Background: Vaccine hesitancy (VH), defined as the delay in acceptance or refusal of vaccination despite its availability, is a global health threat. Paediatric healthcare workers (PHCWs) are key in promoting vaccination but often feel unprepared to manage VH effectively. We developed CONFIVAC, an intervention designed to strengthen the knowledge, self-efficacy, and skills of PHCWs in improving childhood vaccination, addressing VH, and fostering a culture of immunization within primary care. This study protocol outlines the design, contents, planned implementation, and mixed-methods effectiveness evaluation of CONFIVAC. Methods: We will conduct a two-arm parallel cluster randomised controlled trial including PHCWs from 74 paediatric primary healthcare teams from Catalonia, Spain. Paediatric teams will be randomly assigned to the intervention or control arm (standard care). PHCWs in the intervention arm will participate in the training program CONFIVAC, which includes 10 h of online learning and 2 h of in-person training featuring roleplaying exercises. Grounded in health behaviour theories, the curriculum includes evidence-based strategies to improve vaccination uptake. It addresses key topics such as vaccine knowledge, communication strategies, and organizational tools to promote vaccination. Process evaluation will assess overall satisfaction, likelihood of recommending CONFIVAC, and applicability. Main effectiveness outcomes will include vaccine-promoting behaviours (presumptive communication, anticipation of upcoming vaccines, and explicitly recommending vaccination in VH cases) and self-perception of having sufficient training to handle VH. We will perform adjusted ordinal regression models using an intention-to-treat approach. Quantitative results will be triangulated with qualitative insights from focus groups of PHCWs in the intervention arm employing a phenomenological approach.

Background We aim to assess the effect of a smoke-free beaches (SFB) intervention in Barcelona on smoking during the 2021 bathing season. Methods Quasi-experimental pre-post design (pre-intervention period: 15–28 May; post-intervention period: 29 May–12 September). Based on users’ profiles and location, four beaches were assigned to the intervention group (IG) and five to the comparison group (CG). The intervention involved: a mayoral decree (29 May), a communication campaign and beach on-site information. We established two 3 m × 3 m transects per beach from the coastline to the promenade. Trained teams collected smoking-related information in the transects through observations and surveys to beach users. Outcomes are as follows: percentage of people reporting witnessing smoking behaviours the last fortnight and percentage of people observed smoking. We calculated and compared prevalence ratios (PRs) with adjusted Poisson regressions. Results 3751 interviews (1721 IG; 2030 CG) and 1108 observations (498 IG, 610 CG) were carried out. SFB were associated with a significant reduction in the percentage of people reporting witnessing smoking (IG (pre: 87.2%; post: 49.7%); CG (pre: 86.2%; post: 74.1%); PR (95% CI): 0.7 (0.6 to 0.8)); and in the users observed smoking in the beach (IG (pre: 3.8%; post: 3.0%); CG (pre: 2.3%; post: 9.9%); PR (95% CI): 0.3 (0.3 to 0.4)). Satisfaction scores were 8.3 (IG) and 8.1 (CG) out of 10. Conclusion An SFB intervention is an effective and well-accepted measure to reduce smoking and smokers’ visibility. Smoke-free measures should be extended to beaches and other non-regulated outdoor areas.

Childhood obesity has increased worldwide over the past four decades. This quasi-experimental study aimed to assess the effectiveness of a multicomponent and multilevel school-based intervention (POIBA) at 3 years of follow-up. The nutrition intervention focused on food groups, food pyramid, nutrients, portions, and balanced menus. In total, 3624 children participated in the study. Anthropometric measurements and information on food frequency and behavior, physical activity, and daily screen use were collected in the intervention (IG) and comparison group (CG). Positive unadjusted changes toward adherence to recommendations were found for water, meat, sweets, and fried potato consumption, proper breakfast, not having dinner in front of the TV, out-of-school physical activity, and daily screen use. Three scores were used to calculate the proportion of children making more than one change to improve healthy habits regarding physical activity (global Activity score), nutrition (global Nutrition score), and both (global score). Students exposed to the intervention had a significantly better global Activity score (16.2% IG vs. 11.9% CG; p = 0.012) and Global score (63.9% IG vs. 58.5% CG; p = 0.025). Intervention effects on obesity incidence at 3-year follow-up lost significance but maintained the positive trend. In conclusion, school-based interventions including a family component could be useful to address the childhood obesity problem.

