“Nobody complies with it anyway. Well yes, those who do not smoke” – Combining methods for understanding adolescents’ approach to a smoke-free agreement.

Abstract Background: Non-smoking agreements has shown effective in preventing smoking among adolescents. However, to date, this is the first study to explore: 1) if adolescents who do or do not sign have specific characteristics, 2) adolescents’ attitudes towards signing and committing to these smoke-free agreements (SFA). Methods: This is explored by combining questionnaire and focus group data. The questionnaire data is gathered as part of the evaluation of X:IT study II; a smoking preventive intervention targeting adolescents in 7 th -9 th grade. In this paper data from second follow (8 th grade) up is used. Eight focus groups (N=43) were conducted with the adolescents in 8 th grade at two Danish secondary schools. Inspired by theory integration we draw from resistance theory to combine the results from the methods. Results: The questionnaire data showed that adolescents who were partaking in smoking or smoking-related behavior including current or ever smoked as well as have ever tried hash, snuff or electronic cigarettes to a less degree signed a SFA. Focus group analysis showed that even though the adolescents at the two schools emphasized a lack of attention to the SFA, the lack of attention was ascribed to different approaches to smoking and the SFA. In general, adolescents at one of the schools had no intention of smoking and thus willingly signed and committed. Whereas, adolescents at the other school expressed a greater resistance to signing as well as committing to the SFA. Instead, what seemed important for the adolescents at this school was a desire to act freely and appear with no strains, including possibility to smoke, which the SFA seemingly threated. Conclusion: Although non-smoking agreements, implemented in the school setting, have been effective in decreasing smoking among adolescents in other studies, our results suggest that the SFA may appeal differently to adolescents according to certain characteristics, while getting overall very little attention.