Effectiveness of Youth-Led awareness and advocacy intervention in shaping adolescents’ attitudes toward tobacco products in Nepal: A quasi-experimental study

Background: Tobacco use among adolescents (aged 10–19 years) remains a pressing public health concern, particularly in low-and middle-income countries like Nepal. Despite the presence of tobacco control policies, adolescents continue to access tobacco products. This study assessed effectiveness of a youth-led intervention in shaping adolescents’ attitudes toward tobacco products in Budhanilkantha Municipality, Nepal. Design and Methods: Quasi-experimental pre-post study was conducted among 305 adolescents. The intervention, implemented under the “Youth for Tobacco Initiative,” included sensitization, peer-led education, and stakeholder engagement. Data were collected using a structured, self-administered questionnaire, which was completed by students in their classroom setting. The questionnaire assessed sociodemographic characteristics, tobacco exposure, and attitudes toward tobacco use. Changes in attitudes were analyzed using paired t-tests and McNemar’s test, with effect size measured by Cohen’s d. Statistical significance was set at the 5% level. Results: Age of the participants ranged between 12 and 18 years (mean age: 15.0 ± 1.32 years). At baseline, 18.7% of adolescents reported tobacco use, and 13.8% reported currently smoking tobacco. Post-intervention, there was a statistically significant improvement in attitudes toward tobacco (mean score increased from 5.86 to 6.12; p = 0.001), with higher recognition of secondhand smoke harms and greater support for public smoking bans. The proportion of adolescents who anticipated smoking in the future declined. Although the effect size was small (Cohen’s d = 0.26), the change was meaningful. Conclusions: Youth-led awareness initiatives can positively influence adolescents’ attitudes toward tobacco, particularly through peer education and community involvement. Integrating such interventions into broader, multi-sectoral strategies can enhance their long-term impact.