BACKGROUND:Childhood obesity is becoming a serious problem, and prevention programs are needed. OBJECTIVE:The purpose of this study was to evaluate, after 1 y, the effectiveness of a multicomponent, school-based obesity intervention program. METHODS:This intervention, conducted in Barcelona, Spain, was a quasi-experimental obesity primary prevention intervention targeting schoolchildren aged 9-10 y. Participants were assigned to an intervention group (IG) (1464 students) or to a comparison group (CG) (1609 students). The intervention consisted of a 9-session classroom program, 6 weekly sessions of physical education and out-of-school physical activity, and a workshop for families. It lasted from October 2011 to May 2012. Data obtained at baseline (spring 2011) and follow-up (spring 2012) included information on nutrition and physical activity, through 2 self-reported questionnaires, and measurement of weight, height, triceps skinfold thickness, and waist circumference. The cumulative incidence rate (CIR) of obesity was calculated from triceps skinfold measures. A multilevel logistic regression model was fitted to determine the association between the intervention and the CIR of obesity. The effect size of the program was estimated with Cohen's criteria. RESULTS:The overall prevalence of obesity at baseline was 12.7%. At the 12-mo follow-up, the incidence of obesity was 7.8% in the IG compared with 11.4% in the CG (P < 0.005), representing 31% fewer new cases of obesity in the IG. The Cohen's d effect size of the program was 0.33. In the multilevel analysis, there was a protective effect of the intervention on the CIR of obesity at 12 mo (OR: 0.7; 95% CI: 0.5, 0.9) (P = 0.009). CONCLUSIONS:The first Prevención de la Obesidad Infantil en Barcelona (Childhood Obesity Prevention in Barcelona) (POIBA) intervention, targeting children aged 9-10 y, reduced the incidence of obesity as measured by adiposity. The intervention could prevent 1 in 3 new cases of childhood obesity in this age range.

Background: Childhood obesity preventive interventions should promote a healthy diet and physical activity at home and school. This study aims to describe a school-based childhood obesity preventive programme (POIBA Project) targeting 8-to-12year-olds. Design and methods: Evaluation study of a school-based intervention with a pre-post quasi-experimental design and a comparison group. Schools from disadvantaged neighbourhoods are oversampled. The intervention consists of 9 sessions, including 58 activities of a total duration between 9 and 13 hours, and the booster intervention of 2 sessions with 8 activities lasting 3 or 4 hours. They are multilevel (individual, family and school) and multicomponent (classroom, physical activity and family). Data are collected through anthropometric measurements, physical fitness tests and lifestyle surveys before and after the intervention and the booster intervention. In the intervention group, families complete two questionnaires about their children's eating habits and physical activity. The outcome variable is the cumulative incidence rate of obesity, obtained from body mass index values and body fat assessed by triceps skinfold thickness. The independent variables are socio-demo-graphic, contextual, eating habits, food frequency, intensity of physical activity and use of new technologies. Expected impact for public health: It is essential to implement preventive interventions at early ages and to follow its effects over time. Interventions involving diet and physical activity are the most common, being the most effective setting the school. The POIBA Project intervenes in both the school and family setting and focuses on the most disadvantaged groups, in which obesity is most pronounced and difficult to prevent.

Background: It is difficult to obtain good food reports with Food Frequency Questionnaires (FFQ) among children. In addition, validated questionnaires are scarce. Objective: The aim of this study was to validate the 'POIBA-How do we eat?' (POIBA-HDWE) FFQ and whether it could be administered to children under 10 years of age. Design: We validated the FFQ POIBA-HDWE as part of the Childhood Obesity Prevention Program (POIBA project) in Barcelona. Forty-two out of 63 primary school students (9-10 years old) answered three questionnaires: FFQ POBA-HDWE; another questionnaire, 'POIBA-How do our children eat?' (POIBA-HDOCE), which was administered to the children's parents; and the 24-h recall computer program 'Young Adolescents' Nutrition Assessment on Computer' (YANA-C), which was used on three different days as a gold standard. We tested for correlations using the Spearman test for non-parametric variables. Results: We found low compliance with food recommendations (<50%). The POIBA-HDWE and POIBA-HDOCE questionnaires showed a moderate correlation for soft drinks (r = 0.49; p < 0.01), nuts (r = 0.59; p < 0.01), dairy products (r = 0.41; p < 0.01) and juices (r = 0.49; p < 0.01). There were moderate correlations between POIBA-HDWE and YANA-C for fried potatoes (r = 0.42; p = 0.01), dairy products (r = 0.53; p < 0.01), juices (r = 0.41; p < 0.01), and grains(r = 0.50; p < 0.01). Food frequency questions showed a homogeneity of 0.69, and a sensitivity of over 60% for all food items except chips (37.5%) and sweets (51.7%). Conclusions: The POIBA-HDWE FFQ showed moderate correlations with the gold standard, high sensitivity for most food types and acceptable internal consistency. It is an easy and affordable tool for recording food frequency in children under 10 years old.

