This study aims to evaluate the effectiveness of the Smoke-free Teens Programme in strengthening youth's knowledge and attitude on smoking and health.

The objectives are:

i. To evaluate Smoke-free Teens' change in knowledge on smoking hazards, attitudes towards smoking, tobacco control and smoking cessation, and practices for promoting smoking prevention and cessation, ii. To evaluate the process and quality of smoke-free programmes organized by the Smoke-free Teens in their schools/community, and iii. To measure the number of people whom the Smoke-free Teens will deliver the smoke-free messages to.

Participants (thereafter named Smoke-free Teens) Youth between Form 1 and 4 or aged 14 to 18 will be nominated by secondary schools, youth centres and uniform groups to participate in the Smoke-free Teens Programme .

Outcomes The primary outcomes include the change in (1) knowledge on smoking hazards, (2) attitudes towards smoking, tobacco control and smoking cessation, (3) practices for promoting smoking prevention and cessation, and (4) the Smoke-free Teens' satisfaction on the training camp.

The secondary outcomes are (1) the number of people participated in the school- or community-based smoke-free programmes organised by the Smoke-free Teens, and (2) the number of smokers advised and referred to existing smoking cessation services by the Smoke-free Teens.

The Smoke-free teens will join a "2-Day-1-Night" training camp organized by the Hong Kong Council of Smoking and Health(COSH) in July or August . The camp will cover a wide range of indoor, outdoor, adventure-based, experiential learning activities. Besides, the teens will be equipped with the knowledge on smoking hazards, tobacco control and smoking cessation. In addition, the teens will be taught how to deliver a brief smoking cessation intervention using the "AWARD" Model: 1) Ask about smoking, 2) Warn the smokers that at least half will be killed by smoking, 3) Advise to quit (reduce) as soon as possible, 4) Refer to cessation clinics or hotlines, and 5) Do it again until the smokers quit. By the end of the training camp, the teens should be confident and competent in delivering the brief smoking cessation intervention to smokers. After the training camp, the teens will then break down into groups to organize smoke-free programmes in their schools or in the community.

Survey instrument A structured questionnaire designed by the smoking cessation team, School of Nursing, the University of Hong Kong will be used to evaluate the training camp. The questionnaire covers four areas, including (1) knowledge on smoking hazards, (2) attitudes towards smoking, tobacco control and smoking cessation, (3) practices for promoting smoking prevention and cessation, and (4) self-efficacy to deliver smoking cessation advices. The items of the questionnaire have been adopted and modified from previous studies on smoking cessation, with well-established psychometric properties. A process evaluation form will also be developed by the smoking cessation team to assess how the teens satisfy with the training camp, and to determine whether the content of the training camp meets the learning needs and expectations of the teens.

To evaluate the smoke-free programmes organized after the training camp, each group of the Smoke-free Teens will be required to submit a written proposal to COSH. In addition, a final report that contains the information about the number of people reached by the programmes, publicity, and the process and outcomes of the programmes, will be submitted for review.

Data collection Data collection will be conducted by COSH. All Smoke-free Teens will be invited to respond to the structured questionnaire at baseline (T1), immediately after the training camp (T2), and 3 (T3) and 6 months later (T4). In addition, they will be asked to complete a process evaluation form immediately after the training camp (T2). Comments and suggestions provided by the teens in the process evaluation form will be taken into account for future improvement of the training camp. In addition, each group of teens will have to submit the written proposal and final report regarding the smoke-free programme to COSH at 3 (T3) and 6 (T4) months, respectively.

Statistical analysis The Statistical Package for Social Science (SPSS: Version 23; SPSS Inc., Chicago, Illinois, USA) for Windows will be employed to analyze the data. Descriptive statistics will be used to describe the demographic characteristics of the Smoke-free Teens. Paired samples t-test and McNemar's test will be conducted to assess the change in knowledge, attitudes and practices of the Smoke-free Teens regarding smoking, tobacco control and smoking cessation before and after the training camp. To evaluate the smoke-free programmes organized by the Smoke-free Teens after the training camp, descriptive statistics will be used to report the number of people reached by the programmes, publicity, and the process and outcomes of the programmes.

Inclusion Criteria:

• be able to communicate with Cantonese, nominated by secondary schools, youth centres and uniform groups

Exclusion Criteria:

-

The relevant anonymized patient level data, full dataset, technical appendix, and statistical code are available on reasonable request. The approval from the Principal Investigator for the purpose of data use is required.

After the project is completed and the results of the project has been published.

Request could be sent to Principal Investigator (william3@hku.hk)