Internet Use and Perceived Parental Involvement among Adolescents from Lower Socioeconomic Groups in Europe: An Exploration.

Internet usage is a salient developmental factor in adolescents' lives. Although relevant correlates of Internet use have been documented earlier, there is a lack of information on lower socioeconomic status groups. This is important, as these adolescents have increased risk of negative online experiences. The current survey aimed to explore Internet use and parental involvement amongst adolescents from areas of socio-economic disadvantage in 30 urban schools across five European countries. A total of 2594 students participated, of whom 90% were 14-16 years. Virtually all adolescents of socioeconomic disadvantage had Internet access, with 88.5% reporting spending more than two hours per day online, often on apps such as Instagram, Snapchat, and YouTube. Almost one-third of adolescents did not talk with their parents about their Internet use and almost two-thirds indicated that their parents were only a little or not interested in their Internet use. A consistent finding across countries was that girls more often talked with their parents about their Internet use and more often reported that their parents were interested in their Internet use than boys. The results suggest that parents have an important task in explicitly showing interest in their adolescents' Internet use, with special attention needed for boys.

Correlates of Internalized HIV Stigma: A Comprehensive Systematic Review.

Internalized HIV stigma is prevalent and research on internalized HIV stigma has increased during the past 10 years. The aim of this systematic review was to synthesize research on internalized HIV stigma and relationships with various health-related variables in order to better inform the development of interventions aimed at reducing internalized HIV stigma. We reviewed 176 studies with a quantitative design reporting correlates that were peer-reviewed, published in English before January 2021, drawn from PubMed, PSYCHINFO, Web of Science, EBSCO, and Scopus. Synthesis showed consistent associations between internalized stigma and negative psychological (e.g., depression, anxiety), social (e.g., lack of social support, discrimination, nondisclosure, and intersecting stigmas), and health (e.g., substance use, treatment nonadherence, negative clinical HIV outcomes) variables. We argue for a more socioecological approach to internalized stigma, with greater attention for intersectional stigmas, and more longitudinal research, if we are to effectively develop interventions that reduce internalized stigma.

Stay Safe and Strong: Characteristics, Roles and Emotions of Student-Produced Comics Related to Cyberbullying.

The present study aimed at giving voice to students from disadvantaged socio-economic backgrounds using a co-participatory approach. Participants were 59 adolescents (52.5% males) aged between 14 and 16 from five European countries who created ten comics to illustrate cyberbullying for a broader audience of peers. We analyzed texts and images according to four primary themes: cyberbullying episodes (types, platforms, co-occurrence with bullying), coping strategies, characters (roles, gender, and group membership), and emotions. The content analysis showed that online denigration on social media platforms was widely represented and that cyberbullying co-existed with bullying. Social strategies were frequently combined with passive and confrontational coping, up to suicide. All roles (cyberbully, cybervictim, bystander, reinforcer, defender) were portrayed among the 154 characters identified, even if victims and defenders appeared in the vignettes more often. Males, females, peers, and adults were represented in all roles. Among the 87 emotions detected, sadness was the most frequently expressed, followed by joy, surprise, anger, and fear. Emotions, mainly represented by drawings or drawings with text, were most often represented in association with cybervictims. The results are discussed in terms of their methodological and practical implications, as they emphasize the importance of valorizing young peoples' voices in research and interventions against cyberbullying.

Online interventions aimed at reducing psychological distress in cancer patients: evidence update and suggestions for future directions.

PURPOSE OF REVIEW: A great proportion of people affected by cancer experience psychological distress. To reduce pressure on limited health-management resources available, evidence-based eHealth or online interventions can fill an important gap by making psychosocial care more easily accessible. However, evidence of their effectiveness is mixed. This present review provides an update on the effectiveness of online interventions in reducing psychological distress in patients with cancer by including studies published from January 2018 to September 2019. RECENT FINDINGS: Thirty-three publications describing online interventions were included in the review, including web-based, blended care, telehealth, mHealth, and other online interventions. There was great heterogeneity across studies. The evidence of online interventions' effectiveness in reducing distress was mixed; there was partial support for reduction in psychological distress and depression, but limited evidence for reducing anxiety. Some important limitations should be taken into account when interpreting the results. SUMMARY: Online interventions for people affected by cancer, in general, are well received and seem to be a necessary component of comprehensive cancer care. However, these interventions should be more rigorously tested to provide more conclusive evidence about their effectiveness.

