What question did this study set out to answer?

This trial aimed to assess the impact of a Health Belief Model-based intervention on tobacco use intentions among adolescents.

April 8, 2026

Effectiveness of a school-based health education intervention on tobacco use intention among adolescents: a cluster-randomised controlled trial

Key Points

This trial aimed to assess the impact of a Health Belief Model-based intervention on tobacco use intentions among adolescents.
Conducted a two-arm, parallel, cluster-randomised controlled trial among 720 students aged 12–19.
Random assignment of schools to intervention or control groups.
Intervention group received a 45-minute HBM-based education session with culturally adapted materials.
Outcomes measured included intentions to use tobacco, knowledge, and harm perception, assessed at baseline and 6 months.
Intention to use tobacco decreased in the intervention group from 13.6% to 8.9%, while it increased in the control group to 14.4%.
Intervention group had lower odds (adjusted OR 0.57) of intending to use tobacco compared to the control group.
Knowledge and harm perception significantly improved in the intervention group.

Abstract

Background Adolescence is a critical period for tobacco initiation, and intention to use tobacco strongly predicts uptake. In Nigeria, adolescent tobacco use is a growing concern requiring early prevention. We evaluated a Health Belief Model (HBM)-based tobacco-education intervention on knowledge, harm-perception and intention to use tobacco among in-school adolescents in Ibadan, Nigeria. Methods A two-arm, parallel, cluster-randomised controlled trial was conducted among 720 students aged 12–19 years. Schools were randomly assigned to an intervention group (IG) or a control group (CG). IG participants received a 45 min HBM-based tobacco education session reinforced with culturally adapted posters and notebooks developed from the WHO Tobacco Control Manual for Secondary Schools ; the CG participants received a general health lecture. Assessments were conducted at baseline, immediately postintervention and at 6 months. The primary outcome was intention to use tobacco; secondary outcomes included tobacco-related knowledge and harm-perception. Analyses followed intention-to-treat principles. Cluster-adjusted logistic generalised estimating equation models were used to estimate intervention effects on intention. Results At baseline, intention to use tobacco was identical in both groups (13.6%). At 6-month follow-up, intention declined in the IG (8.9%) but increased in the CG (14.4%). In cluster-adjusted analyses, IG participants had lower odds of reporting intention to use tobacco than CG participants (adjusted OR 0.57, 95% CI 0.35 to 0.94), with no evidence of effect modification by age group. The IG also showed greater improvements in knowledge and harm-perception. Conclusions This brief, theory-driven, culturally adapted school-based intervention reduced intention to use tobacco and improved tobacco-related knowledge and harm-perception among adolescents. The findings support the integration of evidence-based tobacco education into adolescent tobacco prevention strategies in low-income and middle-income countries. Trial registration number PACTR202103802475677.

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