Impact of School-Based Anti-Smoking Interventions On Tobacco-Related Health Knowledge and Smoking Status of Adolescents: A Prospective Cohort Study

Introduction: In Hungary, mandatory school-based anti-tobacco programs usually not evidence-based and mediate predominantly information about the health consequences of smoking. The prevalence of smoking among adolescents still does not change in a favorable rate. Our research aimed to assess the impact of school-based interventions on changes in the knowledge of adverse health consequences of smoking and to explore association between the level of relevant knowledge and smoking status of adolescents.

Methods: Baseline and two follow-up self-administered surveys were conducted yearly (2010-2012) among students in six Hungarian metropolitan cities. At baseline, randomly selected 6th and 9th graders completed the survey (n=1,096; 54% girls). Measures included a 14 items scale for the knowledge of adverse health consequences of smoking, socio-demographic variables, self-reported smoking status, parental and peer smoking, ever (at baseline) and past-year (at follow-ups) participation in school-based anti-tobacco interventions.

Results: The prevalence of smoking increased gradually (Baseline: 16%, Follow-up 1: 22%, Follow-up 2: 26%; χ²₍₁₎=90.16, p<0.001). At baseline and follow-up 1, students who were older, had better academic achievement, non-smoking parents and had ever or past-year participated in school-based anti-tobacco program were significantly more aware of the harmful consequences of smoking, while at follow-up 2, beside older age and better academic achievement, girls were significantly more aware of the tobacco-related health consequences. Past year participation in school-based anti-tobacco program significantly decreased from follow-up 1 to follow-up 2 (45% vs. 41%, χ²₍₁₎=8.88; p=0.003). The knowledge of adverse health consequences of smoking increased significantly during the prospective survey (F₍₂₎=18.51; p<0.001), especially among the younger participants. Neither the knowledge nor its increase predicted current smoking at baseline and follow-ups after adjusting for potential confounding variables. There was no significant difference in the tobacco-related health knowledge among respondents who became smoker or quit smoking during the prospective survey compared to non-smokers and current smokers respectively.  

Conclusions: According to our results, participation rate in school-based anti-tobacco programs was low in Hungary. As the knowledge of harmful health consequences of smoking and its increase did not predict smoking status, prevention programs used so far should be enhanced with skill development and discussions about factors underlying smoking and about alternative healthy behaviours for replacing smoking.