Model of No-Tobacco-Use-in School (NTUIS) on tobacco use knowledge, attitude and behaviour among adolescents in Bhutan: A quasi-experimental study

Abstract

Introduction: Tobacco use among the 13–15 year olds is a major concern in Bhutan. The prevalence of tobacco use is higher in adolescents than in adults. It had been reported that 28.6% of boys and 11.1% of girls are current smokers. There has not been a single study conducted to this point on the tobacco use prevention in schools. This study attempted to explore a school-based peer-led health education model called ‘No-Tobacco-Use in Schools’ (NTUIS) to evaluate changes in the student’s tobacco use knowledge, attitudes towards tobacco use, intentions to use tobacco in the future and maintenance of non-user status. Method: A total of 378 eighth grade-students from four secondary schools in Wangdue Phodrang district, Bhutan took part in a quasi-experimental study in 2016. The schools and study subjects were selected using a multi-stage sampling. The intervention schools had 186 participants and the control had 192. The model was implemented in three phases by the peer educators in the intervention schools for five weeks. The data on the study variables were collected at the baseline, posttest, 3-month follow-up and 6-month follow assessments using a self-administered questionnaire. The overall effect of the model was evaluated using a repeated-measures analysis of variance. Results: Of the 378 students enrolled, 363 completed the study. Their mean age was 14.9 years. Implementation of the NTUIS model had improved the knowledge scores of students, and there was a significant difference between the intervention and control groups (F=645.64, p<0.001, d=0.64). Although the attitudes of the participants were significantly different between the groups (χ2 =6.890, p=0.009), their attitudes turned negative. The intention of participants in the intervention group to remain tobacco free was significant both for five years (F=284.603, p <0.001, d=0.446) and for lifetime (F=331.590, p <0.001, d= 0.484). However, the model had no significant effect either on the student’s use of cigarettes/bidi (χ2 =0.771, p = 0.380) nor on the use of smokeless tobacco products (χ2 =0.834, p=0.361). Conclusion: The NTUIS model had a positive effect on the student’s knowledge and their intentions to remain tobacco free in the future. But the model did not determine the student’s use of tobacco products. Nevertheless, the study findings will provide basis for strengthening the existing tobacco education programs for youth in schools.