Designing a Smoking Intervention for Youth Smokers Using Q-Methodology: A Pilot Randomized Controlled Trial
NCT ID: NCT07178899
Last Updated: 2025-09-17
Study Results
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Basic Information
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NOT_YET_RECRUITING
NA
100 participants
INTERVENTIONAL
2025-09-15
2027-03-31
Brief Summary
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Detailed Description
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The tobacco epidemic remains a pressing global health challenge, with tobacco-related illness contributing significantly to a high death rate worldwide. Smoking is the predominant mode of tobacco consumption worldwide and serves as the driving force behind this epidemic. According to the World Health Organization \[1\], there are an estimated 1.3 billion tobacco users worldwide currently. In Hong Kong, the smoking rate is estimated to be around 9.5%, with approximately 580 000 daily smokers in 2021 \[2\]. Despite the rate has decreased significantly from 23.3% in 1982, the Hong Kong government aims to further reduce the prevalence from 9.5% to 7.8% in 2025. The high prevalence of smoking imposes a significant public health burden worldwide, with tobacco use killing up to 50% of its users \[3\]. Additionally, smoking causes cancers, stroke, cardiovascular diseases and respiratory diseases \[4\], with around 7000 deaths reported each year \[5\]. One approach to reduce the smoking prevalence is to promote smoking cessation (SC) treatment among current smokers.
Young smokers constitute a large cohort of new smokers every year. It is estimated that up to 90% of daily smokers first tried smoking before 18 years old \[6\]. Published studies consistently highlight the concerning prevalence of youth smoking within our community. Data from the recent school survey \[7\] highlighted that despite only 1.2% of secondary school engages in smoking, a significant portion (7.4%, equivalent to around 24 000 students) of the youth population have previously engaged in smoking behaviour. The rate of youth ever smokers remain high at 7.4% in Hong Kong \[2\], equivalent to approximately 24 000 secondary school students, suggesting that youths are eagerly experimenting. This is also evident in the high prevalence of youths trying other tobacco products such as e-cigarettes or heated tobacco products, from 57.4% (178/310) in 2017 to 2018 to 85.9% (243/283) in 2019 to 2020 \[8\]. The shift from occasional smoking to dependency in youth is a crucial stage, making the adolescent years a key period for understanding and addressing smoking behaviours. It represents a key window for targeted interventions to prevent the progression towards regular smoking habits.
Smoking imposes severe health risks and long-term consequences. Effects of tobacco are well demonstrated \[9\] including the effects of nicotine on brain development \[10\]. The prevalence of tobacco use among youths not only jeopardizes their immediate health but negatively impacts their future well-being \[11\]. Moreover, observations from our communities \[12\] further emphasize the pressing need for effective SC initiatives tailored to the unique needs of youths. The multifaceted challenges such as peer pressure and social influences are faced by struggling youths.
In response to these identified needs, it is imperative to develop comprehensive youth-orientated SC programs that encompass various aspects of prevention, intervention and support. Evidence-based strategies such as counselling services \[13\] have shown promising outcomes in promoting smoke-free lifestyles among youths. Additionally, collaborations among healthcare institutions, government agencies and community organizations are crucial for maximizing the reach and effectiveness of cessation efforts. By addressing the health needs of our local community through targeted youth SC initiatives, we can significantly mitigate the adverse health effects of tobacco use among our young population.
Phase 3 Randomized control trial outcomes The primary outcomes of Phase 3 of this study will be smokers' (1) self-reported abstinence in the past 30 days at 2-month follow-up; (2) iScreen OFD Cotinine Saliva Test Kit (\<30ng/ml) biochemical validated tobacco abstinence; (3) the difference of the feasibility and acceptability score of the typology-based intervention between the intervention and control group.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
NONE
Study Groups
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Intervention group
In the intervention group, in addition to routine counselling (15-30 minutes), they will classify their identity with our screening tool (developed in Phase 2) and then apply the counselling protocol for the participants (5-10 minutes). After the counselling session, the personalized e-messages will be sent to the participants by the counsellor for 4 weeks.
typology-based intervention
The typology-based intervention includes: (1) typology-based counselling, (2) personalized E-message based on the counselling content discussed (3) a booklet introducing the typology of quit identity. All interventions and materials are delivered by smoking counselling.
Control Group
In the control group, the routine smoking cessation counselling, including generic advice on preventing smoking relapse, will be retained, and they will receive brief e-messages that only consist of general quit advice for 4 weeks.
Routine Treatment
The routine smoking cessation intervention includes: (1) Routine counselling generic advice on preventing smoking relapse (2) Brief e-messages that consist of general quit advice for 4 weeks. Counsellors implement both routine practices.
Interventions
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typology-based intervention
The typology-based intervention includes: (1) typology-based counselling, (2) personalized E-message based on the counselling content discussed (3) a booklet introducing the typology of quit identity. All interventions and materials are delivered by smoking counselling.
Routine Treatment
The routine smoking cessation intervention includes: (1) Routine counselling generic advice on preventing smoking relapse (2) Brief e-messages that consist of general quit advice for 4 weeks. Counsellors implement both routine practices.
Eligibility Criteria
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Inclusion Criteria
* Have ever habitually used conventional cigarettes in the past year
* Not using cigarettes for the past 7 days
* Aged 18-25
* No barriers in communicating in Cantonese and reading and writing Chinese
* Quit smoking without using cessation services
* Hong Kong citizens
* Have ever habitually used conventional cigarettes in the past year
* Received at least 4 weeks of smoking cessation service before enrolling into the study
* abstained from tobacco use for 7 to 30 days without using any cessation services
* Aged 18-25
* No barriers in communicating in Cantonese and reading and writing Chinese
* SC counsellors from local SC clinics under HKU Youth Quit Line, Tung Wah Group of Hospitals Integrated Center on Smoking Cessation and United Christian Nethersole Community Health Service
Exclusion Criteria
* Are users of illicit drugs (e.g., heroin, marijuana, ketamine, etc.)
