Effectiveness of an Online Quiz in Promoting Tobacco-Related Knowledge, Attitudes, and Behaviours Among Primary Students

A Modified Pilot Randomised Controlled Trial (RCT) on the Effectiveness of an Online Quiz Game to Promote Tobacco-Related Knowledge, Attitudes, and Behaviours Among Primary School Students

The goal of this modified pilot RCT is to evaluate the effects of the intervention (online platform) on tobacco-related knowledge, attitudes and intentions on smoking among local primary 5-6 school students. The main questions it aims to answer are:

• Is the intervention effective in improving tobacco-related knowledge (including alternative smoking products (ASPs) and tobacco control development in the world and Hong Kong)?
• Is the intervention effective in improving tobacco-related attitudes and intentions (including ASPs and tobacco control development in the world and Hong Kong)?

Researchers will compare the questionnaire results from students to see if intervention groups (students doing tobacco-related questions on the online quiz platform) will have better tobacco-related knowledge, higher anti-tobacco attitudes and lower intention to smoke.

Study Overview

• Status: Recruiting
• Conditions: Tobacco Prevention
• Intervention / Treatment: Other: Online quiz competition

• Study Type: Interventional
• Enrollment (Estimated): 700
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Sze Lam Luk; Phone Number: 852 54962808; Email: clamlsl@connect.hku.hk

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong
    • Recruiting
    • Local primary schools
    • Contact: Sze Lam Luk; Phone Number: 852 54962808; Email: clamlsl@connect.hku.hk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Primary 5-6 students from local primary schools
• Able to read and communicate in Chinese
• Have a digital device for online access to the quiz game at home

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Quiz related to tobacco topics; Students will engage in an online quiz competition for 5 days on tobacco-related topics. Each day, students could answer a maximum of 10 questions.	Other: Online quiz competition; Students in the intervention and control arm will participate in an online quiz game on tobacco or diet related topics respectively. Each day, students could answer a maximum of 10 questions randomly selected from the respective pool of questions by the platform. The students logged onto the online platform and played the quiz competition on weekdays for 5 days.
Active Comparator: Quiz related to healthy eating topics; Students will engage in an online quiz competition for 5 days on healthy eating-related topics. Each day, students could answer a maximum of 10 questions.	Other: Online quiz competition; Students in the intervention and control arm will participate in an online quiz game on tobacco or diet related topics respectively. Each day, students could answer a maximum of 10 questions randomly selected from the respective pool of questions by the platform. The students logged onto the online platform and played the quiz competition on weekdays for 5 days.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Effectiveness of intervention on tobacco-related knowledge (including ASPs and tobacco control development in the world and Hong Kong)	Students reported their opinions towards 5 statements in pre and post tests: [Pre-test] 1) Smoking causes wrinkles to form on the skin; 2) Third-hand smoke can remain on surfaces for weeks; 3) E-cigarettes can help with smoking cessation; 4) Tobacco companies aim to prevent teenagers from smoking; 5) The Hong Kong government has already banned the sale of e-cigarettes. [Post-test] 1) Smoking can cause hair loss; 2) Opening windows or turning on a fan can eliminate the effects of thirdhand smoke; 3) E-cigarettes avoid the problem of secondhand smoke; 4) Tobacco companies hire influencers to promote tobacco products; 5) The Hong Kong government has already banned the sale of heated tobacco products. Students' knowledge will be assessed using a 5-point Likert scale, with each item rated on a 5-point Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). Item scores will be recoded as appropriate, so that higher scores consistently reflect better knowledge.	Right before the intervention and at 8-12th days
Effectiveness of intervention on tobacco-related attitudes (including ASPs and tobacco control development in the world and Hong Kong)	Students will report their opinions towards 5 statements: 1) Smoking is a selfish behavior; 2) I hope to avoid exposure to secondhand smoke; 3) Vaping is a trend.; 4) Tobacco companies use different methods to attract people to smoke; 5) The government should prohibit people from smoking while walking. Students' attitudes will be assessed using a 5-point Likert scale, with each item rated on a 5-point Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). Item scores will be recoded as appropriate, so that higher scores consistently reflect more negative attitudes.	Right before the intervention and at 8-12th days.
Effectiveness of intervention on tobacco-related intentions (including ASPs and tobacco control development in the world and Hong Kong)	Students were asked: If one of your good friends offers you a traditional cigarette, e-cigarette or heated tobacco product, ask you to have a few puffs, and no one will know about this as no more smoking in the future. Will you use them? Students' intention will be assessed using a 5-point Likert scale, with each item rated on a 5-point Likert scale ranging from 1 (Definitely no) to 5 (Definitely yes). Lower scores indicate a lower intention to use ASPs.	Right before the intervention and at 8-12th days.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Effectiveness of intervention on tobacco use	Students were asked: 1) Which of the following tobacco products have you ever used? 2) In the past 30 days, which of the following tobacco products have you used?	Right before the intervention and at 8-12th days.
Adherence to the 5-day intervention	Students will report their adherence to the 5-day intervention. This information will be extracted directly from online quiz log of the participants via the backend of the system.	At 8-12th days
Satisfaction of students and parents towards intervention	These will be assessed using a qualitative interview for a subset of the participants and their family (10 students and parents)	From 2-8 weeks after the completion of the post-questionnaire
Effectiveness of intervention on SHS and THS exposure at home	Students were asked: In the past 7 days, how many days (0-7) 1) was someone smoking next to you when you were at home? 2) do you smell secondhand smoke drifting in from outside when you were at home? 3) was someone smoking next to you when you were outside home? 4) you can smell cigarette smoke on objects or people when you are at home and no one is smoking, and you don't see any smoke? Each item was rated on an 8-point scale ranging from 0 (0 days) to 7 (7 days), with higher scores indicating more frequent exposure to secondhand smoke (i.e., a worse outcome).	Right before the intervention and at 8-12th days.

Collaborators and Investigators

• Sponsor: The University of Hong Kong
• Collaborators: Hong Kong Council on Smoking and Health
• Investigators: Principal Investigator: Shiu Lun Ryan Au Yeung, School of Public Health, The University of Hong Kong

Study record dates

Study Major Dates

• Study Start (Actual): April 11, 2025
• Primary Completion (Estimated): August 31, 2025
• Study Completion (Estimated): September 30, 2025

Study Registration Dates

• First Submitted: March 19, 2025
• First Submitted That Met QC Criteria: March 29, 2025
• First Posted (Actual): April 6, 2025

Study Record Updates

• Last Update Posted (Actual): April 22, 2025
• Last Update Submitted That Met QC Criteria: April 16, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: adolescents; tobacco cessation; literacy; non-pharmaceutical intervention
• Other Study ID Numbers: coshdrama2425

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data underlying the results in this article, including text, tables, figures, and appendices, along with the study protocol and statistical analysis plan, will be available for sharing. Data access will be granted starting three months after publication and will remain available for up to five years. Researchers with a methodologically sound proposal aligned with the approved study objectives may request access by contacting the principal investigator(PI) (Ryan Au Yeung) at ayslryan@hku.hk. Approved data requestors will be required to sign a data-access agreement.
• IPD Sharing Time Frame: Starting three months after publication and will remain available for up to five years.
• IPD Sharing Access Criteria: Researchers with a methodologically sound proposal aligned with the approved study objectives may request access by contacting the PI (Ryan Au Yeung) at ayslryan@hku.hk. Approved data requestors will be required to sign a data-access agreement.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No