Smoking cessation intervention programme in four secondary boys' schools in Malaysia

Abstract

Background and challenges to implementation: Smoking among Malaysian secondary school students is on the rise especially among boys between 13-15 years old. There are no proven sustainable school-based intervention programmes to tackle this issue. Hence, a 6-month smoking cessation programme at 4 boys' schools in urban Kuala Lumpur was conducted. The initial challenges faced during the implementation of this programme include lack of cooperation from school personnel, inadequate time, high absenteeism among students and inability to prescribe pharmacotherapy. The recruitment process consists of a talk and screening using the CO breath analyzer. 143 identified smokers were offered to voluntarily participate with 128 non-smoking support buddies recruited. Weekly visits were scheduled during the first month, followed by once a fortnight for the 2nd and 3rd months, and once a month for the last 3 months. Group counselling was conducted during each visit with interactive activities including quizzes, video case studies, essay writing and games. Smokers with CO level >10 ppm and unable to quit after the 6th counselling session were counselled individually. Intervention or response: The team worked with the Ministry of Health to train school counsellors in smoking cessation. WhatsApp groups were created to provide off-site support, reminders and problem solving. Vitamin C tablets were given instead of pharmacotherapy and special attention was given to the heavy smokers. The team worked closely with the school counsellors, discipline teachers and buddies in making informed decisions. Results and lessons learnt: CO-verified smoking cessation rate at 6-month follow-up was 64.0%. Four students had transferred. Those who continued to smoke were recruited into the 2017 programme. Frequent school visits, face-to-face support, utilizing social media, involvement of the counsellors and rewards were supportive factors of the programme's success rate. Conclusions and key recommendations: High smoking cessation rate can be achieved via an integrated programme.