Online psychosocial interventions for posttreatment cancer survivors: an international evidence review and update.

PURPOSE OF REVIEW: The present review describes recent research on online psychosocial interventions for posttreatment cancer survivors from January 2018 to June 2019. RECENT FINDINGS: Twenty-three studies were included in the review (the majority included were feasibility studies and only five randomized controlled trials had large samples). Websites were the most common platforms for intervention delivery (9/23) and cognitive behavioral therapy was the most frequently used therapeutic approach (11/23). Three interventions based on this framework and delivered via websites or combined website-telehealth platforms showed to be effective in improving psychosocial issues (fear of cancer recurrence, insomnia, sleep quality, and prospective memory failures) in posttreatment cancer survivors. Web-based self-compassion writing was also found to be effective in addressing body image distress and body appreciation in breast cancer survivors. Feasibility studies mostly showed online interventions to be plausible and acceptable to cancer survivors. A good representation of online interventions for young adult cancer survivors (30%) was found. SUMMARY: Online interventions show promise in addressing the psychosocial needs of cancer survivors. Despite new online interventions being found to be feasible and acceptable and some showing promise in addressing important psychosocial issues in cancer survivors posttreatment, more rigorous studies are required to inform supportive care for this population.

Long-term effectiveness and moderators of a web-based tailored intervention for cancer survivors on social and emotional functioning, depression, and fatigue: randomized controlled trial.

PURPOSE: The web-based computer-tailored Kanker Nazorg Wijzer (Cancer Aftercare Guide) supports cancer survivors with psychosocial issues during cancer recovery. The current study investigates whether the 6-month effects in increasing emotional and social functioning and reducing depression and fatigue hold at 12 months from baseline. Moreover, it explores whether patient characteristics moderate the 6- and 12-month intervention effectiveness. METHODS: Cancer survivors from 21 Dutch hospitals (November 2013-June 2014) were randomized to an intervention (n = 231) or a wait-list control group (n = 231). Intervention effects on emotional and social functioning (EORTC QLQ-C30), depression (HADS), and fatigue (CIS) were evaluated through multilevel linear regression analyses. RESULTS: At 12 months from baseline, the intervention group no longer differed from the control group in emotional and social functioning, depression, and fatigue. Moderator analyses indicated that, at 6 months, the intervention was effective in improving social functioning for men (d = 0.34), reducing fatigue for participants ≤56 years (d = 0.44), and reducing depression for participants who received chemotherapy (d = 0.36). At 12 months, participants with a medium educational level reported higher social functioning (d = 0.19), while participants with a low educational level reported lower social functioning (d = 0.22) than participants with a similar educational level in the control group. CONCLUSIONS: The intervention gave cancer patients a head start to psychological recovery after the end of cancer treatment. The control group caught up in the long run. IMPLICATIONS FOR CANCER SURVIVORS: The Cancer Aftercare Guide expedited recovery after cancer treatment. Being a low intensity, easy accessible, and relatively low cost intervention, it could serve as a relevant step in recovery and stepped care.

Working mechanisms of a web-based self-management intervention for cancer survivors: a randomised controlled trial.

OBJECTIVE: The aim of this study was to investigate whether problem-solving skills and perceived personal control over cancer recovery mediated the intervention effects on depression and fatigue of a web-based computer-tailored intervention for cancer survivors - the Kanker Nazorg Wijzer (Cancer Aftercare Guide). DESIGN: Patients were recruited through 21 Dutch hospitals (November 2013-June 2014). The mediation model was tested in a randomised controlled trial with an intervention group (n = 231) and a waiting list control group (n = 231). MAIN OUTCOME MEASURES: Hypothesised mediators problem-solving skills (SPSI-R) and personal control (IPQ-R) were measured at baseline and 3 months from baseline. Outcomes depression (HADS) and fatigue (CIS) were measured at baseline and 6 months from baseline. RESULTS: The intervention effects in decreasing depression and fatigue were mediated by personal control. Problem-solving skills did not mediate the intervention effects on depression and fatigue. CONCLUSION: While personal control in the control group decreased in the first three months after baseline, levels of personal control within the intervention group were maintained. This effect partially explained the intervention effects on depression and fatigue. The results provide evidence for the relevance of addressing personal control in web-based interventions in order to improve psychosocial well-being in early cancer survivors.

