne. 2026. “Evaluating the KickAsh!-Intervention’s Effectiveness in Preventing Smoking among Vulnerable Flemish Adolescents : A Non-Randomized Cluster-Controlled Trial.” HEALTH PROMOTION INTERNATIONAL 41 (1). doi:10.1093/heapro/daag022.
Vancouver
1.
Leta DrK, Lauwerier E, Willems S, Demeester B, Van Oeckel V, Verloigne M. Evaluating the KickAsh!-intervention’s effectiveness in preventing smoking among vulnerable Flemish adolescents : a non-randomized cluster-controlled trial. HEALTH PROMOTION INTERNATIONAL. 2026;41(1).
IEEE
[1]
Dr. K. Leta, E. Lauwerier, S. Willems, B. Demeester, V. Van Oeckel, and M. Verloigne, “Evaluating the KickAsh!-intervention’s effectiveness in preventing smoking among vulnerable Flemish adolescents : a non-randomized cluster-controlled trial,” HEALTH PROMOTION INTERNATIONAL, vol. 41, no. 1, 2026.
@article{01KJ4V86CYSY028MT5VD1PKB7R,
  abstract     = {{Adolescents experiencing societal vulnerability are at heightened risk of smoking uptake, exacerbating health disparities. To address this, the KickAsh!-intervention was co-created with adolescents and youth workers in Flanders, Belgium, using the intervention mapping protocol (IMP), aiming to prevent smoking uptake among 10- to 16-year-olds, particularly those from disadvantaged backgrounds. This study evaluates its effectiveness on adolescents’ smoking initiation behaviour and related determinants: smoking intention, attitude, self-efficacy beliefs, coping planning, perceived subjective norms, perceived social pressure, risk perception, and perceived smoking behaviour of peers and youth workers. A non-randomized cluster-controlled trial was conducted across 23 youth social work organizations, with 12 implementing the intervention over four months. Co-creation organizations were pre-assigned to the intervention group. Data were collected via questionnaires at baseline, post-intervention, and seven-month follow-up (total N = 670; mean age = 12.85 years, SD = 2.40; 63.2% boys). Generalized linear mixed models (GLMMs) in R were used to analyse intervention effects. A significant intervention effect was found for coping planning at post-test (B = 0.57, SE = 0.28, P = .04) and follow-up (B = 1.32, SE = 0.29, P < .001), with intervention participants showing an increase in preparing strategies to resist smoking. No significant effects were observed for smoking initiation behaviour or other determinants. This study found that combining co-creation with the IMP to develop a smoking prevention intervention yielded limited effects. High anti-smoking baseline levels and irregular adolescent attendance may have limited impact, highlighting challenges for implementing and evaluating interventions in youth social work settings.}},
  articleno    = {{daag022}},
  author       = {{Leta, Dr. Kenji and Lauwerier, Emelien and Willems, Sara and Demeester, Babette and Van Oeckel, Veerle and Verloigne, Maïté}},
  issn         = {{0957-4824}},
  journal      = {{HEALTH PROMOTION INTERNATIONAL}},
  keywords     = {{smoking prevention,socially vulnerable adolescents,co-creation,youth social work,health inequalities,SOCIOECONOMIC-STATUS,CIGARETTE-SMOKING,RISK-FACTORS,TOBACCO USE,INITIATION,FRAMEWORK,CHILDREN,MODEL,DETERMINANTS,CESSATION}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{16}},
  title        = {{Evaluating the KickAsh!-intervention’s effectiveness in preventing smoking among vulnerable Flemish adolescents : a non-randomized cluster-controlled trial}},
  url          = {{http://doi.org/10.1093/heapro/daag022}},
  volume       = {{41}},
  year         = {{2026}},
}

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