Stakeholders’ views about implementing Very Brief Advice to address tobacco use among Romanian adolescents: Insights from the stakeholder workshops within FRESHAIR4Life

Introduction: Adolescents' tobacco use remains a pressing public health issue, particularly in Romania, where prevalence rates have increased despite national prevention efforts. This study, part of the FRESHAIR4Life Project, investigates students’ and stakeholders’ perspectives on implementing Very Brief Advice (VBA) to reduce smoking among adolescents in Brașov County, Romania. While VBA has been successfully implemented for smoking cessation among adults, its application to adolescents remains underexplored. Method: Using mixed methods, data were gathered during a two-day stakeholder meeting involving 50 participants, including educators, healthcare professionals, adolescents and policy makers. Results: Quantitative data from questionnaires revealed that VBA was perceived as a low-cost intervention (m= 2.17) on 5-point Likert scales. Adolescents rated the reach of VBA higher (47%) compared to educators and healthcare professionals (37.67%). Both adolescents and providers underscored the importance of delivery by trusted figures such as family, close friends, or teachers who genuinely connect with adolescents. They also mentioned the need for tailored, school-based support systems for smoking cessation, such as behavioral therapy provided by psychologists or a mobile app offering cessation support for those hesitant to seek in-person counseling. Barriers to accessing such resources as seen by adolescents include shame and lack of trust in confidentiality. To overcome these barriers, students suggested creating a safe and accepting environment, where relapses are viewed as part of the quitting journey rather than a failure. Providers identified as barriers insufficient resources, time, and competing priorities (ex. drug use). Moreover, teachers highlighted the critical importance of collaborating with parents. Discussion: The findings illustrate the potential of VBA as a cost-effective smoking prevention strategy if tailored to the unique needs of adolescents. Addressing identified barriers and leveraging facilitators, including trusted relationships and digital tools, may enhance the effectiveness and reach of VBA in adolescent populations.