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Capstone Paper Overview and Requirements for POL 688[footnoteRef:1] [1: Note: I must highlight that most of the information contained in these documents has been acquired from outside sources and adapted for the purposes of my classes over the years. I take no credit for anything in this document as my original work and have attempted to give credit where possible

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The MPA Capstone Project (Project here after) is constructed over two courses POL 688 and POL 689. This document will detail the expectations of required work in POL 688, as well as overall expectations of the Project that will be submitted in POL 689.

The Capstone Project is required for students in all concentrations. It provides an opportunity for students to integrate theory and practice in a significant problem-solving exercise. For this project students will conduct an original, analytical research project consisting of professional analysis of a management problem leading to practical implementation in governmental, health care, or nonprofit settings, or theoretical inquiry in the field of public administration. The project, in other words, will produce either academic research that provides new generalized knowledge in the field or a solution to a public management problem, often within the context of a specified agency.

All projects must entail

original research and writing
, defined as meeting the following criteria:

The research project has not been previously conducted. If the study is a replication study, it must not have been previously conducted on the project subjects or the agency unless the project involves longitudinal studies of administrative phenomena.
The study must contain strong analysis as the basis for project findings, recommendations, and/or products.

Framing Your Capstone Project

The potential topics that you may choose are endless. Consequently, one of your first and probably most difficult tasks is to clearly and concisely define the problem that you will address. When selecting a topic, please consider the following:

What are your future career goals and how might this project help you advance toward those goals?
What do you hope to accomplish and/or contribute with your research?
Is your topic achievable in one semester?
How will the approach, methods and analyses you propose would address the given problem being considered? (Your approach will determine or guide the type of research paper you write.)
By far the most challenging steps leading to the successful completion of the Project is selecting a manageable the problem or issue to investigate. Experience suggests that some students devote inadequate thought to this important matter and, as a consequence may find themselves caught up in a frustrating and seemingly endless project. The selection of a well-defined, “doable” topic, by contrast, can make the Project one of the most rewarding components of the MPA degree program.

Before undertaking the work of researching and writing the project paper, students must obtain approval of the project topic from their instructor and, where applicable, from an agency representative or other entity where the student intends to collect data. Students are encouraged to gain this approval during POL 688 so that they may begin data collection in POL 689. Students whose project papers focus on a significant agency issue or problem should involve the instructor and agency representative early in the process of selecting a topic. Involvement by the agency should help students receive full recognition of having helped solve an agency problem. The project is intended to increase the students probability of advancement and so any potential political fallout or organizational backlash should be carefully considered in selecting the project.

Criteria for Selection of the Capstone Project
The following criteria apply to the selection of the Project Paper Seminar topic.
The topic should be one that can be completed within the timeframe of POL 688 and POL 689.
The Project is a piece of independent research related to a research questions of significant importance where the student collects and analyzes data to arrive at a conclusion related to the proposed research question.
The paper IS NOT an expanded literature review or a report of activities undertaken during professional field experience/internship, a case study describing a single set of related incidents and decisions reached by other work colleagues, or a report of the day-to-day responsibilities of in-career students. However, when approved by the project paper instructor, the paper may include material related to a students professional field experience assuming the information is not the central focus of the paper.
The project must use appropriate methodologies germane to the topic and its academic or professional field.
The project is clearly aligned with the students MPA curriculum
The paper must represent substantially new research, as defined by the project paper instructor.
All topics involving research with human subjects should conform to the expectations of MSUs IRB. Students are strongly encouraged to work with their instructor early in the process to discuss any IRB requirements. Keep in mind that some agencies will require IRB approval. It is highly recommended that you discuss your Project idea with the agency as soon as possible to understand any necessary documentation needed by the agency.
The length of the project paper will vary depending on the nature of the topics and research design employed for the project. With this said, final Projects (what will be turned in at the end of POL 689) are rarely less than 30 pages of narrative plus the required preliminary materials (abstract, table of contents, executive summary), reference list, appendices, etc.
The project paper may not consist of substantial portions of previous work submitted for credit in a prior course without explicit permission from the capstone instructor.

All Projects will be evaluated for grading purposes on the basis of the following criteria: quality and clarity of the writing, thoroughness and quality of the research, completeness of documentation and literature review, and the clarity of the papers organization. An oral presentation of the papers topic and findings will also be required and evaluated as part of the seminar grade. The project paper instructor may submit the students final paper to an outside reader for feedback prior to assigning the final grade for the seminar.

Recommended MPA Capstone Project Topics
The following are types of projects deemed acceptable for the MPA Capstone Project.
Applied Analytical Research: Applied research using analytical and applied research methods to solve a particular policy or management problem of a specific public or non-profit sector agency. Examples of such projects include: program, policy, and project proposals, needs assessments or evaluations, management studies, and budgetary and fiscal studies. While all applied project papers must have a strong analytical component, they may result in the production of practical administrative products as a component of the project paper. These administrative products may include new program proposals, new or revised management plans and systems, employee or operations manuals, strategic agency plans, etc.

Policy Analysis: Use if you are problem-solving and seeking the best way to solve a public problem. With a policy analysis paper, you should adhere to standard procedures including:

Compare a number of alternative approaches and determine which offers the best solution to the problem.
Establish criteria for selecting the best alternative.
Be able to measure various outcome of each alternative in order to justify and defend your decision.

Program Evaluation: Use if you are determining the efficiency and/or effectiveness of a particular public program, public good, or public service. With a program evaluation, you should follow good evaluation procedures including:

Document and assess the activities, outputs, outcomes, and costs of the program, good, or service.
Determine whether the program can be improved; should it be improved; should be remain as is; should it be eliminated; etc.?

Administrative Analysis: Use if you are assessing an administrative program to determine its fate. Look at the administrative program from various perspectives (e.g., departmental, employees, community, organizational structure, ecological, etc.). Take a case study approach to fully understand and explain the administrative program.

Position Paper: Use if you are developing a policy argument to support a claim that something should or should not be done. Position papers have two main components: a claim and its support. The claim asserts what should or should not be done. Support for the claim presents the facts, interpretations, and assumptions that lead to making that claim. Your goal is to convince others to accept the claim and to agree with the position.