* Have become pregnant in the past two months
* unable to communicate in Cantonese and read Chinese
18 Years
25 Years
ALL
Yes
Sponsors
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The University of Hong Kong
OTHER
Responsible Party
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CHEUNG, Cara Hor Yine
Post Doctoral Fellow
Locations
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LKS Faculty of Medicine
Hong Kong, , Hong Kong
Countries
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Central Contacts
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Facility Contacts
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References
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Zabala A, Pascual U. Bootstrapping Q Methodology to Improve the Understanding of Human Perspectives. PLoS One. 2016 Feb 4;11(2):e0148087. doi: 10.1371/journal.pone.0148087. eCollection 2016.
Watts S, Stenner P. Doing the fieldwork: participants, materials and procedure. 2012 2022/03/11. In: Doing Q Methodological Research: Theory, Method and Interpretation . London: SAGE Publications Ltd
Karpinski JP, Timpe EM, Lubsch L. Smoking cessation treatment for adolescents. J Pediatr Pharmacol Ther. 2010 Oct;15(4):249-63.
Bailey SR, Crew EE, Riske EC, Ammerman S, Robinson TN, Killen JD. Efficacy and tolerability of pharmacotherapies to aid smoking cessation in adolescents. Paediatr Drugs. 2012 Apr 1;14(2):91-108. doi: 10.2165/11594370-000000000-00000.
Duncan Millar J, Mason H, Kidd L. What is Q methodology? Evid Based Nurs. 2022 Jul;25(3):77-78. doi: 10.1136/ebnurs-2022-103568. Epub 2022 May 24. No abstract available.
Bowen NK, Lee JS, Weller BE. SOCIAL ENVIRONMENTAL RISK AND PROTECTION: A TYPOLOGY WITH IMPLICATIONS FOR PRACTICE IN ELEMENTARY SCHOOLS. Child Sch. 2007;29(4):229-242. doi: 10.1093/cs/29.4.229.
Tombor I, Shahab L, Herbec A, Neale J, Michie S, West R. Smoker identity and its potential role in young adults' smoking behavior: A meta-ethnography. Health Psychol. 2015 Oct;34(10):992-1003. doi: 10.1037/hea0000191. Epub 2015 Jan 26.
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Tombor I, Vangeli E, West R, Shahab L. Progression towards smoking cessation: Qualitative analysis of successful, unsuccessful, and never quitters. J Subst Use. 2017 Oct 5;23(2):214-222. doi: 10.1080/14659891.2017.1378746. eCollection 2018.
Rose JS, Chassin L, Presson C, Sherman SJ, Stein MD, Col N. A latent class typology of young women smokers. Addiction. 2007 Aug;102(8):1310-9. doi: 10.1111/j.1360-0443.2007.01889.x.
Thomas JL, Luo X, Bengtson J, Wang Q, Ghidei W, Nyman J, Lust K, An L, Wetter DW, Epstein L, Ahluwalia JS. Enhancing Quit & Win contests to improve cessation among college smokers: a randomized clinical trial. Addiction. 2016 Feb;111(2):331-9. doi: 10.1111/add.13144. Epub 2015 Nov 11.
Villanti AC, West JC, Klemperer EM, Graham AL, Mays D, Mermelstein RJ, Higgins ST. Smoking-Cessation Interventions for U.S. Young Adults: Updated Systematic Review. Am J Prev Med. 2020 Jul;59(1):123-136. doi: 10.1016/j.amepre.2020.01.021. Epub 2020 May 14.
Chaiton M, Diemert L, Cohen JE, Bondy SJ, Selby P, Philipneri A, Schwartz R. Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open. 2016 Jun 9;6(6):e011045. doi: 10.1136/bmjopen-2016-011045.
Rosa JD, Aloise-Young P. A Qualitative Study of Smoker Identity Among College Student Smokers. Subst Use Misuse. 2015;50(12):1510-7. doi: 10.3109/10826084.2015.1018549. Epub 2015 Nov 19.
Davey, G. and Zhao, X. (2020), Turning Points to Becoming a Tobacco Smoker: Smoking Initiation and Identity Change among Chinese Youth. Symbolic Interaction, 43: 308-331
Bitar S, Collonnaz M, O'Loughlin J, Kestens Y, Ricci L, Martini H, Agrinier N, Minary L. A Systematic Review of Qualitative Studies on Factors Associated With Smoking Cessation Among Adolescents and Young Adults. Nicotine Tob Res. 2024 Jan 1;26(1):2-11. doi: 10.1093/ntr/ntad167.
Barrington-Trimis JL, Braymiller JL, Unger JB, McConnell R, Stokes A, Leventhal AM, Sargent JD, Samet JM, Goodwin RD. Trends in the Age of Cigarette Smoking Initiation Among Young Adults in the US From 2002 to 2018. JAMA Netw Open. 2020 Oct 1;3(10):e2019022. doi: 10.1001/jamanetworkopen.2020.19022.
An LC, Klatt C, Perry CL, Lein EB, Hennrikus DJ, Pallonen UE, Bliss RL, Lando HA, Farley DM, Ahluwalia JS, Ehlinger EP. The RealU online cessation intervention for college smokers: a randomized controlled trial. Prev Med. 2008 Aug;47(2):194-9. doi: 10.1016/j.ypmed.2008.04.011. Epub 2008 May 2.
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Other Identifiers
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08230208
Identifier Type: -
Identifier Source: org_study_id
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