From the Experience of Interactivity and Entertainment to Lower Intention to Smoke: A Randomized Controlled Trial and Path Analysis of a Web-Based Smoking Prevention Program for Adolescents

• Published in: Journal of medical Internet research Vol. 19; no. 2; p. e44
• Main Authors: Khalil, Georges Elias, Wang, Hua, Calabro, Karen Sue, Mitra, Natasha, Shegog, Ross, Prokhorov, Alexander V
• Format: Journal Article
• Language: English
• Published: Canada Journal of Medical Internet Research 16-02-2017; Gunther Eysenbach MD MPH, Associate Professor; JMIR Publications
• Subjects: Adolescent; Adolescents; Aspiration; Clinical trials; Communication; Elaboration; Emotions; Entertainment; Experiential learning; Female; Health behavior; Health status; Humans; Hypotheses; Intention; Internet; Intervention; Male; Mediation; Multimedia; Nicotine; Original Paper; Path analysis; Perceptions; Prevention; Prevention programs; Smoking; Smoking - psychology; Smoking and youth; Smoking Cessation - methods; Smoking Cessation - psychology; Smoking Prevention; Success; Teenagers; Tobacco; Web-based intervention; emotions; entertainment; intention to smoke; smoking prevention; adolescent; interactivity; experience; presence
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.7174

Web-based programs for smoking prevention are being increasingly used with some success among adolescents. However, little is known about the mechanisms that link the experience of such programs to intended nicotine or tobacco control outcomes.
Based on the experiential learning theory and extended elaboration likelihood model, this study aimed to evaluate the impact of a Web-based intervention, A Smoking Prevention Interactive Experience (ASPIRE), on adolescents' intention to smoke, while considering the experience of interactivity and entertainment as predictors of reduced intention to smoke, under a transitional user experience model.
A total of 101 adolescents were recruited from after-school programs, provided consent, screened, and randomized in a single-blinded format to 1 of 2 conditions: the full ASPIRE program as the experimental condition (n=50) or an online , text-based version of ASPIRE as the control condition (n=51). Data were collected at baseline and immediate follow-up. Repeated-measures mixed-effects models and path analyses were conducted.
A total of 82 participants completed the study and were included in the analysis. Participants in the experimental condition were more likely to show a decrease in their intention to smoke than those in the control condition (beta=-0.18, P=.008). Perceived interactivity (beta=-0.27, P=.004) and entertainment (beta=-0.20, P=.04) were each associated with a decrease in intention to smoke independently. Results of path analyses indicated that perceived interactivity and perceived entertainment mediated the relationship between ASPIRE use and emotional involvement. Furthermore, perceived presence mediated the relationship between perceived interactivity and emotional involvement. There was a direct relationship between perceived entertainment and emotional involvement. Emotional involvement predicted a decrease in intention to smoke (beta=-0.16, P=.04).
Adolescents' experience of interactivity and entertainment contributed to the expected outcome of lower intention to smoke. Also, emphasis needs to be placed on the emotional experience during Web-based interventions in order to maximize reductions in smoking intentions. Going beyond mere evaluation of the effectiveness of a Web-based smoking prevention program, this study contributes to the understanding of adolescents' psychological experience and its effect on their intention to smoke. With the results of this study, researchers can work to (1) enhance the experience of interactivity and entertainment and (2) amplify concepts of media effects (eg, presence and emotional involvement) in order to better reach health behavior outcomes.
Clinicaltrials.gov NCT02469779; https://clinicaltrials.gov/ct2/show/NCT02469779 (Archived by WebCite at http://www.webcitation.org/6nxyZVOf0).