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.