Abstract
There have been recent surges in the use of smokeless tobacco (SLT) and betel quid (BQ) chew among adolescents in South East Asian countries, with an increase, on average, of 7% to 15% between 2004 and 2013, necessitating interventional investigations to modify this behavior. The current intervention was aimed towards changing adolescents’ perceptions regarding the harmful effects of SLT and BQ use and encouraging them to quit. This randomized control trial involved 2140 adolescents from 26 private and public-sector schools in Karachi, Pakistan. After randomization, 1185 individuals were placed in the intervention group and administered a behavior changing intervention (BCI), while 955 individuals constituted the control group. A generalized estimating equation was employed to measure differences in repeated measures for both groups. The beta coefficients were reported after adjusting the covariates with the 95% confidence interval, and the p-value was considered significant at <0.050. Cohen’s d was employed to report the effect size of the intervention. The BCI resulted in a 0.176-unit (95% CI 0.078–0.274, p-value <0.001) increase in knowledge scores regarding the health hazards of SLT and BQ, a 0.141-unit (95% CI 0.090–0.192, p-value <0.001) increase in use perception scores, and a 0.067-unit (95% CI 0.006–0.129, p-value 0.031) increase in quit perception scores in the intervention group compared with those in the control group. A knowledge related module (p-value 0.024) and quit preparation module (p-value 0.005) were found to be helpful by adolescents in either changing their perceptions regarding SLT and/or BQ chew use or in quitting. The role of BCI is promising in improving adolescents’ knowledge and changing their perceptions in a positive manner regarding their harmful SLT and BQ use. Convincing results may be achieved if interventions are tailored, with an emphasis on the identification of the products that are used by adolescents in addition to highlighting their ill effects and how students may manage to quit them. If included in the schools’ curricula, this BCI method may help in developing schools that are free of SLT and BQ use.Trial registration: ClinicalTrials.gov NCT03488095.
Highlights
Smokeless tobacco (SLT) is an extensively used term that includes various types of tobacco products that are either consumed orally or are taken via the nose [1]
The current study shows that the behavior changing intervention (BCI) significantly changed the knowledge and perceptions regarding SLT and Betel quid (BQ) use and cessation in a promisingly positive direction
The results of the current study suggested that a culturally rooted, school-based behavior changing intervention was an effective way to enhance the knowledge and awareness of school-going adolescents regarding the health hazards that are pertinent to SLT and BQ use
Summary
Smokeless tobacco (SLT) is an extensively used term that includes various types of tobacco products that are either consumed orally or are taken via the nose [1]. In approximately 115 countries, more than 300 million adults consume SLT in various forms [2]; among these, the majority of the consumers (89%) are concentrated in South Asian countries [3, 4]. Betel quid (BQ) is a type of SLT that contains areca nut, which may or may not have tobacco[4, 10]. SLT, betel quid and areca nut alone or in combination are known to increase the incidence of oral squamous cell carcinoma irrespective of their tobacco content [4, 10,11,12], and they can cause oral potentially malignant lesions [4, 13] and coronary heart diseases [4, 14]
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