Empirical Scholarly Research: Empirical research into the behavior, events, and other phenomena found in the administration of public and non-profit organizations. This research must follow accepted social science research designs and methodologies (quantitative, qualitative, or blended approaches) for evaluating empirical models and testing hypotheses. The instructor must approve the projects research design early in the research process. Examples of projects of this type include studies found in academic journals.
Legal or Historical Studies: Legal or historical analyses, using accepted legal or historical research methods, and focused on public, healthcare, or nonprofit policy making and policy or program implementation issues.

– PAGE 2 –

Other Projects: Occasionally, unique projects not defined above are presented to take advantage of rare opportunities to examine issues or problems relevant to public administration as a field of inquiry or practice. Such projects may be approved by the instructor, provided that they meet the criteria for original research.

Required Capstone Project Components for POL 688
In POL 688 students will propose a research project that consists of a research question, literature review, and research design. Each Project requires a research proposal (Due Week 3 of the course) that includes a preliminary research question, why the student is interested in the topic and what they hope to contribute with the research, and a brief description of where the data to answer the research question will come from and how the data will be accessed. Students should review the course schedule for due dates related to drafts and final submissions for Part 1: Literature Review and Part 2: Research Design. Part 1 and Part 2 are discussed in more detail below.

Part I: Literature Review

Abstract: A concise paragraph describing the topic, project focus, and key research question.

Project Description: An introduction to the topic and its applied importance to the field and practice of public administration

Preliminary Literature Review: A preliminary review of professional and scholarly literature establishing how this project is placed within the context of the wider body of knowledge about the topic. Professional or scholarly literature reviews are not to be annotated bibliographies; they are to be integrative reviews that establish where the students project can be placed in the broader content and theoretical context of prior published research and analysis. In other words, the literature review should be thematic rather than organized author-by-author or study-by-study. The requirements for the approach and content of acceptable literature reviews should be clearly stated in the course syllabus. The documents should be a minimum of 10 pages (double-spaced, Times New Roman, 12pt font), excluding Abstract and Project Description, and contain a minimum of 15 appropriate sources.

Part 2: Research Design

A research design is a plan for carrying out your capstone project. It lays out the problem to be examined, the program to be evaluated, the policy to be analyzed, and the propositions, recommendations or conclusions to be presented. Then it puts them in the context of the research that has already been done or the information already available, and explains how the necessary information will be gathered and applied to support or test the propositions, recommendations or conclusions.

In a research design, you are providing a plan of how to do the work in the allotted time. You will need to research existing studies, writings, and current events on the topic. You will also have to figure out how to obtain the necessary data, what methods you will use in applying it, and the standards you will use to evaluate your program, policy, propositions, recommendations, or conclusions. Below is a list of sections that should be included in your 688 submission.

Research Question and Methodology: The nature of the methodology to be employed in conducting the project analysis, and a clear statement of the research question(s) and, where relevant, hypotheses of the research. Your methodology should include a detailed description of the potential variables (this includes clear definitions and measurements).

Data Collection Strategies: A description of the information and data sources and methodologies to be used to access the data

Methods: Your project must also include a detailed description of your proposed method of analysis.

It is highly recommended that you explicitly link each of the above criteria to your research question to ensure you are making correct decisions. Projects involving the use of proprietary agency data, interviews with agency personnel, or on-site observations of agency operations may require a letter of agency endorsement and any specific requirements required to collect and use data for the project.

Final Capstone Project Formatting Requirements and Organization

Publication Manual of the American Psychological Association (most current edition) as the standard for headings/subheadings, in-text citations, and reference format.

The finished project submitted in POL 689 will contain the following sections, in the following order.
1. Title page (must adhere to Graduate College guidelines)
2. Abstract (a 200 word summary that includes topic, major findings, and conclusions)
3. Table of Contents (with page numbers)
4. Introduction (a statement of purpose and organization of the paper, including the expected contribution to knowledge in the field of public administration)
5. Literature Review (a review of the most important documents from related scholarly research and professional sources)
6. Research Design and Methodology
7. Data Analysis and Findings
8. Conclusions and Recommendations (summary of findings, conclusions drawn, recommendations for action or further study)
9. APA-style Reference List (not bibliography)


Notes before getting started:

Keep in mind that the below document is meant to be a guide on how to approach the various sections of your capstone.
There are several rubrics built into this document. Please know that these rubrics are intended for self-reflection and are not the official rubric for this assignment. With this said, the official rubric will include nearly all the criteria youll see here.
Below is a link to Creswell and Creswells Research Design textbook. The document closely follows this book. You might find it helpful to review the document and consult this text along the way for more details. One of the things I really like about the Creswell text, in addition to providing good information, is the authors provide examples of what each thing looks like for both qualitative and quantitative designs. For example, on page 120 the author provides an example of what Purpose Statement could look like under the various types of designs. Youll find a chapter for most of the items in the Introduction, Literature Review, and Design sections.

This text covers mixed method designs. Please consult with your instructor if this is something that you are thinking about employing! These are very valuable designs; however, unless you are careful with how you approach your project, this type can be too large of a task to finish in the allotted Capstone time.



This section describes the conceptual basis for what the researcher will investigate, including the research questions, hypotheses, and basic research design. The introduction develops the significance of the study by describing how the study is new or different from other studies, how it addresses something that is not already known or has not been studied before, or how it extends prior research on the topic in some way. This section should also briefly describe the basic nature of the study and provide an overview of the Capstone Project contents.
To ensure the quality of both your proposal and your final Capstone and reduce the time, your writing needs to reflect masters level, scholarly writing standards
from your very first draft. Each section within the proposal or Capstone should be well organized and easy for the reader to follow. Each paragraph should be short, clear, and focused. A paragraph should (1) be three to eight sentences in length, (2) focus on one point, topic, or argument, (3) include a topic sentence the defines the focus for the paragraph, and (4) include a transition sentence to the next paragraph. Include one space after each period. There should be no grammatical, punctuation, sentence structure, or

APA formatting errors. Verb tense is an important consideration for Sections 1 through

3. For the proposal, the researcher uses
future tense (e.g. The purpose of this study is to), whereas in the Capstone, the body is revised to reflect past tense (e.g. The purpose of this study was to). Taking the time to ensure high quality, scholarly writing for each draft will save you time in all the steps of the development and review phases of the Capstone process so make sure to do it right the first time!

