Effectiveness of a School Based Smokeless Tobacco Intervention: A Cluster Randomized Trial

  • Shafquat RoziEmail author
  • Nida Zahid
  • Talat Roome
  • Maryam Pyar Ali Lakhdir
  • Sobiya Sawani
  • Anam Razzak
  • Zahid Ahmad Butt
Original Paper


To assess the effectiveness of intervention in improving knowledge, attitude and perception regarding smokeless tobacco (SLT) use and its harmful effects and intention to quit SLT among school going adolescents. A school-based cluster randomized control trial was carried out in 18 secondary schools targeting male and female students from grades 6 to 10 in Karachi. Primary outcome was knowledge about hazards of smokeless tobacco (SLT) and secondary outcomes were attitude and Perception about hazards of SLT, and intention to quit SLT. We enrolled 738 participants in intervention group and 589 in the control group. Mean score of knowledge significantly improved in intervention as compared to control group (P value < 0.01). Intention to quit was found to be proportionately higher (33%) in the intervention group as compared to control group. Generalized estimating equations were used to assess the association of factors with knowledge regarding harmful effects of SLT use. Significant predictors of increase in knowledge score were found in children: who had seen any anti SLT messages on social media in the past 30 days, who were getting information regarding harmful effects of SLT use in school or textbooks and who had friends using SLT. A school-based intervention was effective in increasing knowledge regarding the harmful effects of SLT use and intention to quit SLT use among school adolescents. Introduction of such educational programmes on a regular basis in schools or as part of school curriculum can have an impact on reducing prevalence of SLT use.

Trial Registration NCT03418506.


Smokeless tobacco Cluster randomized trial Adolescents School based intervention 



We are indebted to the District Officer of Education, City District Govt. Karachi and Town Administration Malir, Bin-Qasim and Gadap Towns for their support in conducting study. We acknowledge all the selected govt. and private schools for their participation. We would like to thank the study field team, especially MS Farida Baig, Ms Barkha Raj, Ms Yasmeen Mirzaman for their assistance as programme providers. We are greatly indebted to MS Naureen Akbar Ali for providing valuable support.

Author Contributions

SR: conceived and designed the study, education material, data analysis, manuscript drafting and finalized. NZ: responsible for manuscript writing, and reviewing the paper and educational material. ML: assisted in data analysis, preparing educational material and supervised field activities. SS: data management and basic descriptive analysis. TR: contributed to manuscript drafting. AR: coordinated budget and logistics of the study. ZB: reviewed the final manuscript. All authors saw and approved the final version of manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethical approval for the study was obtained for the institutional review board at Dow University of Health Sciences.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Community Health SciencesAga Khan UniversityKarachiPakistan
  2. 2.Department of SurgeryAga Khan UniversityKarachiPakistan
  3. 3.Department of PathologyDow University of Health SciencesKarachiPakistan
  4. 4.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada

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