Abstract
Background: Tobacco use by adolescents is one of the most devastating social challenges throughout the world, threatening the health of future generations and communities in all social, cultural, health, and environmental aspects. This study aims to evaluate the effectiveness of the prevention against Tobacco dependence (PAD) interventions among students in Varamin City in 2020.
 Methods: This study utilized the findings from the initial phase of the Prevention against Tobacco Dependence (PAD) project, which was conducted using a cohort method in Varamin city (Tehran province). The study encompassed four phases and involved both male and female students. For the second phase, a sample of 780 ninth-grade students was chosen using stratified sampling, with 350 students (45%) serving as PAD-helpers. Data was collected using a modified version of a questionnaire developed by the World Health Organization (WHO).
 Results: In the students’ families, most fathers still used cigarettes (25.5%) and hookah (11.4%). In total, the prevalence of hookah, cigarette, and new tobacco product use among students was 35%, 15.9%, and 22.2%, respectively. The most important reason for smoking was curiosity (56.7%), and more than 71% of students believed that PAD project increased their knowledge about dangers of smoking. Based on t-test scores, there was a significant difference between PAD-helpers and non-PAD-helpers in terms of anti-smoking knowledge, attitude, and practice. Two variables of the level of knowledge and attitude towards smoking had a significant direct relationship with the variable of anti-smoking practice (p < 0.05).
 Conclusion: This project contained effective interventions to raise the students’ knowledge and change their attitudes towards smoking, and these changes have been more evident among PAD-helpers and their anti-smoking practice.
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