As a researcher, it is your responsibility to ensure the clarity, quality, and correctness of your writing and APA formatting. Your instructor is not obligated to edit your documents. If you do not have outstanding writing skills, you may need to identify a writing coach, editor and/or other resource to help you with writing and editing.
The quality of a Capstone is not only evaluated on the quality of writing. It is also evaluated based on the criteria that have been established for each section of the Capstone. The criteria describe what must be addressed in each section within each section. As you develop a section, first read the section description. Then review each criterion contained in the table below the description. Use both the overall description and criteria as you write each section. It is important that each listed criterion is addressed in a way that it is clear to your instructor. You should be able to point out where each criterion is met in each section.
Prior to submitting a draft of your proposal or Capstone, please assess yourself on the degree to which each criterion has been met.
You need to continuously and objectively self-evaluate the quality of your writing and content for each section within the Capstone. Keep in mind the process will likely require several editorial/revisions rounds, so plan for multiple revision cycles as you develop your Capstone completion plan and project timeline. See the rubric below to help review the Introduction of your Capstone project.


This section provides a brief overview of the research focus or problem, explains why this study is worth conducting, and discusses how this study will be completed. (Minimum three to four paragraphs or approximately one page)

Capstone topic is introduced and value of conducting the study is discussed.

Discussion provides an overview of what is contained in the section.

Provide the reader with a clear understanding of the problem in a concise yet complete manner

Articulate that the problem is worthy of further investigation.

Briefly describe how the study will be done

Present the guiding research question or hypothesis for the study

Explain how this study can contribute to the existing knowledge

Describe how the study will address something that is not already known or has not been studied before

Describe how the study will fill a gap in existing literature or research.

Describe how the study extends prior research on the topic in some way

Background, Context and Theoretical Framework

The background, context, and theoretical framework of the study should tell the reader what has happened in the past to create the problem or need today. It is a brief historical overview that answers these questions: What do we know? What created the problem? When did the problem begin, and for whom is it a problem? What research has been done?

This section provides information necessary to allow the reader to understand the background of the problem and context in which the problem occurs. The primary objectives in writing this section are (a) to provide a brief overview of research related to the problem; (b) to identify and describe the key components, elements, aspects, concepts of the problem; (c) to provide the reader with an understanding of how the problem arose and the specific context within which the problem is occurring; and (d) to briefly introduce the reader to the theoretical framework and how that framework either supports the proposed study or provides a theoretical context for developing the research problem. The length of this section will depend on the complexity of the problem. Many learner-researchers first develop a working draft of the literature review, since a good portion of this section is a brief summary of the related literature. Typically, background sections are five to eight paragraphs but can be longer for more complex problems or for problems that have an extensive history of investigation.
The context for the study refers to the physical setting of the research and the natural or artificial (simulated) properties of that setting. In some research these properties are called experimental conditions or study environment. This section should introduce the theory that will provide support and justification for your study. It will be used to briefly introduce the primary theoretical topics that will be developed in detail in the literature review.

The purpose of the theoretical framework is to tie the Capstone together. As the researcher, you should approach the proposed research from a theory or set of theories that provide the backdrop for the work (researchers do not create theory; they use established theory in which to embed their work). This section should describe how this study will relate to existing theories and discuss how the methodology being used in the study links to those theories. Questions to answer: Is the theoretical foundation strong? Are the theoretical sources apparent? Are they appropriate for the topic? Do they need further explanation? Further, the theoretical framework describes a context within which to locate the intended project and suggests why doing such a study is worthwhile. The theoretical framework justifies the methods you plan to use for conducting the study and presents how this research will contribute to the body of knowledge and/or practice. Further, it describes the context within which to locate the intended project and suggests why doing such a study is worthwhile.

Background, Context and Theoretical Framework

The background section explains both the history of and the present state of the problem and research focus. It identifies the “gap” or “need” based on a summary of the current literature and discusses how the study will address that “gap” or “need.” (Minimum two to three paragraphs or approximately one page)

Describe why the study is being conducted

Provide a brief overview of research related to the problem

Identify and describe the key components, elements, aspects, concepts of the problem

Describe who or what is impacted by the problem or research focus

Provide the reader with an understanding of how the problem arose and the specific context within which the problem is occurring

Briefly introduce the reader to the theoretical framework and how that framework either supports
the proposed study or provides a theoretical context for developing the research problem.

Describe and justify the research methods planned for the study

Briefly describe why the study is being conducted.

Provides a summary of results from the prior empirical research on the topic and identifies the need as defined by the prior research which this current study will address.

Problem Statement

This section clearly states the problem or research focus, the population affected and how the study will contribute to solving the problem. A well-written problem statement begins with the big picture of the issue (
macro) and works to the small, narrower, and more specific problem (
micro). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Study with a declarative statement such as It is not known if and to what degree/extent… or It is not known how/why and

Other examples are:
It is not known

Absent from the literature is

While the literature indicates
, it is not known in (school/district/organization/community) if

It is not known how or to what extent

As you are writing this section, make sure your research problem passes the ROC test meaning your problem is
Original, and

Problem Statement

This section includes the problem statement, the population affected, and how the study will contribute to solving the problem. (Minimum three or four paragraphs or approximately one page)

States the specific problem proposed for research by presenting a clear declarative statement that begins with It is not known if and to what degree/extent… (quantitative)
~or~ or It is not known how/why and (qualitative)

Identifies the general population affected by the problem.

Suggests how the study may contribute to solving the problem.

Clearly describe the magnitude and importance of the problem.

Identify the need for the study and why it is of concern to the researcher.

Purpose of the Study

The purpose of the Study section provides a reflection of the problem statement and identifies how the study will be accomplished. It explains how the proposed study will contribute to the field. The section begins with a declarative statement, The purpose of this study is. . Included in this statement are also the research design, population, variables (quantitative) or phenomena (qualitative) to be studied, and the geographic location. Further, the section clearly defines the dependent
and independent variables, relationship of variables, or comparison of groups for quantitative studies. For qualitative studies, this section describes the nature of the phenomena to be explored. Keep in mind that the purpose of the study is restated in other sections of the Capstone and should be worded exactly as presented in this section of the Introduction. Refer to Creswell (2014) for sample purpose statement templates that are aligned with the different research methods (qualitative/quantitative).


