{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:35:18Z","timestamp":1793385318794,"version":"4.5.0"},"reference-count":41,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:00:00Z","timestamp":1710720000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Lounais-Suomen Syopayhdistys"},{"name":"Turun Yliopistollisen Keskussairaalan Koulutus- ja Tutkimussaatio"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Educ Behav"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>\n                    Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents\u2019 health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 781) were randomized to the control group (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 394) and the health game intervention group (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents.\n                  <\/jats:p>","DOI":"10.1177\/10901981241237788","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T07:11:15Z","timestamp":1710745875000},"page":"562-572","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Effectiveness of a Digital Health Game Intervention on Early Adolescent Smoking Refusal Self-Efficacy"],"prefix":"10.1177","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5380-7604","authenticated-orcid":false,"given":"Johanna","family":"Nyman","sequence":"first","affiliation":[{"name":"University of Turku, Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2529-6699","authenticated-orcid":false,"given":"Sanna","family":"Salanter\u00e4","sequence":"additional","affiliation":[{"name":"University of Turku, Turku, Finland"},{"name":"Turku University Hospital, Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miko","family":"Pasanen","sequence":"additional","affiliation":[{"name":"University of Turku, Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Parisod","sequence":"additional","affiliation":[{"name":"University of Turku, Turku, Finland"},{"name":"Nursing Research Foundation sr, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,3,18]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Andrews J. 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