El porcentaje de fracasos y recaídas en el tratamiento de la obesidad es alto. Siempre que sea posible, la prevención de la obesidad para modificar hábitos alimentarios y estilos de vida ha de ser la conducta preferente. Este trabajo pretender ofrecer un marco de evidencia sobre los componentes más efectivos de las intervenciones para el abordaje de la obesidad infantil, tanto de su prevención como de su reducción, cuando esta ya está instaurada. A partir de la literatura científica, se presentan los aspectos que debe contemplar la prevención, tanto universal como selectiva, de la obesidad infantil. Habida cuenta también de la controversia sobre los instrumentos de registro y control del problema, se aportan algunos criterios clarificadores. Finalmente, se diferencia el abordaje de la prevención del sobrepeso y la obesidad con una perspectiva comunitaria, ofreciéndose 2 protocolos breves que esquematizan un procedimiento básico a seguir.

The percentage of failure and relapse in the treatment of obesity is high. Where possible, the preferred strategy for preventing obesity is to modify eating habits and lifestyles. This article aims to provide a framework for evidence on the most effective interventions for addressing childhood obesity, both from a prevention point of view, as well as reducing it, when it is already established. After a review of the scientific literature, the issues that must be considered both in the universal and selective prevention of childhood obesity are presented. Also, in light of the controversy over the tools for measuring and controlling the problem, some clarification is provided on the criteria. Finally, the approach to the prevention of overweight and obesity with a community perspective is separated, with two short protocols being offered with diagrams of the basic procedure to follow (C) 2014 Elsevier Espana, S.L.U.

BACKGROUND:To describe the effects of a Spanish smoking prevention programme in the context of an European project on regular smoking, in a sample of Barcelona adolescents.METHOD:A quasi-experimental design was conducted. An experimental group (EG) (1080 pupils) was exposed to programme and compared with a control group (CG) (872 students). The intervention included a school-based programme (16 sessions in 3 years), reinforcement of a smoke-free school policy, smoking cessation for teachers, brochures for parents and other community-based activities involving youth clubs and tobacco sales.RESULTS:At 12 months, 4.5% of boys and 5.6% of girls were new smokers in the EG versus 6.7% and 11.7% in the CG (P < 0.001). At 36 months, 18.6% of boys and 31.2% of girls in the EG were regular smokers versus 21.6% of boys and 38.3% of girls in the CG (P < 0.001). The main factors associated with progression to regular smoking at 36 months were to be girl, to attend to a public school and to belong to the CG.CONCLUSION:These results endorse the effectiveness of multi-modal smoking prevention programmes, which include strategies with adults who influence adolescents.

OBJECTIVE: To analyze the predictors of smoking onset among schoolchildren.METHODS: A cohort study of 1056 children starting in first year secondary school at 44 schools in Barcelona was carried out. Participating children were invited to answer a lifestyle questionnaire every year for 4 years. Each questionnaire carried a personal code to allow the 4 questionnaires to be matched. Matching questionnaires were found for 729 children, 70% of the initial sample.RESULTS: Over the study period, the prevalence of regular smokers increased from 1.7% to 22% among boys and from 1.6% to 38.2% among girls. The predictors of smoking onset among boys were scoring high on the pro-smoking attitudes index (odds ratio [OR]=1.2; 95% confidence interval [CI], 1.1-1.3), intention to smoke in the future (OR=2.2; 95% CI, 1.0-4.9), low self-efficacy in resisting pressures to smoke (OR=0.98; 95% CI, 0.96-0.99), having siblings that smoke (OR=2.5; 95% CI, 1.2-5.4), and spending some free time in bars (OR=2.4; CI, 1.1-4.9). Among girls, the predictors were having low self-esteem (OR=0.94; 95% CI, 0.88-0.99), scoring low on the anti-tobacco attitudes index (OR=0.92; 95% CI, 0.88-0.97), having siblings who smoke (OR=2.5; 95% CI, 1.2-5.5), spending some free time in discotheques (OR=43; 95% CI, 1.9-11.8), and living in high socioeconomic-status neighborhoods (OR=3.1; 95% CI, 1.4-10.9).CONCLUSIONS: The results show the importance of cognitive variables as well as a variety of environmental variables, particularly the pattern of free time use and the influence of sibling models. Prevention programs must take into account smoking onset risk factors as a whole.

