Incentivos para la prevención del hábito de fumar en niños y adolescentes
Appendices
Appendix 1. Specialized Register search strategy
The register search combined the following topic specific terms in title, abstract or keyword fields: (motivation OR reinforcement OR reward* OR 'token economy' OR punishment OR incentive* OR competition* OR contest* OR lotter* OR raffle* OR prize* OR voucher* OR gift* OR inducement* OR 'contingent payment' OR 'deposit contract') AND (adolescen* OR young OR child* or minor* OR juvenile OR girl* or boy*).
Appendix 2. MEDLINE search strategy
1 RANDOMIZED‐CONTROLLED‐TRIAL.pt.
2 CONTROLLED‐CLINICAL‐TRIAL.pt.
3 CLINICAL‐TRIAL.pt.
4 Meta analysis.pt.
5 exp Clinical Trial/
6 Random‐Allocation/
7 randomized‐controlled trials/
8 double‐blind‐method/
9 single‐blind‐method/
10 placebos/
11 Research‐Design/
12 ((clin$ adj5 trial$) or placebo$ or random$).ti,ab.
13 ((singl$ or doubl$ or trebl$ or tripl$) adj5 (blind$ or mask$)).ti,ab.
14 (volunteer$ or prospective$).ti,ab.
15 exp Follow‐Up‐Studies/
16 exp Retrospective‐Studies/
17 exp Prospective‐Studies/
18 exp Evaluation‐Studies/ or Program‐Evaluation.mp.
19 exp Cross‐Sectional‐Studies/
20 exp Behavior‐therapy/
21 exp Health‐Promotion/
22 exp Community‐Health‐Services/
23 exp Health‐Education/
24 exp Health‐Behavior/
25 or/1‐24
26 ((Smok$ or cigar$ or tobacco$) adj7 (prevent$ or uptake or initiation)).ti,ab.
27 exp Smoking/pc [Prevention & Control]
28 26 or 27 [Smoking prevention terms]
29 token economy/ or motivation/ or "aspirations(psychology)"/ or goals/ or intention/
30 "reinforcement psychology"/ or punishment/ or reinforcement schedule/ or reward/
31 (reinforcement or punishment).tw.
32 (incentive$ or competition$ or contest$ or lotter$ or raffl$ or reward$ or prize$).mp.
33 (voucher$ or gift$ or inducement$ or contingent payment$ or deposit contract$).mp.
34 or/29‐33 [Intervention terms]
35 child/ or minors/
36 (young people or minor$1).tw.
37 (child$ or juvenile$ or girl$ or boy$ or teen$ or adolescent$).ti,ab.
38 school$.tw.
39 or/35‐38 [Age specific terms]
40 25 and 28 and 34 and 39
Appendix 3. EMBASE search strategy
1 random$.ti,ab.
2 factorial$.ti,ab.
3 (cross over$ or crossover$ or cross‐over$).ti,ab.
4 placebo$.ti,ab.
5 (double$ adj blind$).ti,ab.
6 (single$ adj blind$).ti,ab.
7 assign$.ti,ab.
8 allocat$.ti,ab.
9 volunteer$.ti,ab.
10 CROSSOVER PROCEDURE.sh.
11 DOUBLE‐BLIND PROCEDURE.sh.
12 RANDOMIZED CONTROLLED TRIAL.sh.
13 SINGLE‐BLIND PROCEDURE.sh.
14 or/1‐13
15 ((smok$ or cigar$ or tobacco$) adj7 (prevent$ or uptake)).ti,ab.
16 Smoking/pc
17 "smoking and smoking related phenomena"/
18 adolescent smoking/
19 (abstin$ adj3 smok$).mp.
20 (prevent$ adj smok$).mp.
21 or/15‐20
22 motivation/ or reinforcement/ or reward/
23 (token economy or reward or reinforcement or punishment or incentive$ or competition$ or contest$ of lotter$ or raffle$ or prize$ or voucher$ or gift$ or inducement$).ti,ab.
24 contingent payment$.ti,ab.
25 deposit contract$.ti,ab.