Long-term effects of a web-based cancer aftercare intervention on moderate physical activity and vegetable consumption among early cancer survivors: a randomized controlled trial.

BACKGROUND: The number of cancer survivors is growing. Negative physical and psychosocial consequences of cancer treatment can occur during survivorship. Following healthy lifestyle recommendations is beneficial to increase quality of life and to reduce the risk of cancer recurrence and comorbidities. To meet individual needs, web-based interventions can supply a large population of cancer survivors with easily accessible and personalized information. Evidence concerning the long-term effects of web-based cancer aftercare interventions on lifestyle outcomes is limited. The present study evaluates the 12-month effects of a fully automated web-based cancer aftercare intervention. We investigated whether the previously determined 6-month effects on moderate physical activity and vegetable intake were maintained over 12 months. Possible moderator effects of using specific intervention modules, gender, age, and education were also explored. METHOD: A two-armed randomized controlled trial was conducted using online self-report questionnaires among survivors of various types of cancer (N = 462). The intervention group had access to the online intervention for 6 months, and the control group received access after 12-months. Multilevel linear regression analyses (complete cases and intention-to-treat) were conducted to explore 12- month effects. RESULTS: A significant intervention effect after 12 months was found for moderate physical activity (complete cases: B = 128.475, p = .010, d = .35; intention-to-treat: B = 129.473, p = .011). Age was the only significant moderator (p = .010), with the intervention being effective among participants aged younger than 57 years (B = 256.549, p = .000, d = .59). No significant intervention effect remained for vegetable consumption after 12 months (complete cases: B = 5.860, p = .121; intention-to-treat: B = 5.560, p = .132). CONCLUSION: The online cancer after care intervention is effective in increasing and maintaining moderate physical activity in the long term among early cancer survivors younger than 57 years. Short-term increases in vegetable consumption were not sustained in the long term. These findings indicate the value and potential of eHealth interventions for cancer survivors. Based on the study results, web-based self-management interventions could be recommended for younger cancer survivors (<57 years of age) as a possible method to increase physical activity. TRIAL REGISTRATION: Dutch Trial Register NTR3375 . Registered 29 March 2012.

Short-term effectiveness of a web-based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial.

BACKGROUND: The aim of this study was to evaluate the short-term effectiveness of the web-based computer-tailored intervention Kanker Nazorg Wijzer (Cancer Aftercare Guide). The intervention aims to support cancer survivors with managing psychosocial and lifestyle-related issues. In this study, the impact on quality of life, anxiety, depression, and fatigue were evaluated. METHODS: Cancer survivors were recruited through 21 Dutch hospitals (November 2013-June 2014). Outcome measures included quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30), anxiety and depression (Hospital Anxiety and Depression Scale), and fatigue (Checklist Individual Strength). In a randomized controlled trial with an intervention group (n = 231) and a waiting list control group (n = 231), the short-term effectiveness was evaluated through multilevel linear regression analyses, controlling for selective dropout, baseline differences, and several demographic and disease-related characteristics. RESULTS: In total, 188 participants of the intervention group and 221 of the control group completed the 6-month measurement (dropout = 11.5%). The intervention was effective in reducing depression (B = -0.63, p = 0.007, f2 = 0.019, d = 0.21) and fatigue (B = -4.36, p = 0.020, f2 = 0.013, d = 0.21). In addition, effects were found for emotional (B = 3.47, p = 0.022, f2 = 0.013, d = 0.15) and social functioning (B = 3.95, p = 0.011, f2 = 0.017, d = 0.15), although this evidence was less strong. There were indications that the effects of fatigue and social functioning were influenced by module use. CONCLUSIONS: While effect sizes were small, they can be considered as clinically relevant. With the Cancer Aftercare Guide being an effective, low-intensive, and easy accessible intervention, it could serve as a first step in stepped care for needs assessment and initial support for psychosocial problems that are present after cancer treatment. Copyright © 2016 John Wiley & Sons, Ltd.

Abstract and Metadata Correction of: Use and Appreciation of a Tailored Self-Management eHealth Intervention for Early Cancer Survivors: Process Evaluation of a Randomized Controlled Trial.