The purpose statement section expands on the problem statement and identifies how the study will be accomplished. It explains how the proposed study will contribute to the field. (Minimum two to three paragraphs)

Presents a declarative statement: The purpose of this study is. that identifies the research methodology and design, population, variables (quantitative) or phenomena (qualitative) to be studied and geographic location.

Identifies research methodology as qualitative, or quantitative, and identifies the specific research design.

Describes the target population and geographic location for the study.

Quantitative: Defines the variables, relationship of variables, or comparison of groups.

Qualitative: Describes the nature of the phenomena to be explored.

Research Question(s) and Hypotheses

This section narrows the focus of the study and specifies the research questions to address the problem statement. Based on the research questions, it describes the variables or groups and their hypothesized relationship for a quantitative study or the phenomena under investigation for a qualitative study. The research questions and hypotheses should be derived from, and are directly aligned with, the problem and purpose statements, research methods, and data analyses. The Research Questions or Hypotheses section of
Introduction will be presented again in Methods section to provide clear continuity for the reader and to help frame your data analysis.
If your study is qualitative, state the research question(s) the study will answer, and describe the phenomenon to be studied. Qualitative studies will typically have one overarching research question with three or more sub-questions. If your study is quantitative, state the research questions the study will answer, identify the variables, and state the hypotheses (predictive statements) using the format appropriate for the specific design. Quantitative studies will typically have three or four research questions and associated hypotheses; mixed method studies can use both depending on the design.
In a paragraph prior to listing the research questions or hypotheses, include a discussion of the research questions, relating them to the problem statement. Then, include a leading phrase to introduce the questions such as: The following research questions guide this qualitative study:
RQ1: This is an example of how a qualitative research question should align within the text of the manuscript. Indent .25 inches from the left margin. Text that wraps around to the next line is indented using the Hanging Indent feature at

RQ2: Add a research question here following the format above. Additional research questions should follow the same format.
Or for a quantitative study the research questions are formatted as below. The following research question and hypotheses guide this quantitative study:
RQ1: This is an example of how a quantitative research questions and hypotheses should align within the text of the manuscript. Indent .25 inches from the left
margin. Text that wraps around to the next line is indented using the Hanging Indent feature at .5.
H10: The null hypothesis that aligns to the research question is listed here.

H1a: The alternative hypothesis that aligns to the research question and null hypothesis is listed here. Repeat this pattern for each quantitative research question and associated hypotheses.

Research Question(s) and/or Hypotheses

This section narrows the focus of the study by specifying the research questions to address the problem statement. Based on the research questions, it describes the variables and/or groups and their hypothesized relationship (quantitative study) or the phenomena under investigation (qualitative study). It describes how the research questions are related to the problem statement and how the research questions will facilitate
collection of the data needed to answer the research questions. (
Minimum one to three paragraphs or approximately one page)

Qualitative Designs:
States the research question(s) the study will answe


That is the questions below and we will use the article and CASP checklist

Respond to this prompt following rubric guidelines as posted:
1. State your overall appraisal of this article (include/exclude/seek further info) and provide a rationale of ~2-3 paragraphs, citing evidence from the article, as to why you think the article is appropriate to include or not in the making of a clinically-based decision.
In your initial posting, refer to at least 2 of the components of the CASP_RCT_Checklist_PDF_Fillable_Form-2.pdfDownload CASP_RCT_Checklist_PDF_Fillable_Form-2.pdf critical appraisal tool that you already completed.
2. Ask 2 follow-up questions to your peers. For example: “The measurement of the outcome variables was confusing to me- how did you interpret the reliability of the measurement?” or “The methods section lacked enough detail for me to be able to replicate this study. What would have helped that?”
Rubric for grading
Student introduces topic (1), cites article to be appraised, and appraisal tool utilized (1), provides 2-3 sentences summarizing the overarching appraisal strengths and weaknesses of the article (2), and includes summary statement that indicates that the article was include, seek further information or exclude (1
The student chooses 2 criteria from the assigned appraisal tool that were found to be weaknesses or that introduced bias into the study. In a sentence the student states what the 2 criteria are that they will be expanding upon
The student: 1. Explains the criteria and why it is important 2. States whether and how the article meets the desired level of quality for the criteria 3. The student cites the article, the appraisal tool, and other resources as necessary for explanation.
The student includes 2 thoughtful questions that are related to the article content and appraisal with their initial post.

Effectiveness and Cost-Effectiveness of Repeated Implementation Intention
Formation on Adolescent Smoking Initiation: A Cluster Randomized

Controlled Trial

Mark Conner
University of Leeds

Sarah Grogan
Manchester Metropolitan University

Robert West and Ruth Simms-Ellis
University of Leeds

Keira Scholtens
Staffordshire University

Bianca Sykes-Muskett
University of Leeds

Lisa Cowap
Staffordshire University

Rebecca Lawton
University of Leeds

Christopher J. Armitage
University of Manchester

David Meads
University of Leeds

Laetitia Schmitt
University of York

Carole Torgerson
Durham University

Kamran Siddiqi
University of York

Objective: Forming implementation intentions (ifthen plans) about how to refuse cigarette offers plus
antismoking messages was tested for reducing adolescent smoking. Method: Cluster randomized con-
trolled trial with schools randomized (1:1) to receive implementation intention intervention and messages
targeting not smoking (intervention) or completing homework (control). Adolescents (1112 years at
baseline) formed implementation intentions and read messages on 8 occasions over 4 years meaning
masking treatment allocation was not possible. Outcomes were: follow-up (48 months) ever smoking,
any smoking in last 30 days, regular smoking, and breath carbon monoxide levels. Analyses excluded
baseline ever smokers, controlled for clustering by schools and examined effects of controlling for
demographic variables. Economic evaluation (incremental cost effectiveness ratio; ICER) was con-
ducted. Trial is registered (ISRCTN27596806). Results: Schools were randomly allocated (September
October 2012) to intervention (n 25) or control (n 23). At follow-up, among 6,155 baseline never
smokers from 45 retained schools, ever smoking was significantly lower (RR 0.83, 95% CI [0.71,
0.97], p .016) in intervention (29.3%) compared with control (35.8%) and remained so controlling for
demographics. Similar patterns observed for any smoking in last 30 days. Less consistent effects were
observed for regular smoking and breath carbon monoxide levels. Economic analysis yielded an ICER
of $134 per ever smoker avoided at age 1516 years. Conclusions: This pragmatic trial supports the use

