A Mediation Analysis of a Tobacco Prevention Program for Adolescents in India: How Did Project MYTRI Work?

This article presents the results of a mediation analysis of Project MYTRI (Mobilizing Youth for Tobacco Related Initiatives in India), a randomized, controlled trial of a multiple-component, school-based tobacco prevention program for sixth- to ninth-graders ( n = 14,085) in Delhi and Chennai, India. A mediation analysis identifies how an intervention achieves its effects. In MYTRI, changes in students’ (a) knowledge about the negative health effects of tobacco, (b) beliefs about its social consequences, (c) reasons to use tobacco, (d) reasons not to use tobacco, (e) advocacy skills self-efficacy, and (f) normative beliefs about tobacco use were significantly associated with reductions in students’ intentions to use tobacco and tobacco use behaviors. In contrast, changes in students’ perceptions of the prevalence of smoking and chewing tobacco were significantly related to increases in students’ intentions to use and use of tobacco. Implications for intervention design are considered.

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Protocol for the evaluation of cost-effectiveness and health equity impact of a school-based tobacco prevention programme in a cluster randomised controlled trial (the TOPAS study)

BMJ Open ◽

10.1136/bmjopen-2020-045476 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045476

Author(s):

Anni-Maria Pulkki-Brännström ◽

Maria R Galanti ◽

Maria Nilsson

Keyword(s):

Cost Effectiveness ◽

Health Equity ◽

Tobacco Use ◽

Controlled Trial ◽

Health Agency ◽

Sensitivity Analyses ◽

Tobacco Prevention ◽

Net Benefit ◽

School Based ◽

Registration Number

IntroductionDespite a long-term downward trend in smoking prevalence, tobacco remains the number one risk factor for death and disability in Sweden. Globally, tobacco use generates a substantial economic burden for health systems and is also a major driver of socioeconomic inequalities in health. This article describes the planned cost-effectiveness and health equity impact evaluation of a multicomponent school-based programme to prevent the onset of tobacco use in adolescents.Methods and analysisCost-effectiveness of the multicomponent Tobacco-Free Duo programme will be evaluated against the educational component of the same programme only. An incremental cost-effectiveness ratio (ICER) will be calculated in terms of the cost per case prevented using the trial primary outcome and within-trial payer costs. If the ICER is negative, an incremental net benefit ratio will be calculated. Robustness of the results will be assessed through one-way sensitivity analyses. The slope index of inequality will be computed to assess the potential impact of the Tobacco-free Duo programme on education-related inequalities in the onset of smoking and in adult smoking cessation, comparing the two trial arms.Ethics and disseminationEthical approval was obtained from the Regional Ethics Review Board, Umeå (registration number 2017/255-31). The Public Health Agency of Sweden commissioned the study. The findings will be disseminated internationally within academia and to national and local policy-makers.Trial registration numberISRCTN52858080; Pre-results.

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Effectiveness of a School-Based Tobacco Prevention Program for Middle School Students in Saudi Arabia: A Quasi-Experimental Controlled Trial

Tobacco Use Insights ◽

10.1177/1179173x20953403 ◽

2020 ◽

Vol 13 ◽

pp. 1179173X2095340

Author(s):

Dania E Al Agili ◽

Hamisu M Salihu

Keyword(s):

Saudi Arabia ◽

Tobacco Use ◽

Prevention Program ◽

Intervention Group ◽

Tobacco Prevention ◽

Post Intervention ◽

School Based ◽

Post Test ◽

Quasi Experimental ◽

And Control

Objective: To evaluate the effect of a school-based tobacco program in preventing initiation of tobacco use among adolescents in Saudi Arabia. Methods: We used a quasi-experimental controlled design. Four intervention and four control schools were selected from the regional education registry. A baseline questionnaire was administered to all grade 7 students before implementing the tobacco prevention program, Dentists Fighting Nicotine Dependence (DFND). The intervention group (n =379) received the DFND program whereas the control group (n = 255) received the regular tobacco program administered by the Department of Education. The program was delivered by trained health educators over 5 weeks. Pre- and post-test surveys (immediate and 2-year post-intervention) were collected. Study outcomes were current tobacco use, tobacco knowledge, attitude towards not using tobacco, and perceived behavioral control (PBC) of tobacco use. Covariates included sex, parent education, academic performance, absenteeism, student allowance, and religiosity. Data were analyzed using a two-level hierarchical mixed models. Results: In the immediate post-test, 597 participants (intervention, n = 366; control, n = 231) were surveyed. There was no difference in tobacco use between intervention and control schools, however, the intervention group had significantly higher mean scores for knowledge (β = 1.27, SE = 0.27, P < .01) and attitude toward not using tobacco (β = 5.17, SE = 2.48, P < .05) after adjusting for covariates. At 2-year post-intervention, 463 participants (intervention, n = 289; control, n = 173) were surveyed. There were no differences in tobacco use, knowledge, attitude or PBC between intervention and control groups. Conclusions: Our program did not impact tobacco use. In the short-term, the program significantly improved knowledge and attitude towards not using tobacco. These effects decayed 2 years post-intervention without additional programming. Increasing the effectiveness of DFND may be achieved by expanding curriculum content and practice time throughout the school years and by targeting high-risk adolescents within the program.

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