Intervention for Adolescent Tobacco Initiation Prevention

To assess this, a two-item Likert scale will be used: (1) "if someone (cousin/friend/close relative) offers you a tobacco product, would you use it?" and (2) "at any time during the next 12 months, do you think you will use any form of tobacco?". Responses to these questions will be categorized into four options: "Definitely not," "Probably not," "Probably yes," and "Definitely yes." This scale produces a potential range of 0-6, with lower scores indicating a lower likelihood of intending to initiate tobacco use within the next 12 months. The potential effect of the intervention will be determined by changes in scores between baseline and follow-up.

To assess self-rated physical health status, participants will be asked to rate their overall physical health conditions with five response options: 1 = very poor, 2 = poor, 3 =moderate, 4 = good and 5 = very good. The response options will be treated as a continuous ordinal measure. Therefore, a higher score indicates a better health condition. The potential effect of the intervention will be determined by changes in scores between baseline and follow-up.

The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) will be used to measure participants' overall mental well-being. This validated 7-item 5-point Likert scale scores range from 7 to 35 and higher scores indicate higher positive mental wellbeing. The potential effect of the intervention will be determined by changes in scores between baseline and follow-up.

To assess the participants' level of stress, the 10-item Perceived Stress Scale (PSS) will be used. This widely recognized scale assesses the extent to which individuals perceive situations in their lives as stressful. Responses will be collected on a 5-point Likert scale, with 0 indicating 'never,' 1 = almost never, 2 = sometimes, 3 = fairly often, and 4 indicating 'very often.' A total score for each adolescent will be obtained by summing the scores across all 10 items for a total range of 0 to 40. A higher score indicates higher perceived stress. The potential effect of the intervention will be determined by changes in scores between baseline and follow-up.

One of the most popularly used 7-item scales, the Generalized Anxiety Disorder-7 (GAD-7) will be used to identify participant's anxiety in this trial. Participants will be asked how often they were bothered by each of the seven core symptoms of GAD with four response options: 0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day, over the last 14 days. The response options will also be calculated as a continuous ordinal measure. Therefore, the range of scores of the GAD-7 will be 0 to 21. A higher score indicates a higher level of anxiety. The potential effect of the intervention will be determined by changes in scores between baseline and follow-up.

The Patient Health Questionnaire-9 (PHQ-9) will be used to assess the level of depression. Participants will be asked how often they were bothered by each of the nine core symptoms of PHQ-9 with four response options: 0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day, over the last 14 days. The response options will also be calculated as a continuous ordinal measure. Therefore, the range of scores of the GAD-7 will be 0 to 27. A higher score indicates a higher level of depression. The potential effect of the intervention will be determined by changes in scores between baseline and follow-up.

To assess participant's knowledge about tobacco and health, a set of 20 items will be used. A participant will earn 1 point for each correct response, while an incorrect or unknown answer will be scored as 0 points. The cumulative knowledge score will be calculated by summing the points from all items, with a maximum achievable score of 20 points. A higher score indicates a more knowledgeable individual. The potential effect of the intervention will be determined by changes in scores between baseline and follow-up.

To measure participants' attitudes toward tobacco and health, a 16-item standardized scale will be utilised. Each item is structured as a Likert-type scale with five ranks. A quantitative approach will be employed to summarize the responses across all attitude items. For positive attitude items, responses of ''extremely agree'' will be scored as 5 points, ''agree'' as 4 points, ''unclear'' as 3 points, ''disagree'' as 2 points, and ''extremely disagree'' as 1 point. Conversely, for negative attitude items, the scoring will be reversed as 1, 2, 3, 4, and 5 points. The total attitude scale score will be the sum of all item scores, with a maximum attainable score of 80 points and a minimum of 16 points. A higher score indicates a more negative attitude toward tobacco.

To assess participants' beliefs about tobacco use, an 8-item scale will be used. This scale focuses on both positive (4 items) and negative (4 items) beliefs concerning various aspects of tobacco use. Participants will be asked to rate the likelihood of each scenario happening to them if they use tobacco in the next month. Responses will be collected on a 4-point Likert-type scale: 1=very likely, 2=likely, 3=unlikely, 4=very unlikely. Positive beliefs (score 8 to 32) include feeling relaxed, having fun, being popular, and being confident and outgoing. Negative beliefs (score 8 to 32) encompass issues with parents and friends, financial problems, and the risk of addiction. A lower score indicates more positive or negative beliefs about tobacco.

For 'Decision-Making Skills,' Participants will respond to statements reflecting different approaches to decision-making, indicating their level of agreement (1=Strongly Agree, 2=Agree, 3=Disagree, 4=Strongly Disagree) across five items. Differences in item responses between baseline and follow-up will be assessed to evaluate the effect of the intervention.

For 'Refusal Skills,' participants will navigate hypothetical situations, expressing their likelihood of refusal (1=Very Likely, 2=Likely, 3=Unlikely, 4=Very Unlikely) in response to three scenarios. Differences in item responses between baseline and follow-up will be assessed to evaluate the effect of the intervention.

'Self-esteem' will be assessed through agreement with self-descriptive statements (1=Strongly Agree, 2=Agree, 3=Disagree, 4=Strongly Disagree), encompassing ten items. Differences in item responses between baseline and follow-up will be assessed to evaluate the effect of the intervention.

'Problem-Solving Skills' will be assessed by responses to statements related to interpersonal dealings (1=Strongly Agree, 2=Agree, 3=Disagree, 4=Strongly Disagree), consisting of five items. Differences in item responses between baseline and follow-up will be assessed to evaluate the effect of the intervention.

'Assertiveness' will be evaluated by considering the ease or difficulty participants perceived in accomplishing certain tasks (1=Very Easy, 2=Easy, 3=Difficult, 4=Very Difficult) across six scenarios. Differences in item responses between baseline and follow-up will be assessed to evaluate the effect of the intervention.