Effectiveness of Comics to Promote Tobacco-related Knowledge, Attitudes and Behaviours Among Primary School Students

NCT07453745 | Active Not Recruiting

• 1 other identifier: coshrct2526
• Study Type: interventional
• Target: 1,000
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this pilot RCT is to evaluate the effectiveness of comics containing tobacco-related content in improving tobacco-related knowledge and attitudes among Hong Kong primary school students. The main questions it aims to answer are:

• Is the intervention (i.e. comics) effective in improving tobacco-related knowledge (including alternative smoking products (ASPs) and tobacco control development in the world and Hong Kong) compared to controls (i.e. information sheets)?
• Is the intervention (i.e.comics) effective in improving tobacco-related attitudes and intentions (including ASPs and tobacco control development in the world and Hong Kong) compared to controls (i.e. information sheets)? Researchers will compare the questionnaire results from students to see if intervention groups (students reading comics) will have better tobacco-related knowledge, higher anti-tobacco attitudes and lower intention to smoke compared to the control group (students reading information sheets).

Conditions

Tobacco Prevention

Keywords

Tobacco prevention; Health literacy; Non-pharmaceutical intervention; Children

Outcome Measures

Primary Outcomes (3)

• Effectiveness of intervention on tobacco-related knowledge (including ASPs and tobacco control development in the world and Hong Kong)

  Students reported their opinions towards 5 statements in both pre-test and post-test: 1\) Smoking accelerates skin ageing; 2) Secondhand smoke can trigger asthma and middle ear infections in children; 3) Opening windows or using a fan can eliminate the effects of thirdhand smoke; 4) E-cigarettes with added flavors are harmless to the body; 5) Hong Kong prohibits smoking while queuing for public transport. Questions may be subject to change, as they will be adjusted according to the leaflets/comics, while maintaining a similar format. Students' knowledge will be assessed using a 3-point Likert scale, with each item rated on a 3-point Likert scale ranging from -1 (wrong) to 1 (correct).

  Right before the intervention and at 12-16th days

• Effectiveness of intervention on tobacco-related attitudes (including ASPs and tobacco control development in the world and Hong Kong)

  Students will report their opinions towards 5 statements: 1) Banning smoking in all places would harm smokers' rights; 2) I will actively avoid secondhand smoke; 3) Using e-cigarettes is safer than smoking traditional cigarettes; 4) Tobacco companies use various methods to encourage people to smoke; 5) The government should ban the sale of flavored smoking products. Questions may be subject to change, as they will be adjusted according to the leaflets/comics, while maintaining a similar format. Students' attitudes will be assessed using a 5-point Likert scale, with each item rated on a 5-point Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). Item scores will be recoded as appropriate, so that higher scores consistently reflect more negative attitudes.

  Right before the intervention and at 12-16th days.

• Effectiveness of intervention on tobacco-related intentions (including ASPs and tobacco control development in the world and Hong Kong)

  Students were asked: If one of your good friends offers you a traditional cigarette, e-cigarette or heated tobacco product, ask you to have a few puffs, and no one will know about this as no more smoking in the future. Will you use them? Students' intention will be assessed using a 5-point Likert scale, with each item rated on a 5-point Likert scale ranging from 1 (Definitely no) to 5 (Definitely yes). Lower scores indicate a lower intention to use ASPs.

  Right before the intervention and at 12-16th days.

Secondary Outcomes (4)

• Effectiveness of intervention on SHS and THS exposure at home

  Right before the intervention and at 12-16th days.

• Effectiveness of intervention on tobacco use

  Right before the intervention and at 12-16th days.

• Adherence to the 5-day intervention

  At 12-16th days

• Satisfaction of students towards intervention

  At 12-16th days

Study Arms (2)

Intervention

EXPERIMENTAL

Intervention group students will receive a series of five tobacco-related comics during the 2-week study period.

Other: Tobacco-related comics

Control

ACTIVE COMPARATOR

Control group students will receive five conventional health leaflets or related educational materials.

Other: Conventional health leaflet

Interventions

Tobacco-related comics OTHER

A series of five comics are developed specifically for this study. The comics will address five key themes which we found could be reinforced based on our previous project. This includes \[1\] the harms of tobacco use, \[2\] secondhand smoke (SHS), \[3\] thirdhand smoke (THS), \[4\] alternative smoking products (ASPs), and \[5\] the tobacco industry and tobacco-related policies in Hong Kong and worldwide.

Intervention

Conventional health leaflet OTHER

The selected leaflets will be based on information from existing tobacco prevention leaflets routinely distributed by the Tobacco and Alcohol Control Office and the Student Health Service and specifically targeting students.

Control

Eligibility Criteria

• Age: 9 Years - 14 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Primary 5-6 students from local primary schools
• Able to read Chinese

You may not qualify if:

• \- None

Sponsors & Collaborators

• The University of Hong Kong: lead
• Hong Kong Council on Smoking and Health: collaborator

Study Sites (1)

Local primary schools

Hong Kong, Hong Kong

Location

Study Officials

• Shiu Lun Ryan Au Yeung

  School of Public Health, The University of Hong Kong

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: February 27, 2026
• First Posted: March 6, 2026
• Study Start: April 20, 2026
• Primary Completion: July 31, 2026
• Study Completion (Estimated): August 31, 2026
• Last Updated: May 4, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• Time Frame: Starting three months after publication and will remain available for up to five years.
• Access Criteria: Researchers with a methodologically sound proposal aligned with the approved study objectives may request access by contacting the PI (Ryan Au Yeung) at ayslryan@hku.hk. Approved data requestors will be required to sign a data-access agreement.

Locations

HK (1)