This article was published Online First March 7, 2019.
Mark Conner, School of Psychology, University of Leeds; Sarah Gro-

gan, Department of Psychology, Manchester Metropolitan University;
Robert West, Institute of Health Sciences, University of Leeds; Ruth
Simms-Ellis, School of Psychology, University of Leeds; Keira Scholtens,
Faculty of Health Sciences, Staffordshire University; Bianca Sykes-
Muskett, School of Psychology, University of Leeds; Lisa Cowap, Faculty
of Health Sciences, Staffordshire University; Rebecca Lawton, School of
Psychology, University of Leeds; Christopher J. Armitage, Manchester
Centre for Health Psychology, University of Manchester; David Meads,
Institute of Health Sciences, University of Leeds; Laetitia Schmitt, Centre
for Health Economics, University of York; Carole Torgerson, School of
Education, Durham University; Kamran Siddiqi, Department of Health
Sciences, University of York.

This research was supported by a grant (MR/J000264/1) from the United
Kingdom Medical Research Council/ National Prevention Research Initiative.
Christopher J. Armitage is also supported by the NIHR Manchester Biomed-
ical Research Centre.

This article has been published under the terms of the Creative Com-
mons Attribution License (,
which permits unrestricted use, distribution, and reproduction in any me-
dium, provided the original author and source are credited. Copyright for
this article is retained by the author(s). Author(s) grant(s) the American
Psychological Association the exclusive right to publish the article and
identify itself as the original publisher.

Correspondence concerning this article should be addressed to Mark
Conner, School of Psychology, University of Leeds, Leeds LS2 9JT,
United Kingdom. E-mail: [emailprotected]

Journal of Consulting and Clinical Psychology
2019 The Author(s) 2019, Vol. 87, No. 5, 422432



of repeated implementation intentions about how to refuse the offer of a cigarette plus antismoking
messages as an effective and cost-effective intervention to reduce smoking initiation in adolescents.

What is the public health significance of this article?
This study suggests that getting adolescents to read anti-smoking messages and form implementation
intentions about how to refuse the offer of a cigarette in classroom time reduces smoking initiation.
Such a classroom-based intervention is an effective and cost-effective way to reduce smoking
initiation in adolescents and is readily scalable.

Keywords: smoking initiation, adolescents, implementation intentions, smoking prevention

Supplemental materials:

Tobacco smoking continues to be an important cause of mor-
bidity and mortality, particularly later in life (Gowing et al., 2015).
Most smokers initiate the habit as adolescents (McRobbie, Bullen,
Hartmann-Boyce, & Hajek, 2014; Polosa, Rodu, Caponnetto,
Maglia, & Raciti, 2013; Singh et al., 2016) with around 40% of
adult smokers having started before they reached 15 or 16 years of
age (Warner, 2016). Although quitting smoking at any age is
beneficial, maximum health benefit accrues from never initiating
smoking. Addiction to nicotine can be established rapidly in ado-
lescence (DiFranza et al., 2007) with strong associations between
having a first cigarette (Sargent, Gabrielli, Budney, Soneji, &
Wills, 2017) or smoking as infrequently as 1 day in the past month
(Saddleson et al., 2016) and progression to regular smoking as an
adult. Additionally, early uptake of smoking is associated with
more cigarettes smoked (Chassin, Presson, Pitts, & Sherman,
2000; Taioli & Wynder, 1991) and lower quit rates (Ferguson,
Bauld, Chesterman, & Judge, 2005) in adulthood. These findings
point to the potential value of effective interventions to reduce
smoking initiation and avoiding that first cigarette in adolescents.
The present article reports a pragmatic trial of an intervention
designed to reduce smoking initiation in adolescents by targeting
the refusal of offers of a cigarette.

The current intervention was based on implementation inten-
tions. Implementation intentions are specific ifthen plans (Goll-
witzer, 1993). Gollwitzer (1993, 1999) defined an implementation
intention as a plan of how, where, and when to perform a behavior.
This type of plan establishes a link between a critical situation and
a planned behavior (If I encounter Situation X then I will do Y).
Through forming an implementation intention, it has been argued
that an individual passes control of goal directed activities from the
self to critical situations (e.g., Aarts, Dijksterhuis, & Midden,
1999). The critical situation when encountered then prompts the
intended behavior, through automatic activation of the plan (see
Webb & Sheeran, 2003). In this way implementation intentions
facilitate quick and reliable initiation of the intended behavior by
increasing readiness to respond to specified opportunities (when
X occurs; Gollwitzer, 1993).

Implementation intentions have been found to be effective
means to change a range of behaviors (Gollwitzer & Sheeran,
2006), including promoting smoking cessation (Armitage, 2016).
Empirical findings indicate that the effects of forming implemen-
tation intentions are often contingent on the presence of strong
motivation or goal intention to perform the behavior (e.g., Prest-

wich, Sheeran, Webb, & Gollwitzer, 2015; Sheeran, Webb, &
Gollwitzer, 2005). A number of studies (including the present one)
therefore use interventions that combine the formation of imple-
mentation intentions with the presence of motivational messages
about the target behavior (e.g., Prestwich, Lawton, & Conner,

Two previous studies tested implementation intentions in
conjunction with antismoking messages in relation to smoking
initiation in adolescents. In a pilot study, Higgins and Conner
(2003) tested the effects of engaging with antismoking mes-
sages plus forming a single implementation intention on self-
reported ever-smoking 2 months later. Implementation inten-
tions were formed in relation to refusing offers of a cigarette
(intervention; e.g., If offered a cigarette then I will say no
thanks, I do not smoke) or completing homework (control). Of
the 104 baseline never smokers, 0% initiated smoking in the
intervention group, while 6% initiated smoking in the control
group. In a later explanatory trial with 1,338 adolescents, Con-
ner and Higgins (2010) tested the effects of forming implemen-
tation intentions on how to refuse the offer of a cigarette after
engaging with antismoking messages on eight occasions (inter-
vention). The control conditions also included engaging with
antismoking messages on eight occasions plus an intervention
designed to promote self-efficacy not to smoke, or forming
implementation intentions about completing homework or pro-
moting self-efficacy to complete homework. Compared with the
combined control conditions, the intervention was shown to
reduce self-reported smoking and breath carbon monoxide lev-
els significantly at 4 years postbaseline.

