Pragmatic pilot cluster randomised control trial of a school-based peer-led anti-smoking intervention for 13-14 year olds in Malaysia

Purpose The purpose of this paper is to report the process evaluation of a pilot randomised control trial of an anti-smoking intervention for Malaysian 13-14-year olds, conducted in 2011/2012. It was hypothesised that trained peer supporters would promote non-smoking among classmates through informal conversations. Design/methodology/approach Smoking-related baseline and follow-up questionnaires were administered, seven months apart, to Form 1 students (n=2,118) attending eight schools across two districts in Sabah (Kota Kinabalu; Keningau). Concealed stratified randomisation assigned two schools per district to the control and intervention arms. Control schools received usual care. Intervention schools received usual care and the peer supporter intervention. Peer supporters completed smoking-related knowledge and attitudes questionnaires before and after peer supporter training and peer supporter training evaluation questionnaires. They also discussed the peer supporter training and role in focus groups immediately following training (n=4) and three months later (n=3), and additionally, recorded post-training anti-smoking activity in diaries. Findings The pilot trial found that student recruitment was high (baseline students matched at follow-up n=1,681 (79 per cent of class-registered students). More boys (n=38) than girls (n=35) attended peer supporter training. Post-training, most peer supporters had improved smoking-related knowledge (n=55; 75 per cent) and attitudes (n=57; 78 per cent) and returned diaries (n=49; 67 per cent). Some focus group boys reported they were reluctant peer supporters and/or found resisting smoking difficult. Practical implications Future trials would benefit from outlined modifications to peer supporter selection, recruitment and training and additionally, assessments of context and intervention acceptability and reach. Originality/value Trials of complex public health interventions are scarce in economically developing countries

The development and evaluation of a school-based smoking prevention intervention for adolescents in Malaysia

Objectives: To develop and evaluate the effectiveness of a school-based intervention for preventing the uptake of smoking among adolescents in the State of Sabah, Malaysia Methods: The study design was a pilot randomised controlled trials with 7 months follow-up. A total of 1971 Form 1 students mostly aged 13 years old involved in the questionnaire. Eight secondary schools were randomly allocated equally to four intervention and control arms. The intervention schools received the health promotion activities as usual care and the peer educator intervention whereas the control schools received just the usual care of the health promotion activities. A total of 73 selected students were trained to be peer educators and given tasks to have an informal conversation and giving opinion about smoking issues and advocating not smoking norms. Individual-level analyses (relative risk and chi square analyses) and multilevel analyses which account for the clustering of students in schools were conducted. Three data sets were used from the complete data set, a data set that was comprised on students who could be matched at both baseline and follow-up and two data sets that were based on one of two assumptions. The first assumption was that baseline participants who could not be matched at follow-up retained their baseline smoking behaviour at follow-up. The second assumption was that baseline participants who could not be matched at follow-up were all regular smokers. Results: The main finding was that the intervention had a significant positive effect on the smoking behaviour of baseline current smokers. That is baseline current smokers were less likely to have continued to be current smokers if they attended an intervention school. Five out of the nine tests supported this proposal including the most rigorous analyses which were all based on multilevel models. The impact of the intervention on baseline never smokers was less obvious as only one of the nine tests of significance indicated that the intervention had a significant positive effect on follow-up smoking behaviour. In relation to baseline occasional smokers only two of the nine analyses indicated that the intervention had a significant positive effect on the smoking behaviour at follow-up. The analysis on interactions with friends in school showed that the intervention schools (43%) had a significantly higher proportion of students than in control schools (38%) who had a conversation about smoking issues. Conclusion: The peer educator intervention is a promising approach in the smoking prevention programmes for adolescents in Malaysia

Pragmatic pilot cluster randomised control trial of a schoolbased peer-led anti-smoking intervention for 13-14 year olds in Malaysia: process evaluation

Purpose: This paper reports the process evaluation of a pilot randomised control trial of an anti-smoking intervention for Malaysian 13-14 year olds, conducted in 2011/12. It was hypothesised that trained peer supporters would promote non-smoking among classmates through informal conversations. Design/methodology/approach: Smoking-related baseline and follow-up questionnaires were administered, seven months apart, to Form 1 students (n=2118) attending eight schools across two districts in Sabah (Kota Kinabalu; Keningau). Concealed stratified randomisation assigned two schools per-district to the control and intervention arms. Control schools received usual care. Intervention schools received usual care and the peer supporter intervention. Peer supporters completed smoking-related knowledge and attitudes questionnaires before and after peer supporter training and peer supporter training evaluation questionnaires. They also discussed the peer supporter training and role in focus groups immediately following training (n=4) and three months later (n=3), and additionally, recorded post-training anti-smoking activity in diaries. Findings:The pilot trial found that student recruitment was high (baseline students matched at follow-up n=1681 (79% of class-registered students). More boys (n=38) than girls (n=35) attended peer supporter training. Post-training, most peer supporters had improved smoking-related knowledge (n=55; 75%) and attitudes (n=57; 78%), and returned diaries (n=49; 67%). Some focus group boys reported they were reluctant peer supporters and/or found resisting smoking difficult. Research limitations/implications: Practical implications: Future trials would benefit from outlined modifications to peer supporter selection, recruitment and training and additionally, assessments of context and intervention reach. Social implications: Originality/value: Trials of complex public health interventions are scarce in economically developing countries