26 22 or 23 or 24 or 25
27 exp child/ or exp adolescent/
28 (young people or minors or minor or child$ or teen$ or girl$ or boy$ or juvenile$ or adolescent$ or school$).ti,ab. (960983)
29 27 or 28
30 14 and 21 and 26 and 29
Appendix 4. CINAHL search strategy
S36 S17 and S25 and S31 and S35
S35 S32 or S33 or S34
S34 young people or ( minor or minors or child* or juvenil* or girl* or boy* or teen* or adolescen* or school* )
S33 (MH "Adolescence") OR (MH "Minors (Legal)")
S32 (MH "Child+")
S31 S26 or S27 or S28 or S29 or S30
S30 ( reinforcement* or punishment* or incentive* or competition* or contest* or lotter* or raffle* or reward* or prize* or voucher* or gift* or inducement* ) or contingent payment* or deposit contract*
S29 (MH "Reinforcement (Psychology)+")
S28 MH "Goals and Objectives+")
S27 (MH "Motivation") OR (MH "Intention")
S26 token economy
S25 S18 or S19 or S20 or S21 or S22 or S23 or S24
S24 (MH "Smoking/PC")
S23 tobacco* N7 uptake*
S22 cigar* N7 uptake*
S21 smok* N7 uptake*
S20 tobacco* N7 prevent*
S19 cigar* N7 prevent*
S18 smok* N7 prevent*
S17 S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15 or S16
S16 (MH "Health Behavior+")
S15 (MH "Health Education")
S14 (MH "Community Health Services+")
S13 (MH "Health Promotion")
S12 (MH "Behavior Therapy")
S11 (MH "Cross Sectional Studies")
S10 (MH "Evaluation Research+")
S9 (MH "Retrospective Design")
S8 (MH "Experimental Studies+") OR (MH "Quasi‐Experimental Studies+")
S7 (MH "Placebos")
S6 (MH "Random Sample+")
S5 (MH "Clinical Trials+")
S4 (MH "Prospective Studies+")
S3 placebo* or random*
S2 clin* n5 trial*
S1 ((((((ZT "clinical trial")) or ((ZT "systematic review"))) or ((ZT "meta analysis") or (ZT "protocol"))) or ((ZT "protocol"))) or ((ZT "proceedings"))) or ((ZT "systematic review"))
Appendix 5. PsycINFO search strategy
1 tobacco‐smoking/
2 (smok$ or tobacco$ or cigar$).mp.
3 Prevention/
4 (1 or 2) and 3
5 ((Smok$ or cigar$ or tobacco$) adj7 (prevent$ or uptake or initiation)).ti,ab.
6 4 or 5 [smoking prevention terms]
7 (incentive$ or competition$ or contest$ or lotter$ or raffl$ or reward$ or prize$).mp.
8 (voucher$ or gift$ or inducement$ or contingent payment$ or deposit contract$).mp.
9 7 or 8 [intervention terms]
10 (young people or minor$1 or child$ or juvenile$ or girl$ or boy$ or teen$ or adolescent$).tw.
11 school$.mp.
12 10 or 1 [Age specific limits]
13 6 and 9 and 12
Appendix 6. CSA search strategy
This strategy was used for ASSIA, ERIC, Sociological Abstracts and PAIS
(Keyword includes title, abstract and descriptors)
KW=(Incentive* or competition* or contest* or lotter* or raffle* or reward* or prize* or voucher* or gift* or inducement* or ‘contingent payment*’ or ‘deposit contract*’ or reinforcement or punishment)) and (KW=(smok* or tobacco or cigarette*)) and (KW=(adolescen* or minor or minors or child* or juvenile* or girl* or boy* or teen* or adolescent* or youth or young people))
PRISMA study flow diagram of search results
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Comparison 1 Incentive versus control. Randomized and non‐randomized controlled studies (adjusted for clustering), Outcome 1 Smoking uptake at longest follow‐up (RR).
| Study | Number of non‐smokers at baseline | Number of smokers at endpoint who reported not smoking at baseline | Time point | Outcome | Biological criterion | Results | Secondary outcomes (dose response, cost, harms) |
| Crone 2003 | 556 intervention; 420 control (data from authors) | 112 intervention; 88 control
| 19 months | Smoking = current smoking, including daily/weekly/experimental | Not biochemically verified | Not reported at 19 months in published paper. Our reanalysis: RR 0.92 (95% CI 0.53 to 1.61) | Not reported |
| Isensee 2012a | 430 never‐ smokers in intervention; 610 never‐smokers in control (data from authors) | 136 intervention; 184 control | 19 months | Smoking = ever smoking, even just a puff | Not biochemically verified | From published paper: Authors reported that no group differences were found in the frequency of smoking initiation but data not presented in paper. Our reanalysis: RR 1.05 (95% CI 0.80 to 1.38) | Bullying (Hanewinkel 2010): "When compared with control classrooms on all three dependent variables – being victimised, active bullying or being isolated – the adjusted ORs indicated no significant differences at post‐test for any of the IGs [Intervention Groups]". |
| Schulze 2006 | 591 never‐smokers in intervention; 449 never‐smokers in control | 224 intervention; 173 control | 24 months | Smoking = current smoking, including irregular (less than weekly) smoking | Not biochemically verified | From published paper: 62.1% remained ‘never smoker’ in intervention group at follow‐up versus 61.4% in control group: OR 1.02 (0.83 to 1.24) adjusted for age, sex and school type.
