| Summary: | Introduction
We used the Theory of Planned Behavior
(TPB) to guide the development and evaluation of a
comprehensive tobacco prevention program (Dentists
Fighting Nicotine Dependence [DFND]) to prevent tobacco
use among seventh grade female students in Jeddah, Saudi
Arabia.
Methods
We used a quasi-experimental controlled design.
Two middle schools served as intervention (n=203) and two
as control (n=168). Intervention schools received the new
tobacco prevention program (DFND), whereas the control
schools received only a tobacco informational booklet. The
program was administered by trained instructors over
five weeks, two sessions/week. Pre- and post-test surveys
were collected. Study outcomes were current tobacco use,
tobacco knowledge, attitude towards not using tobacco,
and perceived behavioral control of tobacco use. Covariates
included sex, parent education, academic performance,
absenteeism, student allowance, and religiosity. Data were
analyzed using two-level hierarchical mixed models.
Results
At one week post-intervention, 349 surveys were
analyzed: intervention = 195; control = 154. Intervention
group participants had higher mean scores for knowledge
and attitude toward not using tobacco compared to controls.
Tobacco use prevalence decreased from 8.9% to 5.6% among
intervention participants but remained the same for controls
(3.0%).
At two years post-intervention, 278 surveys were analyzed:
intervention = 163; control = 115. Tobacco use prevalence
increased threefold compared to baseline among control
participants (from 3% to 10%), whereas it only doubled
among intervention participants (9% to 20%). This
difference was not significant after adjustment for covariates.
Conclusions
Our study contributes to the existing knowledge
about tobacco use and documents a steady increase in
tobacco use among adolescent females in Saudi Arabia.
Findings suggest that designing developmental school-based
tobacco programs for adolescent females is feasible and
when carefully implemented can be effective in increasing
knowledge about the adverse health effects of tobacco use,
promoting attitudes towards not using tobacco, and reducing
intentions and initiation of tobacco use.
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