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Use and Appreciation of a Tailored Self-Management eHealth Intervention for Early Cancer Survivors: Process Evaluation of a Randomized Controlled Trial.

BACKGROUND: A fully automated computer-tailored Web-based self-management intervention, Kanker Nazorg Wijzer (KNW [Cancer Aftercare Guide]), was developed to support early cancer survivors to adequately cope with psychosocial complaints and to promote a healthy lifestyle. The KNW self-management training modules target the following topics: return to work, fatigue, anxiety and depression, relationships, physical activity, diet, and smoking cessation. Participants were guided to relevant modules by personalized module referral advice that was based on participants' current complaints and identified needs. OBJECTIVE: The aim of this study was to evaluate the adherence to the module referral advice, examine the KNW module use and its predictors, and describe the appreciation of the KNW and its predictors. Additionally, we explored predictors of personal relevance. METHODS: This process evaluation was conducted as part of a randomized controlled trial. Early cancer survivors with various types of cancer were recruited from 21 Dutch hospitals. Data from online self-report questionnaires and logging data were analyzed from participants allocated to the intervention condition. Chi-square tests were applied to assess the adherence to the module referral advice, negative binominal regression analysis was used to identify predictors of module use, multiple linear regression analysis was applied to identify predictors of the appreciation, and ordered logistic regression analysis was conducted to explore possible predictors of perceived personal relevance. RESULTS: From the respondents (N=231; mean age 55.6, SD 11.5; 79.2% female [183/231]), 98.3% (227/231) were referred to one or more KNW modules (mean 2.9, SD 1.5), and 85.7% (198/231) of participants visited at least one module (mean 2.1, SD 1.6). Significant positive associations were found between the referral to specific modules (range 1-7) and the use of corresponding modules. The likelihoods of visiting modules were higher when respondents were referred to those modules by the module referral advice. Predictors of visiting a higher number of modules were a higher number of referrals by the module referral advice (ß=.136, P=.009), and having a partner was significantly related with a lower number of modules used (ß=-.256, P=.044). Overall appreciation was high (mean 7.5, SD 1.2; scale 1-10) and was significantly predicted by a higher perceived personal relevance (ß=.623, P=.000). None of the demographic and cancer-related characteristics significantly predicted the perceived personal relevance. CONCLUSIONS: The KNW in general and more specifically the KNW modules were well used and highly appreciated by early cancer survivors. Indications were found that the module referral advice might be a meaningful intervention component to guide the users in following a preferred selection of modules. These results indicate that the fully automated Web-based KNW provides personal relevant and valuable information and support for early cancer survivors. Therefore, this intervention can complement usual cancer aftercare and may serve as a first step in a stepped-care approach. TRIAL REGISTRATION: Nederlands Trial Register: NTR3375; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3375 (Archived by WebCite at http://www.webcitation.org/6jo4jO7kb).

Lifestyle-related effects of the web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) intervention for cancer survivors: a randomized controlled trial.

PURPOSE: The web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) responds to the needs of cancer survivors and oncology care providers to improve the counseling related to self-management of lifestyle and psychosocial challenges. In present study, overall intervention effects and the effects of using specific components were evaluated on vegetable, fruit, whole grain bread, and fish consumption, physical activity (PA), and smoking behavior. METHODS: Cancer survivors from 21 Dutch hospitals were recruited for a randomized controlled trial (N = 432). Intervention effects after 6 months were evaluated using multilevel linear regression analysis (complete cases and intention-to-treat). By conducting moderation analyses, additional effects of following the behavior-related modules were explored. The false discovery rate correction was applied to account for multiple testing. RESULTS: After 6 months, 409 participants completed follow-up (dropout = 11.5 %). Indications were found that access to the intervention may result in increases of moderate PA and vegetable intake. The moderate PA increase was meaningful: 74.74 min p/w higher increase in the intervention condition. Effect sizes of moderate PA (d = .25) and vegetable (d = .37) consumption were comparable to prior effective interventions. Visiting behavior-related modules affected moderate PA, fruit, and fish consumption. However, after correction for multiple testing, significances expired. No significant intervention effect was found on smoking behavior due to low numbers of smokers. IMPLICATIONS FOR CANCER SURVIVORS: Although the effectiveness was only shown only to a limited extend, this study provided several indications that this theory-based, comprehensive, and personalized eHealth intervention provides valuable content to complement usual cancer aftercare.

