Evaluation of a School-based Smoking Prevention and Cessation Programme in Negeri Sembilan
Condition: Smoking
Study type: Interventional

Summary: 
      School-based smoking cessation programmes stretched longer than a year had 12% reduction in
      preventing smoking uptake. With regards to smoking intervention programme among adolescents,
      there is a lack of evidences regarding its long-term effectiveness. This was due to lack of
      clear guidelines, methodological issues and the fact that adolescents were likely to be
      sporadic or non-daily smoker, leading to discrepancies in their self-reported claim.
      Adolescent's smoking relapse rate was at 47% while those who never smoke have a 13% chance to
      become smoker. Light and regular smokers have 30% and 75% chance becoming an adult smoker
      respectively. A review paper in smoking research in Malaysia showed that the provision of
      anti-smoking education in school was associated with reduced susceptibility in female
      smoking.Male students perceived printable media, radio and the Internet as effective in
      delivering anti-smoking messages.School-based smoking cessation programme has been shown to
      be cost-effective in helping the students to quit smoking both in developed and developing
      countries.For this reason, it is essential to explore what are the factors that amplify the
      success rate of smoking cessation effect of the KOTAK programme.
    

Detailed description: 
      Through this study the investigators will seek to answer the following questions:

        -  To determine the quit-smoking rate of the KOTAK programme

        -  To determine the factors associated with quitting smoking with the KOTAK programme

      Important aspects of the KOTAK programme evaluation will involve assessing its impacts on
      preventing smoking initiation and promoting smoking cessation among the adolescents. This
      form of assessment is vital in achieving the KOTAK's objectives to reduce the prevalence of
      smokers in Malaysian schools. An average of 8 hours of training were required for dental
      officers and dental nurses to deliver the modules in the KOTAK programme. This programme has
      an important financial implication as it involved almost 4 thousand dental officers and 3
      thousand dental nurses to screen almost 4.6 million Malaysian schoolchildren in 2018.

      Factors yielding promising results for adolescents to quit smoking are important to be
      researched. This will provide us with valuable insights from the perspectives of the
      stakeholders pertaining on areas that needed improvement. Despite the existence of various
      tobacco-prevention program in public schools, KOTAK is deemed significant as it is a yearly
      collaboration of School Dental Services with the schools. This study will compare the quit
      smoking rate between Intervention (with KOTAK Programme) and Control (without KOTAK programme
      ) schools. The sampling unit was the school.
    

Intervention name(s): School-based smoking prevention and cessation program (The KOTAK program)
Intervention type(s): Behavioral
Intervention description(s): Advance Intervention: Following the screening process, this intervention package was inclusive of group-briefing for the smokers in at least 3 subsequent sessions in one academic year. The content delivered by the dentist were based on the KOTAK guidebook consisted of 8 Modules.The modules were as follows:
Introduction: Identifying students who smoke
Cigarette and addiction
The danger of smoking and passive smokers
Advantages of smoke-free lifestyle and adolescent perception on smoking
Legal and religious perception of smoking
The benefits of smoking cessation
Preparation and how to stop smoking
Nicotine withdrawal symptom and relapse prevention
The Intervention schools: Screened smokers were given Advanced Intervention sessions. After discussion with the State's oral health deputy director and district's programme coordinator, for the purpose of this study, the interval of the Advance Intervention session was decided at 1-month interval.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study design is a cluster (cluster = school) randomized trial of schoolchildren participating in the school-based smoking prevention and cessation program (The KOTAK) . Randomization were done at the school level,after the schools were paired and matched base on the schools' overall academic achievement.The matched pairs were randomly selected.The selected pairs were then randomly allocated to either Intervention or Control schools. The Advance Intervention section of the KOTAK program will be assigned to the Intervention Schools.The cluster size will be treated as balancing factors in stratified allocation or as covariate in the statistical analysis.
Masking: Single (Participant)
Primary purpose: Treatment