El objetivo del estudio es analizar los factores predictivos del inicio del consumo de tabaco entre los escolares. Se ha realizado un estudio longitudinal de seguimiento de 1.056 escolares de primer curso de Educación Secundaria Obligatoria de 44 escuelas de Barcelona. Durante los 4 años del estudio, se invitó a todos los escolares de la cohorte a responder cada año a un cuestionario sobre estilo de vida. A través de un código personal, al final del estudio se pudieron aparear los 4 cuestionarios de 729 escolares, un 70% de la muestra inicial. En el período estudiado la prevalencia de fumadores regulares pasó del 1,7 al 22% entre los chicos, y del 1,6 al 38,2% entre las chicas. Los factores predictivos del inicio del consumo fueron en los chicos tener una puntuación elevada en la escala de actitudes pro tabaco (odds ratio [OR] = 1,2; intervalo de confianza [IC] del 95%, 1,1–1,3), la intención de fumar en el futuro (OR = 2,2; IC del 95%, 1,0–4,9), una baja autoeficacia para resistir presiones hacia el consumo (OR = 0,98; IC del 95%, 0,96–0,99), el consumo de tabaco de los hermanos (OR = 2,5; IC del 95%, 1,2–5,4) y pasar parte del tiempo libre en bares (OR = 2,4; 1,1–4,9). Para las chicas las variables predictoras fueron tener una baja autoestima (OR = 0,94; IC del 95%, 0,88–0,99), tener una baja puntuación en la escala de actitudes contra el tabaco (OR = 0,92; IC del 95%, 0,88–0,97), el tabaquismo de los hermanos (OR = 2,5; IC del 95%, 1,2–5,5), pasar parte del tiempo libre en discotecas (OR = 4,5; IC del 95%, 1,9–11,8) y vivir en barrios de nivel socioeconómico elevado (OR = 3,1; IC del 95%, 1,4–10,9). Los resultados señalan la importancia de las variables cognitivas, así como una diversidad de variables del entorno, entre las que destaca el patrón de tiempo libre y la influencia de modelos de los hermanos. Los programas preventivos deberían tener en cuenta el conjunto de factores de riesgo para el inicio del tabaquismo desde una perspectiva global. To analyze the predictors of smoking onset among schoolchildren. A cohort study of 1056 children starting in first year secondary school at 44 schools in Barcelona was carried out. Participating children were invited to answer a lifestyle questionnaire every year for 4 years. Each questionnaire carried a personal code to allow the 4 questionnaires to be matched. Matching questionnaires were found for 729 children, 70% of the initial sample. Over the study period, the prevalence of regular smokers increased from 1.7% to 22% among boys and from 1.6% to 38.2% among girls. The predictors of smoking onset among boys were scoring high on the pro-smoking attitudes index (odds ratio [OR]=1.2; 95% confidence interval [CI], 1.1–1.3), intention to smoke in the future (OR = 2.2; 95% CI, 1.0–4.9), low self-efficacy in resisting pressures to smoke (OR = 0.98; 95% CI, 0.96–0.99), having siblings that smoke (OR = 2.5; 95% CI, 1.2–5.4), and spending some free time in bars (OR = 2.4; CI, 1.1–4.9). Among girls, the predictors were having low self-esteem (OR = 0.94; 95% CI, 0.88–0.99), scoring low on the anti-tobacco attitudes index (OR = 0.92; 95% CI, 0.88–0.97), having siblings who smoke (OR = 2.5; 95% CI, 1.2–5.5), spending some free time in discotheques (OR = 4.5; 95% CI, 1.9–11.8), and living in high socioeconomic-status neighborhoods (OR = 3.1; 95% CI, 1.4–10.9). The results show the importance of cognitive variables as well as a variety of environmental variables, particularly the pattern of free time use and the influence of sibling models. Prevention programs must take into account smoking onset risk factors as a whole.

