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A Randomized Controlled Trial of a Theory-Informed School-Based Intervention to Prevent Waterpipe Tobacco Smoking: Changes in Knowledge, Attitude, and Behaviors in 6th and 7th Graders in Lebanon

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Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
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Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
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Independent consultant, Dusseldorf 40210, Germany
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Soins Infirmiers et Développement Communautaire (SIDC), Sin El Fil 1100, Lebanon
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Academic Coordinator, Sorbonne University Abu Dhabi, 38044 Abu Dhabi, United Arab Emirates
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Independent consultant, Aley 1501, Lebanon
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Department of Medicine, Hamad Medical Corporation, Doha 4147, Qatar
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Department of Global and Public Health, Weill-Cornell Medicine, Doha 24144, Qatar
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Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(9), 1839; https://doi.org/10.3390/ijerph15091839
Received: 12 June 2018 / Revised: 16 August 2018 / Accepted: 17 August 2018 / Published: 26 August 2018
Waterpipe tobacco smoking (WTS) is spreading worldwide. Research has indicated health consequences of WTS similar to cigarettes. Prevalence of WTS is high among young people. In Lebanon, current use rates of 35% have been documented among 13–15 year olds. We evaluated a school-based intervention. Method: We conducted a randomized-controlled-trial of a theory-informed WTS intervention. The intervention consisted of ten sessions based on social cognitive theory and the social influences approach. Thirty-one schools participated: 14 intervention and 17 control; a total of 1279 students completed pre and post assessments. We measured knowledge, attitudes and self-reported behaviors related to WTS using Chi-square tests and regression analyses to compare results between the two study arms. Results: The intervention increased knowledge of intervention group compared to control group participants—about WTS constituents and health consequences; and shifted attitudes of intervention group participants to be even more unfavorable towards WTS. We found no impact of the intervention on WTS behaviors. Discussion: The effectiveness of the intervention on knowledge and attitudes supports previous research. The lack of intervention effect on behavior is not surprising given the timing of the post assessment immediately after the intervention, and the social context that was supportive of waterpipe use. View Full-Text
Keywords: waterpipe; intervention; Lebanon; school; evaluation; RCT waterpipe; intervention; Lebanon; school; evaluation; RCT
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Nakkash, R.; Lotfi, T.; Bteddini, D.; Haddad, P.; Najm, H.; Jbara, L.; Alaouie, H.; Al Aridi, L.; Al Mulla, A.; Mahfoud, Z.; Afifi, R.A. A Randomized Controlled Trial of a Theory-Informed School-Based Intervention to Prevent Waterpipe Tobacco Smoking: Changes in Knowledge, Attitude, and Behaviors in 6th and 7th Graders in Lebanon. Int. J. Environ. Res. Public Health 2018, 15, 1839.

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