INTENT is a smoking prevention programme. It works by targeting adolescents who have never smoked prior to its delivery. INTENT reduces smoking initiation by first getting adolescents to engage with anti-smoking messages, then creating Personal Plans (or “Implementation Intentions”) about how to refuse an offer of cigarettes.
Implementation Intentions are specific “if...then” plans which focus on how, where and when to perform a behaviour. Many people have good intentions about their health (think New Year’s resolutions) but in reality, only about 50% of these good intentions translate into action: they might fail to get started, get de-railed or willpower simply fizzles out.
Implementation Intentions involve people thinking through in advance specific situations they will encounter (e.g. “if my friend doesn’t want to go for a run with me”) and forming a definite plan to ensure the intended behaviour will actually happen (e.g. “then I will go alone and run to my new playlist”). A meta-analysis of several studies has shown that these “if… then” plans reduces the intention-behaviour gap, and improves rates of performance of health behaviours. By forming a concrete plan about a specific situation, this situation is processed and becomes activated in our brain. This means that we have a better, faster memory of the right thing to do when we’re in that situation for real.
Reduces smoking initiation
4 year groups, ages 11-15
From less than £1 per student
Implementation Intentions in INTENT
INTENT works by raising students’ motivation or intentions to not smoke, then getting them to form concrete plans for what to say/do when confronted with a cigarette offer. For example, “If Callum offers me a cig on the way home, then I’ll say ‘no, I’m ok thanks. It messes with my asthma’”. Or, “no thank you. Smoking is a mug’s game.” The combination of raising motivation/intentions to not smoke and creating implementation intentions to not smoke may be a particularly powerful combination for students who don’t have a good reason to avoid to smoking (e.g. it will interfere with sport) and those who have low intentions or low self-efficacy not to smoke – all of which are high risk factors for smoking.
INTENT is for 11-to-15-year-olds. It is comprised of 8 lessons; 2 sessions per year for 4 years to sustain messages and allow Personal Plans to be created as students move through school. A crucial step is that students will write down their implementation intention, and over time we would expect them to be bespoke to the individual student, even if some younger students might start of by choosing from some suggested examples. It can be fully implemented by teachers in classroom time in any school, thus giving it wide potential reach. It is also affordable , simple and easy to deliver with each of the 2 annual student sessions lasting an hour each.
- Evidence-based and equally effective across all demographic groups
- Cost-effective, from as little as £1 per student, depending on the number of student participants
- Sustainable and asset-based
- Few administrative resources required to manage INTENT.
- Quality Assurance built-in.
- Targets 4 consecutive school year groups.
- Only 2 hour-long sessions per year
- High quality interactive whiteboard materials for teachers and students
- Minimal training required for teachers
- Simple to deliver to students
INTENT’s efficacy and effectiveness has been tested in 3 studies over 15 years. Most recently, it was evaluated in a cluster Randomised Controlled Trial (RCT) which tracked more than 6000 students over a 4-year period. The trial which was published in 2019 found that INTENT reduced smoking initiation by 6.5% in 15-16-year-olds, 4 years after the start of delivering the intervention. 25.6% of the students that received INTENT were less likely to report having ever smoked than those that did not participate in the programme. Importantly, INTENT was found to be equally effective across all demographic groups, e.g. low socioeconomic status or ethnic minority groups.
73% of the teachers that participated rated the programme sessions as good or high quality.
INTENT was also found to be extremely cost-effective, with the analysis revealing an Incremental Cost Effectiveness Ratio (ICER) of £205 per smoker avoided at age 15–16 years based on ever smoking assessment. That means that the programme cost £205 in preventing each additional student from not taking up smoking at the end of the 4-year programme.
While INTENT does not target vaping behaviour specifically, the results from the trial also indicated that students that received INTENT were less likely to progress from vaping to smoking cigarettes than those that did not.
less likely to smoke
of teachers rated INTENT as high quality
per smoker prevented
Initial training for your team
Electronic materials for schools
Dedicated customer area on website
Here are the key academic publications showing the evolution of INTENT from pilot study to evaluation in an effectiveness study.
How do we know it will work? Can we conduct our own local evaluation of the programme?