The present research was designed as a pragmatic cluster
randomized controlled trial of the effectiveness of forming
repeated implementation intentions about how to refuse an offer
of a cigarette after engaging with antismoking messages com-
pared to usual practice on tobacco control. Previous studies
(Conner & Higgins, 2010; Higgins & Conner, 2003) showed the
efficacy of combining implementation intentions with anti-
smoking messages compared with antismoking messages alone.
Therefore, this pragmatic trial compared the combined inter-
vention with a control condition using the same intervention
techniques (i.e., implementation intentions combined with per-
suasive messages) but focusing on a distinct behavior (com-
pleting homework) rather than, for example, comparison with
antismoking messages alone. In the control condition used here


adolescents formed repeated implementation intentions about
how to complete homework after engaging with prohomework

This present intervention (i.e., forming repeated implementation
intentions on how to refuse the offer of a cigarette after engaging
with antismoking messages), if shown to be effective in a prag-
matic trial, could be deployed across schools to reach the majority
of adolescents in order to tackle smoking initiation in this age
group. In addition, this intervention is relatively low cost, requiring
only 3050 min per session for teachers to implement in classroom
time (including engaging with antismoking messages and complet-
ing an implementation intention questionnaire; Conner & Higgins,
2010; Higgins & Conner, 2003). This contrasts with other anti-
smoking interventions tested in this age group that tend either to
have only mixed evidence for their effectiveness (for reviews see
MacArthur, Harrison, Caldwell, Hickman, & Campbell, 2016;
Thomas, McLellan, & Perera, 2015; Wiehe, Garrison, Christakis,
Ebel, & Rivara, 2005), or have effectiveness evidence but are high
cost (Campbell et al., 2008; Peterson, Kealey, Mann, Marek, &
Sarason, 2000).


Study Design and Participants

Secondary schools in two areas of England (Leeds and Stafford-
shire Local Education Authorities) were eligible for inclusion in
the study. Head teachers provided written consent that their
schools would participate in the trial and continue usual smoking
education and policies on tobacco control for the trial duration.
Schools sought parental consent (i.e., passive consent) by writing
to parents of pupils in the relevant year group (Year 7 at baseline,
11- to 12-year-olds). Very few parents asked for their child to be
excluded from data collection sessions. All adolescents in the
relevant year group were eligible for participation. Adolescents
provided active assent by completing questionnaires. As passive
consent was used, ethical/governance procedures required that
adolescent data be collected anonymously and so matching of data
across time points was based on individually generated codes.

The University of Leeds (School of Psychology, Faculty of
Medicine and Health) ethical review committee approved the
study (reference 120155 on September 24, 2012). The study was
registered on October 26, 2012 (ISRCTN27596806) before any
intervention sessions. There were no changes to the methods after
trial commencement. Details of the trial protocol have been pub-
lished previously (Conner et al., 2013).

Randomization and Masking

School was the unit of randomization. Schools were randomized
by random number generator to intervention or control conditions
on a 1:1 ratio by the trial statistician (RW). Randomization took
place before recruitment of participants within each school. Due to
the nature of the intervention, adolescents, teachers administering
the intervention, heads of school, and data collection assistants
were aware of group allocation. The trial statistician who con-
ducted the analyses was initially blinded to condition.


Self-reported data were collected at baseline plus 12, 24, 36, and
48 months postbaseline by research staff (present to answer ques-
tions) via questionnaire in groups (classes or year group assem-
blies) with adolescents requested not to confer. At each time point
a smokerlyzer measure of breath carbon monoxide levels was
taken individually with readings not available to adolescents.

The eight intervention sessions took place separately to data col-
lection in classroom time (with each session containing approximately
26 adolescents) approximately every 6 months starting within
2 months of baseline data collection and were each led by a teacher.
The content of sessions was designed to be matched (in relation to
duration and frequency plus the use of written motivational materials
and an implementation intention formation task) across the two con-
ditions but focusing on smoking (intervention condition) or complet-
ing homework (control condition) as an unrelated behavior. Adoles-
cents engaged with motivational materials (read antismoking
messages or prohomework messages plus engaged in related tasks
designed to increase engagement with the messages) and then com-
pleted implementation intentions sheets in relation to the target be-
havior (not smoking in intervention condition; completing homework
in control condition). The target behavior in the control condition
(completing homework) was selected to be a nonhealth related be-
havior appropriate for adolescents. The interventions were designed to
run within a standard classroom session (50 min) with the majority
(60%) of the time devoted to the messages.

Implementation intention formation was consistent across inter-
vention sessions. Adolescents were first required to tick an option
to indicate how they could refuse smoking this school term (Tick
ONE of the following things you could say if you were offered a
cigarette or if you were tempted to smoke . . .; No thanks, smoking
makes you smell awful; No, I do not want yellow teeth; No, I do
not want to get addicted; No thanks, if youre buying cigarettes
youre buying cancer; No its really bad for my asthma). They
were then requested to write in the selected response or generate a
new response of their own to complete a statement (If someone
offers me a cigarette, then I will say . . .; e.g., No cancer sticks for
me). Adolescents were then required to indicate where they
would not smoke (Tick ALL the places where you will not
smoke: I will not smoke at school; I will not smoke at home; I will
not smoke at a party; I will not smoke with my friends; I will not
smoke if Im offered a cigarette) and to respond to a question
about smoking this school term (I think I can make sure I do not
smoke this term: yes, no). The task was similar in the control
condition but completed in relation to completing homework.
Participants completed the implementation intention task individ-
ually by ticking boxes and writing down responses. The imple-
mentation intention sheets were collected in by the teacher and
returned to the research team.

The motivational materials provided antismoking or prohome-
work messages and were paper based. The motivational materials
were different in each session (i.e., eight sets of materials), were all
judged to be age-appropriate by an experienced school teacher, and
were similar in content to that used in our previous work (Conner
& Higgins, 2010; Higgins & Conner, 2003). For example, the first
set of antismoking materials (Smoking: Its not worth it) focused
on 10 reasons not to smoke and included text and pictures along
with a quiz designed to promote engagement with the materials.


Full copies of the implementation intention sheets and motiva-
tional materials can be obtained from the first author.

