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Int J Prev Med. 2019 Jun 12;10:111. doi: 10.4103/ijpvm.IJPVM_493_17. eCollection 2019.

Effectiveness of a Peer-Led Behavioral Intervention Program on Tobacco Use-Related Knowledge, Attitude, Normative Beliefs, and Intention to Smoke among Adolescents at Iranian Public High Schools.

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Rasht Health Center, Guilan University of Medical Sciences, Rasht, Iran.
Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia.



Theory-based tobacco use prevention programs in schools were implemented to evaluate the effectiveness of this peer-led intervention on tobacco use-related knowledge, attitude, normative beliefs, and intention to tobacco use of school children aged 14-17 years old.


A school-based cluster randomized controlled intervention study was conducted among 1st, 2nd, and 3rd grade high school children in Sanandaj City, Iran. 4-h integrated tobacco use prevention program comprising of four structured modules was developed and delivered to the intervention group by trained peer educator. Outcome measures comprised changes in students' smoking-related knowledge, attitude, normative beliefs, and intention to tobacco use from baseline to 6-month follow-up through validated anonymous questionnaire.


The present study showed an intervention effect on tobacco use-related knowledge, normative beliefs, and intention to tobacco use but not attitude. The results indicated that there was significant decrease in intention to tobacco use (P ≤ 0.013) observed after 6-month postintervention. The intervention module was also effective in improving smoking knowledge (P ≤ 0.001), normative beliefs with regard to perceived prevalence of cigarette smoking and water-pipe use among adults and adolescents (P ≤ 0.001) in intervention group 6-month postintervention.


Participation in the peer-led education program to tobacco use prevention may have improvement in knowledge, normative beliefs, and intention to tobacco use. An implementation of the peer-led behavioral intervention components in the school setting may have a beneficial effect on public health by decreasing intention to tobacco use among nonsmoker adolescents.


Cigarette smoking; high school children; intervention; peer-led intervention; tobacco use prevention; water-pipe use

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