Background: Tobacco use among the 13 to 15 years old is a major public health concern in Bhutan.

Objective: To determine the changes in the student’s tobacco use when the knowledge, attitude, intention, and behavior is developed from the peer-led health education package called “No-Tobacco-Use in Schools” (NTUIS) model at rural secondary schools in Wangdue Phodrang District, Bhutan.

Materials and Methods: The quasi-experimental study was conducted between May and December 2016 involving 378 eighthgrade students in four schools. The peer educators executed the NTUIS model in the intervention schools while the health workers disseminated the general health messages in the control schools. The knowledge on the harms of tobacco use, attitude towards tobacco use, intention to use tobacco in the future, and maintenance of non-user status of tobacco among the students were assessed at baseline, post-test, 3-month follow-up, and 6-month follow-up using a self-administered questionnaire. ANOVA was used to find the overall effect.

Results: Post assessments, the mean knowledge scores in the intervention group increased more than the control group at every follow-up, and the model’s effect on knowledge was high (p<0.001, d=0.64). More students in the intervention schools than their counterparts in the control schools intended to remain tobacco free for the next five years (p<0.001) and for lifetime (p<0.001). However, there was no overall effect on the student’s attitudes in both groups. Similarly, the model did not have its effects either on the student’s smoking cigarettes (p=0.380) nor on the use of smokeless tobacco products (p=0.361). Nevertheless, the student’s tobacco use did not increase during the study period.

Conclusion: The NTUIS model had high effects on the student’s tobacco harm knowledge and intentions to remain tobacco free but showed no effects on their attitudes and tobacco use behavior.

Keywords: Adolescent tobacco users, Tobacco use prevention, Peer-led health education, Bhutan

Received 19 Feb 2018 | Revised 7 May 2018 | Accepted 14 May 2018