Training sessions were run with teachers in each year of the
study. These were 45-min sessions run in each school that focused
on the broad purpose of the intervention and details of the inter-
vention content (motivational messages and implementation inten-
tion sheets plus a plan of how to run the session). An opportunity
to discuss the content and any potential problems with delivery
was provided. The need to stick to the planned content and ensure
all implementation intention sheets were fully completed was
emphasized. A teacher in each school acted as a coordinator and
monitored the delivery of all sessions and was available to answer
teachers questions.

Outcome Measures

Four measures of smoking were used as outcomes at the 48-month
follow-up. Self-reported cigarette use was assessed at each time point
using a standardized measure (Office for National Statistics, 1997);
adolescents ticked one of: (a) I have never smoked; (b) I have only
tried smoking once; (c) I used to smoke sometimes, but I never smoke
cigarettes now; (d) I sometimes smoke cigarettes now, but I do not
smoke as many as one a week; (e) I usually smoke between one and
six cigarettes a week; (f) I usually smoke more than six cigarettes a
week. This was used to create our first two measures of smoking: ever
smoking (ticking response a coded 0; ticking responses bf coded 1);
regular smoking (ticking responses ad coded 0; ticking responses
ef coded 1).

Any smoking (last 30 days) was assessed at 48-month postbase-
line only (self-reported number of days in last 30 days using each
of cigarettes, cigars, pipes, or sheesha/hookah was recorded and
summed). Any smoking (last 30 days; 0 days coded 0; 1 day
coded 1) was our third smoking measure.

Breath carbon monoxide (CO) levels (in parts per million;
COppm) were assessed using the Micro Smokerlyzer CO
Monitor (Bedfont Scientific Limited, Kent, United Kingdom) at
each time point. However, the short half-life (four-six hours) of
breath CO means that such measures are only reliable and valid for
assessing recent cigarette smoking (Bedfont, 2017; Jarvis,
Tunstall-Pedoe, Feyerabend, Vesey, & Saloojee, 1987; Stookey,
Katz, Olson, Drook, & Cohen, 1987). A variety of cut-offs have
been used in the literature to indicate smoking in adults. We used
the cut-off recommended by the device manufacturer as a clear
indication of recent smoking in adolescents (6 ppm CO coded as
0; 6 ppm CO coded as 1). Breath CO 6 ppm was our fourth
smoking outcome measure.

For the three smoking measures taken at each time point (ever
smoking, regular smoking, breath CO 6 ppm) we also created
measures of smoking across Time Points 2 to 5 (based on being
categorized as smoking on a measure on at least one of the time

Other Measures

Other measures were assessed as covariates and/or moderators
and measured at 48 months follow-up. At the school level we
recorded geographical area (Leeds; Staffordshire) and size (num-
ber of pupils), and area level socioeconomic status (percentage of
pupils in a school receiving free school meals; Croxford, 2000). At

the individual level we assessed gender, ethnicity (self-reported
classification dichotomized into non-White vs. White) and
individual-level socioeconomic status (four-item Family Affluence
Scale [FAS] scored 09 with higher scores indicating greater
affluence; Boyce, Torsheim, Currie, & Zambon, 2006).

Fidelity checks assessed adherence, quality of delivery, and
exposure to the intervention. The study coordinator in each school
was requested to monitor adherence and provide feedback on the
number of intervention sessions in their school not run as planned.
Teachers were requested to return to the study coordinator com-
pleted implementation intention sheets after each session. These
were subsequently collected from each school. For approximately
half of these sessions, teachers were also requested to complete
feedback sheets on session delivery. The feedback sheets included
a rating of how well the session went (The lesson went incredibly
well; strongly disagree, disagree, neither agree nor disagree,
agree, strongly agree). Quality of delivery was also assessed in
observation of sessions by researchers. Approximately 7% of
sessions were observed by researchers, including at least one
session in each school. Observation sheets included a rating of
overall quality of delivery (Overall session quality was . . .; low,
moderate, satisfactory, good, high). Exposure to the intervention
was assessed by self-reported questions from participants at the
final follow-up. Those in the intervention (antismoking) condition
were asked to indicate which sessions they attended by checking a
box next to each session (identified by number, short title, and
image of the antismoking information) to give a score between 0
and 8. All participants were requested to indicate if they had
moved school since the beginning of the study and to specify the
old school and year of change (coded into total numbers changing
school, numbers moving between schools in different conditions,
numbers moving from nonstudy schools or nonspecified schools).

Data relevant to costing the intervention fully were also col-
lected. A number of other measures were taken but are not reported
here (full details available from first author along with intervention
materials, analysis scripts, and raw data).

Statistical Analyses

Based on a power of 90% to detect a 5% difference in smoking
rates, an intraclass correlation (ICC) of .01, and alpha of .05, prior
sample size calculations indicated the need for at least 3,672
adolescents from 36 schools in the analyses (Conner et al., 2013).
We first summarized the measures taken for the full sample and
the intervention and control conditions. The main analyses tested
for differences between the intervention and control conditions at
48-month postbaseline in each of the four smoking measures
among those who were self-reported never smokers at baseline.
Those who self-reported ever smoking at baseline (N 301) were
removed from all analyses. The largest amount of missing data was
for baseline ever smoking, principally due to a failure to match
individually generated codes. Missing self-reported ever smoking
at baseline was imputed to be zero (i.e., never smoking). Missing
data from other variables ranged from 0.2% for gender to 5.8% for
any smoking (in last 30 days; see Table 1 for details of numbers of
missing data points for each variable) and only 88% of the 6,115
never smokers in the sample would have been available for anal-
ysis under the traditional listwise deletion method across these
variables. Data were primarily missing due to item nonresponse.


We addressed the problem of missing data through multiple im-
putation using chained equations (MICE; van Buuren &
Groothuis-Oudshoorn, 2011) after confirming that the missing
values were missing at random. The mice command in R was used
to generate 20 imputed data sets that were analyzed using the
pooled command. Imputed values compared reasonably with ob-
served values and the results using listwise deletion were similar to
multiple imputation, so imputed results are presented.

