Short-Term Effects of a Randomized Computer-Based Out-of-School Smoking Prevention Trial Aimed at Elementary Schoolchildren 1 Marlein Ausems, M.P.H.,* ,2 Ilse Mesters, Ph.D.,* Gerard van Breukelen, Ph.D.,† and Hein De Vries, Ph.D.* *The Maastricht Health Research Institute for Prevention and Care, Netherlands School of Primary Care Research, Department of Health Education and Promotion, Faculty of Health Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; and †The Maastricht Health Research Institute for Prevention and Care, Netherlands School of Primary Care Research, Department of Methodology and Statistics, Faculty of Psychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands Background. Smoking prevention programs usually run during school hours. In our study, an out-of-school program was developed consisting of a computer- tailored intervention aimed at the age group before school transition (11- to 12-year-old elementary schoolchildren). The aim of this study is to evaluate the additional effect of out-of-school smoking preven- tion. Methods. One hundred fifty-six participating schools were randomly allocated to one of four research con- ditions: (a) the in-school condition, an existing seven- lesson program; (b) the out-of-school condition, three computer-tailored letters sent to the students’ homes; (c) the in-school and out-of-school condition, a com- bined approach; (d) the control condition. Pretest and 6 months follow-up data on smoking initiation and continuation, and data on psychosocial variables were collected from 3,349 students. Results. Control and out-of-school conditions dif- fered regarding posttest smoking initiation (18.1 and 10.4%) and regarding posttest smoking continuation (23.5 and 13.1%). Multilevel logistic regression analy- ses showed positive effects regarding the out-of-school program. Significant effects were not found regarding the in-school program, nor did the combined approach show stronger effects than the single-method ap- proaches. Conclusions. The findings of this study suggest that smoking prevention trials for elementary schoolchil- dren can be effective when using out-of-school computer-tailored interventions. © 2002 American Health Foundation and Elsevier Science (USA) Key Words: smoking prevention; smoking initiation; smoking continuation; elementary school; computer- tailored intervention; out-of-school; ASE model; RCT; The Netherlands. INTRODUCTION In 1997, approximately 50% of the Dutch population ages 10 –19 years had tried cigarettes; 22% were occa- sional or daily smokers [1]. Smoking Dutch youths had in many cases tried their first cigarette at the age of 11–12 years [2]. In The Netherlands, 27 to 36% of 11- to 12-year-old youths have smoked a cigarette [1]. Many authors state that smoking prevention programs should be aimed at preventing or delaying tobacco use [3–6], implying the need for effective prevention pro- grams targeted at youngsters from the age of 11 years, when they are in the last grade of Dutch elementary schools. The focus of these programs should be to pre- vent youngsters from starting to smoke and to prevent those youngsters already experimenting from continu- ing with smoking. In recent decades, several effective school-based smoking prevention programs for secondary school stu- dents were developed worldwide with a special empha- sis on social influences [7], which represent the most important determinant of smoking initiation [8 –10]. Similar school-based smoking prevention programs for elementary schools appeared less successful in reduc- ing tobacco use [11,12]. Until now, prevention pro- grams for 11- to 12-year-old in The Netherlands have never been evaluated. 1 This study was made possible by grants from the European Commission and the Dutch Cancer Foundation. This study is part of a European three-country project, called “Octopus,” in which the United Kingdom (University of Birmingham), Spain (University of Oviedo), and The Netherlands (Maastricht University) were partic- ipating. We are grateful to coproject leaders M.L. Lopes and H. Thomas and their colleagues for their cooperation in the project. We thank J. Berben for software construction, and all schools and health educators of local departments for their participation in the project. 2 To whom reprint requests should be addressed. Fax: 31-43- 3671032. E-mail: m.ausems@gvo.unimaas.nl. Preventive Medicine 34, 581–589 (2002) doi:10.1006/pmed.2002.1021 581 0091-7435/02 $35.00 © 2002 American Health Foundation and Elsevier Science (USA) All rights reserved.