Incentives for preventing smoking in children and adolescents

Background Adult smoking usually has its roots in adolescence. If individuals do not take up smoking during this period it is unlikely that they ever will. Further, once smoking becomes established, cessation is challenging; the probability of subsequently quitting is inversely proportional to the age of initiation. One novel approach to reducing the prevalence of youth smoking is the use of incentives. Objectives To assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It was also our intention to assess, where possible, the dose‐response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives. Search methods For the original review (published 2012) we searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE, Embase, CINAHL, CSA databases and PsycINFO for terms relating to incentives, in combination with terms for smoking and tobacco use, and children and adolescents. The most recent searches were of the Cochrane Tobacco Addiction Group Specialized Register, and were carried out in December 2016. Selection criteria We considered randomized controlled trials (RCTs) allocating children and adolescents (aged 5 to 18 years) as individuals, groups or communities to intervention or control conditions, where the intervention included an incentive aimed at preventing smoking uptake. We also considered controlled trials (CTs) with baseline measures and post‐intervention outcomes. Data collection and analysis Two review authors extracted and independently assessed the data. The primary outcome was the smoking status of children or adolescents at follow‐up who reported no smoking at baseline. We required a minimum follow‐up of six months from baseline and assessed each included study for risks of bias. We used the most rigorous definition of abstinence in each trial; we did not require biochemical validation of self‐reported tobacco use for study inclusion. Where possible we combined eligible studies to calculate pooled estimates at the longest follow‐up, using the Mantel‐Haenszel fixed‐effect method, grouping studies by study design. Main results We identified three eligible RCTs and five CTs, including participants aged 11 to 14 years, who were non‐smokers at baseline. Of the eight