Objetivo: Describir las tendencias en el consumo de tabaco, alcohol y cannabis entre los adolescentes escolarizados entre 1987 y 1999 de la ciudad de Barcelona. Métodos: Encuestas transversales realizadas a muestras representativas de escolares de segundo curso de Educación Secundaria Obligatoria (ESO) entre 1987 y 1999. Los cuestionarios eran anónimos y autocontestados. Se dispone de datos de 5.013 escolares de la ciudad de Barcelona que participan en alguna de las 5 encuestas. Resultados: Tras disminuir de forma uniforme entre 1987 y 1996, en 1999 se observa un aumento del 13,4% en el consumo regular (diario o semanal) de tabaco y del 38,7% en el consumo experimental de tabaco, respecto a las prevalencias observadas en 1996. Con respecto al consumo de alcohol, se observa una disminución global del 14% de los escolares que ha bebido al menos medio vaso de alcohol entre 1987 y 1999. El consumo problemático de alcohol se iguala en ambos sexos, y la proporción que declara haberse emborrachado alguna vez es en 1999 superior en las chicas (14,0%) que en los chicos (10,5%). Mientras en 1996 un 6,9% declaraba haber probado cannabis, la proporción en 1999, sin diferencias entre sexos, era del 7,3% de la población estudiada. Conclusiones: En el período estudiado se observa un aumento del consumo regular de tabaco, una disminución del consumo de alcohol y una estabilización del consumo de cannabis. Las diferencias entre ambos sexos tienden a desaparecer.Objective: To describe trends in tobacco, alcohol, and cannabis consumption among secondary school pupils in Barcelona between 1987 and 1999. Methods: Cross-sectional surveys administered to representative samples of pupils in the second year of secondary school between 1987 and 1999. The questionnaires were anonymous and self-completed. We present data from 5013 secondary school pupils from Barcelona who participated in one of the five surveys. Results: Regular smoking (daily and weekly) showed a uniform decrease between 1987 and 1996. The results of the last survey (1999) showed an increase over those the 1996 survey, ranging from 13.4% for regular smoking to 38.7% for experimental smoking. Between 1987 and 1999, the percentage of schoolchildren who reported drinking at least half a glass of alcohol at some time showed an overall decrease of 14.0%. No differences in sex were found in problematic alcohol consumption, while a higher proportion of girls (14.0%) than boys (10.5%) reported getting drunk at some time. Whereas in 1996, 6.9% of the population studied had smoked cannabis at some time, in 1999 this proportion was 7.3%, with no differences between sexes. Conclusions: During the study period regular smoking increased, alcohol consumption decreased and cannabis consumption tended to level-off. Differences between boys and girls tended to disappear.

OBJECTIVE To describe trends in tobacco, alcohol, and cannabis consumption among secondary school pupils in Barcelona between 1987 and 1999. METHODS Cross-sectional surveys administered to representative samples of pupils in the second year of secondary school between 1987 and 1999. The questionnaires were anonymous and self-completed. We present data from 5013 secondary school pupils from Barcelona who participated in one of the five surveys. RESULTS Regular smoking (daily and weekly) showed a uniform decrease between 1987 and 1996. The results of the last survey (1999) showed an increase over those the 1996 survey, ranging from 13.4% for regular smoking to 38.7% for experimental smoking. Between 1987 and 1999, the percentage of schoolchildren who reported drinking at least half a glass of alcohol at some time showed an overall decrease of 14.0%. No differences in sex were found in problematic alcohol consumption, while a higher proportion of girls (14.0%) than boys (10.5%) reported getting drunk at some time. Whereas in 1996, 6.9% of the population studied had smoked cannabis at some time, in 1999 this proportion was 7.3%, with no differences between sexes. CONCLUSIONS During the study period regular smoking increased, alcohol consumption decreased and cannabis consumption tended to level-off. Differences between boys and girls tended to disappear.

