Integrating Adolescents' Oral Health Promotion with Smoking Prevention: A Randomised-Trial

OBJECTIVE: Only limited information is available on the effectiveness of integrated oral health promotion strategies. This randomised-controlled trial sought to evaluate the impact of a life skills training (LST) for smoking prevention on adolescents' oral health. METHODS: This study involved 8th-graders in 10 LST intervention and 11 standard-education control high schools in rural Limpopo province, South Africa (age 12-19 years; n=2,119). The intervention schools received an adapted South African version of the US LST curriculum beginning in Grade 8 and continuing through Grade 9 (booster dose). Content focused on building general and tobacco-use specific life skills such as decision-making, stress management, and resisting peer pressure to smoke. Where the information about consequences of smoking was included, short-term health effects was the focus. The programme in particular made prominent the effect of bad breath on social interaction, especially as it relates to the adolescents' romantic aspirations. To evaluate programme's effect, self-administered questionnaire was used to assess oral health and tobacco use outcome measures at baseline (T1), 12-month (T2) and 18-month (T3). Oral hygiene status was recorded at T1 and T3. The programme's effects were analysed using multilevel random coefficients models. RESULTS: Compared to control schools, the adolescents in the intervention schools were less likely to report non-daily brushing (OR=0.61; p<0.001) and experienced less frequent gum bleeding (OR=0.84; p=0.01). Furthermore, the adolescents in the intervention schools demonstrated a more favourable oral hygiene, oral health attitude and cigarette-offer refusal self-efficacy at T3. Although, intervention schools experienced a 51% greater reduction in smoking prevalence, this impact of the programme did not reach statistically significance. The programme was however significantly more effective in reducing smoking rates among adolescents that were non-users of smokeless tobacco at baseline. CONCLUSIONS: LST is at least potentially effective for preventing smoking among adolescents, while effectively promoting their oral health.