INTENT was created and evaluated by a group of academics led by the University of Leeds and funded by a Medical Research Council (MRC) grant. Researchers conducted a 4-year long pragmatic Cluster Randomised Controlled Trial (RCT) with schools from Leeds and Staffordshire comparing 25 schools that received the intervention against 20 schools that did not. After attending a 45-minute training session with the researchers, over 250 teachers in 25 schools were involved in delivering the intervention to students twice a year for 4 years. At the end of the trial, students smoking behaviour, vaping behaviour, teachers perceptions of INTENT and the cost-effectiveness of the programme were investigated.
As INTENT was evaluated as part of a rigorously conducted trial, we can be certain of its effectiveness. Thus, schools , or Local Authority commissioners, do not need to conduct their own evaluation.
Students take part in two hour-long sessions per year for four consecutive school years between the ages of 11 and 15. Each session is made up of two distinct parts. Firstly, an interactive activity to gather age appropriate information about tobacco and reasons not to smoke. Secondly, the creation of a Personal Plan on how to be smoke-free.
Content builds incrementally over the four-year programme, from dispelling the myths around smoking, to exploring the ingredients in a cigarette and their effects on health and wellbeing. The psychology of smoking covers motivation not to smoke and resilience to stay that way.
The actual process of writing a Personal Plan translates more strongly into behaviour change than typing into an app. Also, not all schools allow phones or are discouraging the use of phones. If students wanted and were allowed to, they could take a picture of their Personal Plan so that it is easily available.
INTENT was originally designed to reduce the uptake of smoking tobacco cigarettes by young people. However, additional content has been developed around vaping to reflect the increase in vaping prevalence. Importantly, whilst the original INTENT research did not specifically target vaping, it was found to weaken the progression from vaping to smoking in the intervention group.
No, INTENT can be delivered in any school or youth setting regardless of size although students need to be there for the four consecutive years.
The programme is purchased under licence. This can be by a large organisation such as a Local Authority or Health Board, or by an individual school.
A licence includes training for Local Authority staff, and materials for them to train teachers. In addition, a Quality Assurance Framework to support customers to achieve high quality delivery and fidelity to the original research. Teachers also gain access to a Customer Area where they can access the materials, email and telephone helpdesk support.
INTENT was created and evaluated by a group of academics led by the University of Leeds and funded by a Medical Research Council (MRC) grant. Researchers conducted a 4-year long pragmatic Cluster Randomised Controlled Trial (RCT) comparing 25 schools that received the intervention against 20 schools that did not. At the end of the trial, students’ smoking behaviour, vaping behaviour, teachers’ perceptions of INTENT and the cost-effectiveness of the programme were investigated.
As INTENT was evaluated as part of a rigorously conducted trial, we can be certain of its effectiveness. Thus, schools, or Local Authority commissioners, do not need to conduct their own evaluation.
“It's always nice to have material somebody else has produced to deliver in lessons and I thought because the material was relevant and because the material was attractive to the students that they would respond to it well, and without a doubt, you know, across the board, that's what they did”
~ Participant 5, PSHE lead, intervention, 26-29
“I found it fascinating to teach and to be involved with and I thoroughly enjoyed doing it with my coaching group”
~ Participant 8, history, intervention, 284-285
“Certainly the big thing that stood out was that the resources and the stuff that we’d got through was actually really comprehensive and really easy to follow and use. Speaking to colleagues and other staff members, I don’t think anyone’s come across and said that they were particularly difficult to use or didn’t enjoy teaching them”
~ Participant 10, Science lead, 401-405
“It was so engaging, there was so much food for thought [..] I mean everything, part of it in terms of health, in terms of finance, in terms of various different things that came from it”
~ Participant 8, History, intervention, 219-222
“I think the ones where you like relate it back to like stress or stuff like that, that’s quite interesting, especially like when we’re like doing, we’re in high school and we’re at like our GCSEs. It kind of is more interesting to learn about stuff like that, than the whole like, the getting your health kind of thing, ‘cos we do know about a lot from primary school”
~ Intervention student, school 10, 299-302
“I feel like, because we were sort of left more to sort of like discuss it with each other, it made us feel like more adult and not be, like when we were younger. We were sort of just like “oh what do you guys think?” sort of discuss it in your groups. You felt like when you were hearing what everyone else thought it’s sort of like that you were an adult and that you were being treated like one”
~ Student school 18, 319-324
Contact us to prevent young people taking up smoking in your area:
Room G, The Old Vicarage, Somerset Square
Nailsea, Bristol BS48 1RN
Tel: +44 (0) 7973 241125
INTENT is created by the University of Leeds and licenced to Evidence to Impact.