Our reanalysis: RR 0.98 (95% CI 0.77 to 1.24) | Not reported |
Comparison 2 Results of included studies, Outcome 1 Results table: RCTs.
| Study | Number of non‐smokers at baseline | Number of smokers at endpoint who reported not smoking at baseline | Time point | Outcome | Biological criterion | Results | Secondary outcomes (dose response, cost, harms) | Comment |
| Burke 1992 | Not reported | Not reported | 18 months | Mean (SD) score of 5‐category self‐definition of smoking and 10‐category self‐reported frequency | Salivary thiocyanate (TCN) | From published paper: Mean TCN at follow‐up of pre‐intervention never‐smokers higher (560 mcg/mL, SD 403) versus control (514 mcg/mL, SD 424). Primary outcome for this review not available. | Not reported | |
| Kairouz 2009 | 664 intervention; 915 control | 93 intervention; 165 control | 10 ‐ 18 months | Smoking = ever smoking, even just a puff | Not biochemically verified | From published paper: OR 0.8 (0.5 to 1.1), adjusted for age, gender, school location, social deprivation index. Our reanalysis: RR 0.81 (95% CI 0.55 to1.20) | Intervention participants more likely than control participants to report that people “should not hang out with smokers” (14% versus 11%) and that they, themselves would “not want to be friends with a classmate who smokes” (28% versus 25%) | Concerns about misreporting of smoking status. Note large numbers of ever‐smokers at baseline then denying ever smoking at follow‐up. Stat sig more in intervention vs control (24% vs 16%) |
| Stucki 2014 | 544 intervention, 378 control | 39 intervention, 24 control | About 7 months | Smoking = any smoking in last 6 months, even just a puff and smoking during the previous month | Not biochemically verified | From published and additional data from authors. OR for decreased smoking prevalence 0.7, CI 0.5 to 1.0 | Increased smoking‐related knowledge b ‐1.0, P < 0.01 | |
| Vartiainen 1996 | Not reported and not available from authors | Not reported and not available from authors | 18 months | Smoking = daily smoking | Not biochemically verified | Reports only on the increase in prevalence of smoking from baseline to follow‐up. From baseline to longest follow‐up, increase by 10.8% points in Intervention group vs 11.2% points in control group: OR 1.25 (P = 0.15). Primary outcome for this review not available. | Not reported. Except in discussion – authors report "The social pressure created by the competition process was not greatly criticised in the pupils’ answers." | |
| Wiborg 2002 | 1215 intervention group; 502 control (data from authors) | 207 intervention; 107 control | 12 months | Smoking = 4 week prevalence of smoking | Not biochemically verified | From published paper: OR 1.36 (1.04 to 1.76), adjusted for age, sex, smoking status at baseline Our reanalysis: RR 0.81 (95% CI 0.53 to 1.23) | Cost benefit (Hoeflymayr 2008). Cost benefit ratio: economic modelling based on estimates of reduced smoking prevalence in Intervention group and models of assumed future smoking behaviour and cessation. Not based on prevention of initiation | |
Comparison 2 Results of included studies, Outcome 2 Results table: non‐randomized CTs.
| Smokefree Class Competitions (SFC) for preventing smoking uptake | |||||
| Patient or population: Children and adolescents aged 5 ‐ 18 years who were non‐smokers at baseline Settings: Schools in Germany, the Netherlands, Finland, Switzerland, Canada and the United States Intervention: Participation in SFC Comparison: No participation in SFC | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants Actual number/ effective number2 | Quality of the evidence | |
| Assumed risk1 | Corresponding risk | ||||
| Smoking uptake at longest follow‐up (RCTS) | 317 per 1000 | 320 per 1000 | RR 1.00 (0.84 to 1.19) | 3056/1108 (3) | Low3, 4 |
| Smoking uptake at longest follow‐up (Non‐RCTs) | 158 per 1000 | 132 per 1000 | RR 0.82 (0.63 to 1.08) | 4219/1377 (3) | Very low3, 5, 6 |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| GRADE Working Group grades of evidence | |||||
| 1'Assumed risk' calculated as risk in control groups. | |||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Smoking uptake at longest follow‐up (RR) Show forest plot | 6 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.1 RCTs | 3 | 1108 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.84, 1.19] |
| 1.2 Non‐randomized CTs | 3 | 1377 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.82 [0.63, 1.08] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Results table: RCTs Show forest plot | Other data | No numeric data | ||
| 2 Results table: non‐randomized CTs Show forest plot | Other data | No numeric data | ||
