Effectiveness of school-based smoking intervention in middle school students of Linzhi Tibetan and Guangzhou Han ethnicity in China

• Smoking situation of Linzhi Tibetan is more serious than that of Guangzhou Han.
• The intervention was effective in increase of knowledge in both two ethnic groups.
• The intervention did not change smoking behavior in either ethnic group.
• The intervention changed attitude toward smoking in Tibetan but not so in Han.
• This intervention was more effective for Tibetan when compared with Han ethnic group.

PurposeThe purpose of this paper is to assess the effectiveness of school-based intervention aimed to increase knowledge, to change attitudes and to reduce smoking-related behavior in both Linzhi Tibetan and Guangzhou Han middle school students in China.DesignA concurrent intervention study was conducted in both Linzhi and Guangzhou. Two schools were randomly chosen and one was randomly assigned to the intervention group and the other to the control group in both settings.Setting/participantsParticipants were grade one and grade two middle school students drawn from two schools in Linzhi, Tibet Autonomous Region (southwest China) and two schools in Guangzhou, Guangdong Province (south China).InterventionThe intervention program lasted for one year and covered three aspects: health policies in school, health environment in school and personal health skills.Main outcome measuresPrimary outcomes were smoking-related knowledge, attitudes and behavior (including ever smoking, daily smoking, weekly smoking and current smoking) and were measured by a self-administered questionnaire before and after the intervention.ResultsThis intervention increased smoking-related knowledge in both Tibetan (β = 1.32, 95% CI (0.87–1.77)) and Han ethnic groups (β = 0.47, 95% CI (0.11–0.83)). It changed attitudes toward smoking in Tibetan (β = 1.47, 95% CI (0.06–2.87)) but not so in Han (β = − 0.33, 95% CI (− 1.68–1.01)). The intervention changed the prevalence of smoking in neither ethnic groups (P > 0.05).ConclusionsThe impact of school-based smoking intervention is different among Tibetan and Han students. This intervention was more effective for Tibetans when compared with the Han ethnic group. More research is needed on how intervention can be adapted to address ethnic and cultural differences.