Cigarette smoking in adolescents with asthma in Jordan: Impact of peer-led education in high schools

Abstract

Background: Peer-led smoking prevention programs focus on teaching adolescents-especially those with asthma-who are affected most by cigarettes, refusal skills to lower their intention to smoke. The purpose of this study was to determine the impact of a peer-led asthma education program on students who were smokers in terms of self-efficacy to resist smoking, asthma knowledge and asthma-related quality of life. Methods:This study is a secondary analysis of a cluster-randomized controlled trial of students with asthma (n = 259) in 4 randomly-selected high schools, stratified for gender in Northern Jordan, using a closed-envelope technique. Trained bilingual health workers facilitated the implementation of the peer-led program, which uses a three-step cascade process to train peers from year 11 and 10 over a three week period to deliver asthma education for the school community, with the aid of well-established resources. Students with asthma (n = 261) in grades 8, 9 and 10 were surveyed at baseline in December 2006 and three months post-intervention on the main outcomes, which were asthma-related quality of life, knowledge of asthma management, and self-efficacy to resist smoking. For the purpose of this paper, we assessed the impact on the intervention only on students who were smokers (n = 72). Results:The prevalence of smoking among students with asthma was 29%. Male students (44%) were more likely to smoke than females (6%) (p<0.001). Compared to the control group, the peer-led intervention improved self-efficacy to resist smoking, understand asthma and asthma-related quality of life. Smokers within the intervention schools improved their self-efficacy to resist smoking by 83% (p=0.001), asthma knowledge by 60% (p=0.001) and demonstrated benefits within all the sub-domains of asthma related quality of life when compared to controls (p=0.001). Conclusion:The prevalence of smoking among high school Jordanian students with asthma, especially males, is alarmingly high, highlighting the need for early intervention. A school-based peer-led asthma and smoking education approach can be effective in motivating students to not smoke. Therefore, nurse educators worldwide, especially who work in youth centers, community, and school health fields, need to be aware of the effectiveness, availability, and possible adoption of such innovative interventions in order to improve overall well-being for adolescents in general and for smokers in specific.

Incorporating HPS Model into Lebanese Public Schools: Comparison of Adolescents’ Smoking, Alcohol and Drug Use Behavior in HPS versus Other Public and Private Schools in Lebanon

“…Underage drinking often occurs at social events that adolescents enjoy and attend, such as sports, concerts, and parties. Adolescents can be responsible partners in spreading anti-smoking related messages and supporting resistance skills among their colleagues[21], which concurs with our findings where the availability of school clubs was inversely associated with smoking and alcohol consumption.Evidently, health instruction was given to students, with no advantage of HPS; risk practices persisted. Therefore, evaluation of efficiency of these programs in diagnosing risk behaviors, preventing them, and referring affected youth to proper counseling services is very much needed.…”

Prevalence, Patterns and Correlates of Cigarette Smoking in Male Adolescents in Northern Jordan, and the Influence of Waterpipe Use and Asthma Diagnosis: A Descriptive Cross-Sectional Study

“…In a recent study in Jordan, this school-based, peer-led asthma and smoking prevention program was implemented for adolescents with asthma. This program was found to be feasible, acceptable, [ 47 ] and effective in increasing self-efficacy to resist smoking and asthma-related quality of life among Jordanian adolescent, especially those with asthma and those who reported cigarette smoking [ 45 ]. Therefore this program is worth further investigation.…”

“…All students who answered yes to the question “have you ever had asthma?”, reported recent symptoms during the last 12 months, and their school files, when reviewed by the researchers, confirmed current asthma diagnosis were considered as having recent asthma diagnosis. The ISAAC written questionnaire was reported to be valid in young people internationally [ 55 ] and in a similar population previously [ 45 ]. The internal consistency “reliability” of the ISAAC written questionnaire was found to be adequate in this study (Cronbach’s Alpha = 0.82).…”

“…Regardless, any study that examines smoking in young people should consider the presence of asthma. In Jordan, cigarette smoking rates are as high as 29% in adolescents who have asthma [ 45 ], however, to the researchers’ knowledge, there is no data is available about the prevalence of WP use among adolescents with asthma in Jordan. Combined with the high prevalence of asthma (17%) among adolescents in Jordan, the added impact of smoking could be extensive and a focus on students who have asthma is crucial [ 46 ].…”

Secondhand smoke exposure among young adults in a developing country &ndash; a Jordanian case

“…Furthermore, there is a growing concern over the increased incidence of smoking among children, who may start as young as 9 years of age 4. The prevalence of tobacco use among university students in Jordan was 56.9% among males and 11.4% for females 5. Among school students between the ages of 13 and 15 years it was reported to be 31.6% among males and 24.0% among females 6.…”