Based on the distribution and frequency of outcomes, log bino-
mial regressions, implemented in R were used to predict each
smoking outcome (ever smoking; any smoking in the last 30 days,
regular smoking, breath CO 6 ppm) controlling for the clustering
among schools (multilevel modeling). Condition and percentage
free school meals were Level 2 variables in these models, while
gender, ethnicity, and the FAS scores were Level 1 variables.
We report the risk ratio (RR), the 95% confidence interval around
the risk ratio (95% CI), and the p value for each predictor variable
in these regressions. The RR is the ratio of likelihood of the
outcome (in this case smoking) across the compared conditions

(intervention vs. control). For each step we also report the ICC. At
Step 1 condition was entered, while at Step 2 we examined the
effects of controlling for demographic variables (school SES; boys
vs. girls; non-White vs. White ethnicity; individual level of socio-
economic status based on FAS). At Step 3 we tested whether each
of these demographic variables significantly moderated the effects
of the intervention. For outcome measures taken at each of the
postbaseline time points (ever smoking, regular smoking, and
breath CO 6 ppm), sensitivity analyses assessed intervention
effects on smoking on at least one time point (i.e., for each
smoking measure an outcome was created: 0 not smoking at any
time point; 1 smoking at one or more time points). Fidelity
analyses also examined whether attending no smoking intervention
sessions versus a few or most smoking intervention sessions in-
fluenced the key findings. Fidelity analyses also examined whether
the key findings were influenced by excluding participants who
self-reported changing school.

The economic evaluation was based on the incremental cost
of the intervention per averted smoker at age 1516 years. The

Table 1
Descriptive Data for Sample (Comparison of Control and Intervention Conditions)

Measures Total Control Intervention p1

School size2 940 (305.9) 878.0 (348.0) 990.2 (264.3) .225

Leeds 20/45 (44.4%) 8/20 (40.0%) 12/25 (48.0%)
Staffordshire 25/45 (55.6%) 12/20 (60.0%) 13/25 (52.0%) .764

Free school meals2 16.55 (9.30) 14.97 (6.81) 17.81 (10.87) .313
Baseline self-reported ever smoking

Nonsmoker 4,101/4,402 (93.2%) 1,858/1,967 (94.5%) 2,243/2,435 (92.1%)
Ever smoker 301/4,402 (6.8%) 109/1,967 (5.5%) 192/2,435 (7.9%) .002

48-month follow-up (baseline never smokers)
Total N 6,155 (100%) 2,719 (100%) 3,436 (100%)

Boys 3,039/6,131 (49.6%) 1,354/2,706 (50.0%) 1,685/3,425 (49.2%)
Girls 3,092/6,131 (50.4%) 1,352/2,706 (50.0%) 1,740/3,425 (50.8%) .520
Missing 24 13 11

Non-White 1,038/5,837 (17.8%) 438/2,579 (17.0%) 600/3,258 (18.4%)
White 4,799/5,837 (82.2%) 2,141/2,681 (83.0%) 2,658/3,258 (81.6%) .158
Missing 318 140 178

Family affluence scale2 6.24 (1.59) 6.28 (1.57) 6.21 (1.61) .120
Missing 257 113 144

Ever smoking
Nonsmoker 4,051/5,974 (67.8%) 1,700/2,648 (64.2%) 2,351/3,326 (70.7%)
Ever smoker 1,923/5,974 (32.2%) 948/2,648 (35.8%) 975/3,326 (29.3%) .001
Missing 181 71 110

Any smoking (last 30 days)
Nonsmoker (0 days) 4,843/5,799 (83.5%) 2,075/2,567 (80.8%) 2,768/3,232 (85.6%)
Recent smoker (1 days) 956/5,799 (16.5%) 492/2,567 (19.2%) 464/3,232 (14.4%) .001
Missing 356 152 204

Regular smoking
Nonsmoker 5576/5,974 (93.3%) 2,458/2,648 (92.8%) 3,118/3,326 (93.7%)
Regular smoker 398/5,974 (6.7%) 190/2,648 (7.2%) 208/3,326 (6.3%) .159
Missing 181 71 110

Breath CO
6 ppm 5,867/5,951 (98.6%) 2,551/2,599 (98.2%) 3,316/3,352 (98.9%)
6 ppm 84/5,951 (1.4%) 48/2,599 (1.8%) 36/3,352 (1.1%) .014
Missing 204 120 84

1 Difference between intervention and control conditions p-value based on Fishers exact test (two-sided). 2 Mean and SD; p-value based on F-test on
normalized scores.


costs of implementing the intervention were gathered by re-
searchers during the study and expressed in United Kingdom
sterling in 2017 prices (converted to U.S. dollars) based on
wages and transport costs as at August 2017 provided by the
Office for National Statistics. Costs included intervention de-
velopment (printing material), delivery (travel and time in-
curred in providing training and support), and receipt (teacher
time in undertaking training). Costs over the 4-year period were
discounted at 3.5% per annum consistent with NICE guidelines
(National Institute for Health & Care Excellence, 2018). An
incremental cost-effectiveness ratio (ICER) was calculated
based on the incremental cost per adolescent of implementing
the intervention divided by the difference in the proportion not
smoking across conditions.


Sample Description

The study took place between September 2012 and January
2017. A total of 73 secondary schools were eligible for inclu-
sion in the study. Of these, 48 schools agreed to participate and
were randomized to intervention (n 25) or control (n 23)
conditions. Three schools subsequently withdrew from the
study before data collection began because of changes in deci-
sions by school management and also declined when requested
to participate at the final time point. The remaining schools (25
intervention, 20 control) were retained for the duration of the
4-year trial.

Table 1 provides details of the sample overall and by condi-
tion for school and individual level data (and numbers of
missing data points). At the school level, the intervention and
control conditions were not significantly different in terms of
school size or geographical area (neither had effects on the
results and are not considered further here), nor in terms of
percentage of pupils eligible for free school meals. Compared
with the value for the United Kingdom as a whole (M 13.8;
Department for Education, 2017), our 45 schools had a slightly
higher percentage of pupils eligible for free school meals (tone

sample(44) 1.98, p .054). This was also true for free school
meals data in our schools from each of the two geographical
areas compared with appropriate regional data (Leeds, M
20.63, SD 11.13 vs. M 16.5 for area, tone sample(19) 1.66,
p .114; Staffordshire, M 13.28, SD 5.97 vs. M 9.30
for area, tone sample(24) 3.34, p .003). This indicates that
the included schools were slightly more deprived than compa-
rable schools.

At the individual lev


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