Prevalence and correlates of healthy lifestyle behaviors among early cancer survivors.

BACKGROUND: Healthy lifestyle behaviors have been demonstrated to be beneficial for positive health outcomes and the quality of life in cancer survivors. However, adherence to recommendations is low. More insight is needed in factors that may explain engagement in lifestyle behaviors to develop effective cancer aftercare interventions. This study assessed different factors, namely socio-demographic, cancer-related, psychological, social cognitive factors (attitude, social support, self-efficacy) and intention, in relationship to five lifestyle behaviors (smoking, physical activity, alcohol, and fruit and vegetable consumption). METHODS: Early survivors of various types of cancer were recruited from eighteen Dutch Hospitals (n = 255). Distal factors (socio-demographic, cancer related, psychological), proximal factors (social cognitive), intention and five lifestyle behaviors (smoking, physical activity, alcohol, fruit and vegetable consumption) were assessed through a self-reported questionnaire. Cross-sectional analyses (correlations and regression analyses) were conducted. RESULTS: The lifestyle of a small group (11%) of the cancer survivors was coherent with all five health recommendations, the majority (>80%) adhered to two, three of four recommendations, and only few (<7%) adhered to one or none recommendation. The highest prevalence in followed recommendations have been detected in physical activity (87.4%), refrain from smoking (82%), and alcohol consumption (75.4%). There was low adherence to the fruit recommendation (54.8%) and to the vegetable recommendation (27.4%). Only weak associations were found between the different behaviors. Each separate lifestyle behavior was influenced by different patterns of correlates. Self-efficacy, attitude, and intention were the strongest correlates in all examined behaviors, although with various contributions, while socio-demographic, cancer-related and psychological factors provided a much smaller contribution. CONCLUSIONS: Outcomes of engagement in healthy lifestyle behaviors were more positive in this study compared to other research in cancer survivors; however, there is room for improvements in adherence to all five lifestyle behaviors. Especially fruit consumption was poor and vegetable consumption even worse. Our findings emphasized that all examined lifestyle behaviors need to be encouraged, with taken into account that each lifestyle behavior may be influenced by a specific set of mainly social cognitive factors or intention.

Cancer survivors in the first year after treatment: the prevalence and correlates of unmet needs in different domains.

OBJECTIVE: To explore cancer survivors' unmet needs in the first year after primary treatment, and to investigate the relationship between demographic, disease-related, and psychosocial characteristics and the number of unmet needs in different domains. METHODS: Cancer survivors were recruited through eight Dutch hospitals (November 2012-January 2013). In a cross-sectional survey, 255 survivors were asked about unmet needs across several domains (CaSUN) and demographic, disease-related, and psychosocial characteristics, comprising quality of life (EORTC QLQ-C30), psychological distress (HADS), mental adjustment (MAC), and problem solving (SPSI-R:S). RESULTS: Sixty-three percent of survivors reported one or more unmet needs (M = 5.13, SD = 6.98, range = 0-34). Common unmet needs concerned emotional support (31.3%), smoking cessation (26.7% of smokers), managing side effects/complications (25.9%), fear of recurrence (23.0%), cancer care (22.0%), social support (22.0%), up-to-date information (19.8%), and carrying out work (19.6%). Regression analysis showed that age, higher education, participation in support programs, anxiety, depression, and negative adjustment style correlated positively, while being female, time since last treatment, and quality of life correlated negatively with the number of unmet needs. Lower number of unmet needs also accounted for other types of cancer (except colon cancer) than breast cancer. These relationships differed per need domain. CONCLUSIONS: The heterogeneity in unmet needs complicates the provision of adequate support for survivors.

The Kanker Nazorg Wijzer (Cancer Aftercare Guide) protocol: the systematic development of a web-based computer tailored intervention providing psychosocial and lifestyle support for cancer survivors.

