Class smoke-free pledge impacts on nicotine dependence in male adolescents: A cluster randomized controlled trial

Abstract

Background: To test the effectiveness of a school-based, peer-led smoking and asthma education program, known as the Triple A (Adolescent Asthma Action) in Jordan (TAJ), with an additional class smoke-free pledge strategy (TAJ-Plus) as compared to the TAJ alone on smoking-related knowledge and perception, nicotine dependence, and asthma control in male high school students in Jordan four months post-intervention. Methods: In this cluster-randomized controlled trial, four public male high schools in Irbid, Jordan were randomly assigned to receive the TAJ-Plus (n = 215) or the TAJ (n = 218). TAJ educators were 3rd year male undergraduate nursing students (n = 9) who received training in a one-day workshop. These educators then trained senior students from the four schools to be Peer Leaders (n = 53), who then taught peers in grades 7 and 8 (n = 433). The Peer Leaders in the TAJ-Plus schools implemented the smoke-free pledge within the 7th and 8th graders, who voluntarily signed the pledge for four months. Data were collected from students in grades 7 and 8 using self-administered questionnaires at baseline and four months post-intervention. Results: Students from the TAJ-Plus group reported significant improvements in smoking-related knowledge and perception (p < 0.001) and lower nicotine dependence (p < 0.001) as compared to the TAJ group. Improvement in asthma control was greater (p = 0.03) in non-smokers versus smokers. Conclusions: Voluntary group commitment smoke-free through a pledge is feasible, and an incentive to motivate adolescents to abstain from smoking. Using social influences approaches in schools is useful in countering current aggressive tobacco marketing campaigns in Arab youth. TRN: NCT01938976