Hossain, Sahadat; (2025) Development and evaluation of a brief school-based intervention to prevent tobacco initiation and promote the health and well-being of adolescents in Dhaka, Bangladesh. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Adolescent tobacco initiation is a pressing global public health concern, particularly in low- and middle-income countries (LMICs), where preventive interventions remain scarce. Schools provide an ideal setting for tobacco prevention initiatives, yet there is a lack of such programmes in Bangladesh. This thesis aimed to develop and evaluate a brief, evidence-based and theory driven, school-based intervention – Intervention for Adolescent Tobacco Initiation Prevention (IATIP) – to prevent tobacco initiation and promote adolescent health and well-being in Dhaka, Bangladesh. This mixed-methods thesis comprises five interrelated studies. First, a systematic review identified that theory-driven, concise, and interactive interventions, incorporating culturally relevant content and trained facilitators, were more likely to be effective in reducing adolescent tobacco use. Second, a school-based survey of 2,593 adolescents (aged 11-18 years) from 24 schools found that 16.0% had ever used tobacco and 7.3% were current users. Students expressed strong preferences for expert-led interventions that addressed peer influence, social norms, and mental well-being. These findings, alongside behaviour change theories and expert consensus, informed the development of IATIP. Third, a qualitative study informed cultural adaptation of the intervention, highlighting the importance of incorporating religious values, relatable visuals, and interactive delivery methods. Fourth, a pilot cluster randomised feasibility trial (n=1,396; aged 11-17 years; 8 schools) demonstrated high recruitment (88.4%) and retention (96.5%) rates, with an approximately 75.4% reduction in intention to use tobacco in the intervention group at one-month follow-up. Feasibility indicators such as fidelity, acceptability, and implementation quality were favourable. Preliminary data also suggested positive trends in mental well-being (mean difference: 6.16), refusal skills (odds ratio: 22.12), and decision-making abilities (mean difference: 3.23). Finally, a process evaluation identified implementation strengths and areas for future refinement. The findings suggest that IATIP is a feasible, acceptable, and contextually relevant school-based intervention for adolescents in Bangladesh. A full-scale trial with extended follow-up is recommended to evaluate the effectiveness of long-term behavioural outcomes and the potential for scalability in Bangladesh and comparable LMIC settings.

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