The effect of a “class smoke free pledge” on breath carbon monoxide in Arabic male adolescents
Al sheyab, NA and Khader, YS and Shah, S and Roydhouse, J and Gallagher, R, The effect of a 'class smoke free pledge' on breath carbon monoxide in Arabic male adolescents, Nicotine & Tobacco Research pp. 568-574. ISSN 1469-994X (2018) [Refereed Article]
Introduction: Arabic male adolescents have a high smoking prevalence. Introduction of "Class
smoke-free" pledges have been successful amongst European adolescents but have not been
evaluated using objective valid measures. We tested the impact of adding a smoke free pledge
strategy to a proven peer-led asthma and smoking prevention program on breath carbon monoxide level (BCO) in male high-school students in Jordan.
Methods: We enrolled male students from four high-schools in Irbid, Jordan. Schools were randomly
assigned to receive either TAJ (Triple A in Jordan, n = 218) or TAJ-Plus (with added class smoke-free
pledge, n = 215). We hypothesized that students receiving TAJ-Plus would have greater reduction in
BCO levels than those only receiving the TAJ intervention. Asthma and smoking status were assessed
by self-administered questionnaires. Smoking outcomes were collected using a BCO Monitor.
Results: Both groups had significant reductions in BCO levels post-intervention (p < .0001), however, decreases were greater in TAJ-Plus group (3.9 ± 0.2 vs. 4.8 ± 0.2, p < .0001). Intervention
effects on BCO over time did not vary by smoking status (p= .085), asthma status (p = .602), or a
combination of the two (p = .702).
Conclusions: An added smoke-free pledge strategy to a proven peer-led asthma education program
appears to be a promising approach to motivate adolescents to abstain from smoking in Jordan. Future
research is required to determine if these results can be extended to Jordanian adolescent females.
Implications: A commitment by students via a "class smoke-free" pledge can be an added incentive to motivate adolescents in Arabic-speaking countries to abstain from smoking. Social influence
approaches in schools can be useful in countering the aggressive tobacco marketing campaigns
targeting Jordanian and other Arabic-speaking youth. The combination of "class smoke-free"
pledges and an evidence-based peer-led asthma and smoking education can be implemented in
schools to influence adolescents with asthma to abstain from smoking.