BACKGROUND: After primary treatment, many cancer survivors experience psychosocial, physical, and lifestyle problems. To address these issues, we developed a web-based computer tailored intervention, the Kanker Nazorg Wijzer (Cancer Aftercare Guide), aimed at providing psychosocial and lifestyle support for cancer survivors. The purpose of this article is to describe the systematic development and the study design for evaluation of this theory and empirical based intervention. METHODS/DESIGN: For the development of the intervention, the steps of the Intervention Mapping protocol were followed. A needs assessment was performed consisting of a literature study, focus group interviews, and a survey study to get more insight into cancer survivors' health issues. This resulted in seven problem areas that were addressed in the intervention: cancer-related fatigue, return to work, anxiety and depression, social relationships and intimacy, physical activity, diet, and smoking. To address these problem areas, the principles of problem-solving therapy and cognitive behavioral therapy are used. At the start of the intervention, participants have to fill in a screening questionnaire. Based on their answers, participants receive tailored advice about which problem areas deserve their attention. Participants were recruited from November 2013 through June 2014 by hospital staff from 21 hospitals in the Netherlands. Patients were selected either during follow-up visits to the hospital or from reviews of the patients' files. The effectiveness of the intervention is being tested in a randomized controlled trial consisting of an intervention group (n = 231) and waiting list control group (n = 231) with a baseline measurement and follow-up measurements at 3, 6, and 12 months. DISCUSSION: Using the Intervention Mapping protocol resulted in a theory and evidence-based intervention providing tailored advice to cancer survivors on how to cope with psychosocial and lifestyle issues after primary treatment. TRIAL REGISTRATION: Dutch Trial Register NTR3375.

Effectiveness of a national reimbursement policy and accompanying media attention on use of cessation treatment and on smoking cessation: a real-world study in the Netherlands.

BACKGROUND: In 2011, the Netherlands implemented a national policy that ensured that health insurance companies reimbursed behavioural counselling for smoking cessation or the combination of behavioural counselling with pharmacological therapy. OBJECTIVE: To examine the real-world impact of a national reimbursement policy and accompanying media attention on use of cessation treatment and on smoking cessation. METHODS: We used a four-wave longitudinal survey among 2763 adult smokers that started in September 2010 and was repeated at approximately 3 month intervals until June 2011. Two survey waves were conducted before the implementation of the policy and two survey waves after. FINDINGS: There were significant increases in quit attempts (among moderate-to-heavy smokers) and in quit success (among all smokers) following the implementation of the reimbursement policy and the media attention. Use of behavioural counselling did not increase, while use of pharmacological therapy without behavioural counselling (unreimbursed treatment) increased among moderate-to-heavy smokers. Attention to media about the reimbursement was significantly associated with more quit attempts and more quit success. Awareness of the policy was significantly associated with more use of reimbursed treatment among all smokers, while attention to the media coverage was only significantly associated with more use of reimbursed treatment among moderate-to-heavy smokers. Awareness/attention variables were not significantly associated with use of unreimbursed treatment. CONCLUSIONS: It seems that a national reimbursement policy for smoking cessation treatment that is accompanied by media attention can increase cessation. Our findings suggest that this increase can (partly) be ascribed to the media attention that accompanied the policy implementation.

Understanding smokers' motivations to use evidence-based smoking cessation aids.

INTRODUCTION: Use of evidence-based smoking cessation aids (SCA) is an efficacious way to improve smoking cessation relapse rates. However, use of SCA in the Netherlands is particularly low. This study examined determinants of intention to use SCA in smokers willing to quit. METHODS: The Dutch Continuous Survey of Smoking Habits, a cross-sectional population survey, was used. Respondents were smokers (n = 594) wanting to quit sometime in the future and who made at least one quit attempt in the past, categorized as past users of evidence-based SCA, past users of nonevidence-based SCA, and smokers who had never used SCA before (nonusers). Respondents were asked about past SCA use, motivational determinants regarding smoking cessation and SCA use, and intention to use SCA during a future quit attempt. RESULTS: Older and more addicted smokers were more likely to have used evidence-based SCA. Evidence-based and nonevidence-based users reported stronger attitudes and perceived social norm as well as lower self-efficacy expectations regarding smoking cessation and SCA use than nonusers. Having positive outcome expectations and perceived social norm regarding SCA use were strong predictors of intention to use SCA. Self-efficacy regarding smoking cessation was negatively related with intention to use SCA. CONCLUSIONS: Nonusers, nonevidence-based users, and evidence-based users have different motivations for using evidence-based SCA and should not be treated as a homogenous group in smoking cessation programs. Additionally, it is unclear whether nonusers should be encouraged to use SCA, given that this group is less addicted and more confident about quitting.