Comparative Effectiveness of Dentist-Led Lecture Versus Self-Directed Learning on Tobacco Knowledge and
Omotayo Francis Fagbule1,2, Mary Ebelechukwu Osuh1,3, Folake Barakat Lawal1,3
1Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Nigeria.
Background:
Adolescents' tobacco susceptibility is a strong predictor of future initiation; yet rigorously evaluated school-based interventions in low- and middle-income countries (LMICs) remain scarce. This study compared the effectiveness of dentist-led lectures versus self-directed learning in improving tobacco-related knowledge and reducing tobacco susceptibility among Nigerian adolescents.
Methodology:
Parallel, 2-arm, cluster-randomized controlled trial involving 720 students (13-19 years) across 8 secondary schools in Ibadan, Nigeria, stratified by school type (public vs private). Schools were randomized to the Dentist-Led Lecture Group (DLG) or Self-Directed Learning Group (SLG). The DLG received a single 45-minute tobacco education lecture; the SLG received customized anti-tobacco notebooks and posters. Outcomes were tobacco-related knowledge scores and susceptibility to tobacco use, assessed at baseline, immediate post-intervention, and 6-month follow-up. Analyses included t-tests, repeated-measures ANOVA, McNemar tests, and logistic generalized estimating equation (GEE) with exchangeable correlation structure and robust standard errors (α = .05).
Results:
Mean (standard deviation) knowledge scores improved from baseline to 6 months in both groups (DLG: 5.2 [3.1]-9.7 [2.3]; SLG: 4.7 [3.5]-8.8 [2.7]; both P < .001), with no between-group difference (P = .200). Baseline susceptibility was comparable (DLG 16.4%; SLG 20.3%; P = .178). At 6 months, susceptibility declined in DLG to 7.3% (P < .001) and SLG to 15.0% (P = .251). Prespecified subgroup analyses showed susceptibility decreased in private schools for both groups (DLG 18.9%-6.6%, P = .002; SLG 17.0%-8.0%, P = .012), but not in public schools (DLG 14.1%-8.0%, P = .152; SLG 23.6%-24.1%, P = .688). In GEE models averaged across time points, SLG participants had higher population-averaged odds of susceptibility than DLG (aOR = 1.98, 95% confidence interval: 1.45-2.70).
Conclusions:
Both interventions improved tobacco-related knowledge at similar rates, but dentist-led education was associated with lower odds of tobacco susceptibility. This trial demonstrates the value of scalable school-based approaches for adolescent tobacco prevention in LMICs.
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