Digital interventions in tobacco prevention for school-aged children: results of systematic review

Objectives: Smoking continues to be a major preventable contributor to global morbidity and mortality. Conventional prevention strategies have not fully succeeded in reducing smoking rates among youth. Digital interventions (DI) present an innovative approach to engage and educate this demographic. Study design: This systematic review evaluates the effectiveness of digital interventions in preventing smoking among school-aged children (6-12 years). Methods: PubMed/MEDLINE, Scopus, and PsycINFO were searched on April 4, 2024, and updated on April 10, 2025. PRISMA 2020 guidelines were followed to conduct the review. Protocol was registered in PROSPERO (CRD 42024534528). Results: From 3330 identified records, 19 studies were reviewed. These studies utilized DIs, such as mobile applications, web-based programs, and multimedia campaigns, targeting knowledge enhancement, attitude shifts, and behavioral changes related to tobacco use. The findings reveal that DIs significantly improve knowledge about smoking risks and positively influence attitudes, particularly through interactive and gamified approaches. However, the effectiveness varied depending on factors such as intervention design, participant demographics, and follow-up duration. Behavioral outcomes, such as reduced smoking intentions and prevalence, showed mixed results, with sustained engagement being a critical factor for long-term success. Family-based and culturally tailored interventions demonstrated additional potential for reinforcing preventive behaviors. Conclusions: Despite methodological diversity and moderate bias risks in some studies, the evidence supports DI as a scalable and accessible strategy for tobacco prevention among youth, particularly in underserved populations.