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.

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.

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.

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.

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
The study was supported entirely by a grant from King Abdulaziz University Deanship of Scientific Research [Grant No. 554/254/1432].
Not commissioned; externally peer reviewed.
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