Six-months follow-up of a cluster randomized trial of school-based smoking prevention education programs in Aceh, Indonesia

Abstract

BackgroundSmoking prevention programs have been taught in schools to reduce the high smoking prevalence and its related problems among adolescent populations. Although short-term benefits have been observed, the long-term effectiveness of such programs appear to be inconsistent. This study aims at investigating the long-term impact of both health and Islamic focused interventions amongst students in Indonesia.MethodsAt 6 months after completion of the interventions, 427 of the original 447 participants (control group = 128, intervention groups = 299) from a school-based cluster randomized control trial were re-assessed for their smoking knowledge, attitudes, intentions and behaviours using a self-report questionnaire. Data was analyzed according to the study’s 2 × 2 factorial design with adjustment for baseline scores, school and classroom clustering effects and multiple comparisons.ResultsCompared to the control group, significant long term effects were found for the health-based intervention program in improved health (β = 4.3 ± 0.4, p < 0.001), Islamic (β = 1.1 ± 0.4, p = 0.01) knowledge and a reduction of smoking attitudes (β = −11.5 ± 1.8, p < 0.001). For the Islamic-based intervention programs there was an improvement of health (β = 3.7 ± 0.4, p < 0.001) and Islamic (β = 2.2 ± 0.5, p < 0.001) knowledge and a reduction towards smoking attitude (β = −6.0 ± 1.9, p < 0.01) and smoking behaviors in the past month (OR = 0.1, 95 % CI = 0.0–0.8, p = 0.03). The effects were greater but less than additive in the combined group for health (β = −3.2 ± 0.9, p < 0.001 for interaction) and Islamic knowledge (β = −2.3 ± 0.9, p = 0.01 for interaction) but were additive for smoking attitudes (β = 6.1 ± 3.2, p = 0.07 for interaction). No significant effects on smoking intentions were observed at 6 months follow-up in the health or Islamic-based intervention programs.ConclusionSchool-based programs can provide long term benefits on Indonesian adolescents’ smoking knowledge and attitudes. Tailoring program intervention components with participants’ religious background might maximise program effectiveness. A larger and more encompassing study is now required to confirm the effectiveness of this new Indonesia culturally-based program. Adolescents in similar areas might also benefit from this type of school-based smoking cessation program.Trial registrationAustralian New Zealand Clinical Trial Registry, ACTRN12612001070820

Socio-economic, demographic and geographic correlates of cigarette smoking among Indonesian adolescents: results from the 2013 Indonesian Basic Health Research (RISKESDAS) survey

“…Apart from recent data on the overall prevalence of adolescent cigarette smoking in Indonesia [12], there is literature reporting prevalence rates in selected districts or provinces, but these findings are based on older data and they do not compare the situation between provinces [25,26,30]. This study found that smoking prevalence was higher among adolescents on Java Island, a pattern reported in a study of smoking among individuals aged 15 years and above from the same survey (the highest smoking prevalence was in West Java Province [32.7%] and the lowest was in Papua [21.9%]) [29], suggesting that adolescent and adult smoking patterns match.…”

Evaluation of the effectiveness of a WHO-5A model based comprehensive tobacco control program among migrant workers in Guangdong, China: a pilot study

“…However, most of these studies occurred in schools or primary care settings rather than in the workplace [34][35][36]. Similarly, some school-based intervention studies also found significant effects on changing both smoking-related knowledge and attitudes [34,35]. Other school-based intervention studies reported [36] that despite smoking knowledge increasing substantially over the follow-up, the attitudes did not change, mainly because attitudes were more stable than knowledge and more resistant to change.…”

“…Smoking knowledge and attitudes scores were often used as parameters of intervention effectiveness. However, most of these studies occurred in schools or primary care settings rather than in the workplace [34][35][36]. Similarly, some school-based intervention studies also found significant effects on changing both smoking-related knowledge and attitudes [34,35].…”

Factors associated with Intermittent and Light Smoking among Korean High School Students: Intermittent and Light Smoking among Korean Adolescents

“…Such programs increase smoking knowledge and critical attitude, and reduce smoking intention; more specifically, school-based smoking prevention programs have been found to be effective for increasing health knowledge and promoting a critical attitude in relation to smoking, and decreasing smoking intention and behaviors in both the short and long term [30]. In addition, adolescents spend most of their week days at school and tend to learn health promotion behaviors from school health providers.…”