Effectiveness of Combined Facilitator-driven and Peer-led Educational Intervention on Intention to use Tobacco among Adolescents in Mangalore: A School based Cluster Randomized Controlled Trial.

Tobacco use is one of the major modifiable risk factors for noncommunicable diseases (NCDs). A large number of adult smokers start smoking during adolescence due to peer pressure, stress, and tobacco companies' aggressive marketing. In India, 8% of adolescents between 13 and 15 years currently smoke. There are very few studies in India regarding the strategies that can reduce adolescents' intention to use tobacco, despite the reality that school-based interventions have shown success worldwide. The intent of this study is to assess the combined peer-led and facilitator-driven educational intervention v/s facilitator driven educational intervention on reducing the intention to use tobacco among school-going adolescents. This study will be conducted in two phases among the urban schools of Mangalore. In phase 1, a module will be created using qualitative Delphi technique with stakeholders. Phase 2 will be a cluster-randomized controlled trial among 400 eighth graders from 10 schools. Schools will be randomly assigned to one of two arms: control (facilitator-only sessions) or intervention (facilitator and peer-led sessions). Using a validated questionnaire, data pertaining students' knowledge, attitudes, perceptions, risk awareness, and intention to use tobacco will be collected at baseline and at six months. The primary outcome will be shift in tobacco use intention. Change in knowledge, attitude, and risk perception will be the secondary outcomes. If peer-led interventions demonstrate superior outcomes in promoting tobacco abstinence, this approach can be scaled and adopted as a sustainable model within school-based tobacco prevention programs. The research protocol is registered with the Clinical Trial Registry of India (CTRI No. CTRI/2025/07/090983)