Stakeholders’ perspectives on implementing a prevention intervention to reduce tobacco use among Romanian adolescents – Insights from FRESHAIR4Life project

Introduction: Tobacco use among adolescents is a significant public health concern in Romania, yet prevention efforts are non-existent. Within FRESHAIR4Life, we explored stakeholders’ perspectives on a tobacco prevention intervention proven effective in the UK. The intervention integrates engagement with anti-smoking messages and the repeated formation of ‘If-Then’ plans to resist cigarette offers, delivered to 12-16 year old in schools. Understanding stakeholders’ views about the importance, acceptability and feasibility of this intervention and likely barriers and facilitators is paramount for its successful adaptation and implementation in Romanian schools. Method: A two-day stakeholder workshop was conducted in Brasov with adolescents (14-16 yrs), high-school teachers, healthcare providers and policy makers (N=50). Using mixed-methods, stakeholders’ views were gathered on each intervention’s importance, target population, potential benefits, reach, feasibility, adaptation requirements, likely costs and potential barriers or facilitators. Results: There was good support for this intervention from all stakeholders. Adolescents preferred receiving this intervention from teachers (particularly sports) and NGO experts. Teachers and school counselors suggested embedding the ‘if-then’ planning skills within a broader health education context. Key barriers included staff smoking, lack of parental support, time and administrative constraints. School medical staff emphasized providing accurate information on emerging nicotine products. Policymakers suggested facilitating the implementation by motivating teachers, using champion students as co-facilitators, and supporting it with a social media campaign. The intervention's implementation was rated as moderately challenging by all (m=3.06 on 5-point Likert scales) reflecting a shared perception of feasible but moderate difficulties. Discussion: The school environment supports "If-then" interventions within the health education curriculum. Teacher motivation is boosted by a new credits-based reward system. Empathic teachers and invited experts are trusted by students, who are eager to be heard and open to innovative educational models.