• Oscar Campos Lisboa, Breno Bernardes-Souza, Luiz Eduardo De Freitas Xavier, Matheus Rocha Almeida, CorrêaPaulo César Rodrigues PintoPCRP0000-0002-8302-9970School of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil., and Titus Josef Brinker.
• School of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil.
• J. Med. Internet Res. 2019 Feb 21; 21 (2): e12854.

BackgroundSmoking is the largest preventable cause of mortality in Brazil. Education Against Tobacco (EAT) is a network of more than 3500 medical students and physicians across 14 countries who volunteer for school-based smoking prevention programs. EAT educates 50,000 adolescents per year in the classroom setting. A recent quasi-experimental study conducted in Germany showed that EAT had significant short-term smoking cessation effects among adolescents aged 11 to 15 years.ObjectiveThe aim is to measure the long-term effectiveness of the most recent version of the EAT curriculum in Brazil.MethodsA randomized controlled trial was conducted among 2348 adolescents aged 12 to 21 years (grades 7-11) at public secondary schools in Brazil. The prospective experimental design included measurements at baseline and at 6 and 12 months postintervention. The study groups comprised randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes in the same schools (no intervention). Data were collected on smoking status, gender, social aspects, and predictors of smoking. The primary endpoint was the difference in the change in smoking prevalence between the intervention group and the control group at 12-month follow-up.ResultsFrom baseline to 12 months, the smoking prevalence increased from 11.0% to 20.9% in the control group and from 14.1% to 15.6% in the intervention group. This difference was statistically significant (P<.01). The effects were smaller for females (control 12.4% to 18.8% vs intervention 13.1% to 14.6%) than for males (control 9.1% to 23.6% vs intervention 15.3% to 16.8%). Increased quitting rates and prevented onset were responsible for the intervention effects. The differences in change in smoking prevalence from baseline to 12 months between the intervention and control groups were increased in students with low school performance.ConclusionsTo our knowledge, this is the first randomized trial on school-based tobacco prevention in Brazil that shows significant long-term favorable effects. The EAT program encourages quitting and prevents smoking onset, especially among males and students with low educational background.Trial RegistrationClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021.International Registered Report Identifier (Irrid)RR2-10.2196/resprot.7134.©Oscar Campos Lisboa, Breno Bernardes-Souza, Luiz Eduardo De Freitas Xavier, Matheus Rocha Almeida, Paulo César Rodrigues Pinto Corrêa, Titus Josef Brinker. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.02.2019.

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