Describir las tendencias en el consumo de tabaco, alcohol y cannabis entre los adolescentes escolarizados entre 1987 y 1999 de la ciudad de Barcelona. Encuestas transversales realizadas a muestras representativas de escolares de segundo curso de Educación Secundaria Obligatoria (ESO) entre 1987 y 1999. Los cuestionarios eran anónimos y autocontestados. Se dispone de datos de 5.013 escolares de la ciudad de Barcelona que participan en alguna de las 5 encuestas. Tras disminuir de forma uniforme entre 1987 y 1996, en 1999 se observa un aumento del 13,4% en el consumo regular (diario o semanal) de tabaco y del 38,7% en el consumo experimental de tabaco, respecto a las prevalencias observadas en 1996. Con respecto al consumo de alcohol, se observa una disminución global del 14% de los escolares que ha bebido al menos medio vaso de alcohol entre 1987 y 1999. El consumo problemático de alcohol se iguala en ambos sexos, y la proporción que declara haberse emborrachado alguna vez es en 1999 superior en las chicas (14,0%) que en los chicos (10,5%). Mientras en 1996 un 6,9% declaraba haber probado cannabis, la proporción en 1999, sin diferencias entre sexos, era del 7,3% de la población estudiada. En el período estudiado se observa un aumento del consumo regular de tabaco, una disminución del consumo de alcohol y una estabilización del consumo de cannabis. Las diferencias entre ambos sexos tienden a desaparecer. To describe trends in tobacco, alcohol, and cannabis consumption among secondary school pupils in Barcelona between 1987 and 1999. Cross-sectional surveys administered to representative samples of pupils in the second year of secondary school between 1987 and 1999. The questionnaires were anonymous and self-completed. We present data from 5013 secondary school pupils from Barcelona who participated in one of the five surveys. Regular smoking (daily and weekly) showed a uniform decrease between 1987 and 1996. The results of the last survey (1999) showed an increase over those the 1996 survey, ranging from 13.4% for regular smoking to 38.7% for experimental smoking. Between 1987 and 1999, the percentage of schoolchildren who reported drinking at least half a glass of alcohol at some time showed an overall decrease of 14.0%. No differences in sex were found in problematic alcohol consumption, while a higher proportion of girls (14.0%) than boys (10.5%) reported getting drunk at some time. Whereas in 1996, 6.9% of the population studied had smoked cannabis at some time, in 1999 this proportion was 7.3%, with no differences between sexes. During the study period regular smoking increased, alcohol consumption decreased and cannabis consumption tended to level-off. Differences between boys and girls tended to disappear.

OBJECTIVE:To describe the factors asssociated with smoking and intention to smoke among a representative sample of first-grade pupils of secondary education (12-13 years old) in Barcelona.SUBJECTS AND METHODS:37 secondary schools were randomly selected to evaluate the impact of a European-wide smoking prevention program (European Smoking prevention Frame Approach, ESFA project). In these schools, 1041 pupils of first grade of secondary education responded to a questionnaire designed at the University of Maastricht to study life-style attitudes and behaviours, mainly smoking.RESULTS:9.8% of boys and 12.6% of girls declared to smoke either regulary or ocasionally. Among the no-smokers, 61.4% of the boys and 73.3% of the girls reported to have the intention to smoke in the future. Among the boys, factors associated with smoking included social norms (odds ratio [OR] = 2.5; 95% confidence interval [CI]: 1.2-5.2), smoking by siblings (OR = 2.4; 95% CI, 1.1-5.2), attitudes against smoking (OR = 0.3; 95% CI, 0.1-0.6), practicing some sports in the leisure time (OR = 0.3; 95% CI, 0.1-0.7) and having more available pocket money (OR = 3.2; 95% CI, 1.5-6.8). Intention to smoke was only related to attitudes (OR = 0.3; 95% CI, 0.2-0.5). Among girls, smoking was associated to perceived pressure to smoke (OR = 2.5; 95% CI, 1.2-5.0), consumption by friends (OR = 6.0; 95% CI, 2.4-15.4) and attitudes against smoking (OR = 0.2; 95% CI, 0.1-0.4), while intention was only associated to attitudes (OR = 0.4; 95% CI, 0.2-0.6) and hanging out in the street in the leisure time (OR = 2.2; 95% CI, 0.3-3.5).CONCLUSIONS:The results stress the need to deal simultaneoulsy with the different factors associated to smoking initiation and attitude shaping, including cognitive factors, environmental factors, and patterns of leisure time utilization.