Effectiveness of Comics to Promote Tobacco-related Knowledge, Attitudes and Behaviours Among Primary School Students

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

The goal of this pilot RCT is to evaluate the effectiveness of comics containing tobacco-related content in improving tobacco-related knowledge and attitudes among Hong Kong primary school students. The main questions it aims to answer are:

• Is the intervention (i.e. comics) effective in improving tobacco-related knowledge (including alternative smoking products (ASPs) and tobacco control development in the world and Hong Kong) compared to controls (i.e. information sheets)?
• Is the intervention (i.e.comics) effective in improving tobacco-related attitudes and intentions (including ASPs and tobacco control development in the world and Hong Kong) compared to controls (i.e. information sheets)?

Researchers will compare the questionnaire results from students to see if intervention groups (students reading comics) will have better tobacco-related knowledge, higher anti-tobacco attitudes and lower intention to smoke compared to the control group (students reading information sheets).

Study Overview

• Status: Active, not recruiting
• Conditions: Tobacco Prevention
• Intervention / Treatment: Other: Tobacco-related comics; Other: Conventional health leaflet

• Study Type: Interventional
• Enrollment (Estimated): 1000
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong
    • Local primary schools

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 Chinese

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: Intervention; Intervention group students will receive a series of five tobacco-related comics during the 2-week study period.	Other: Tobacco-related comics; A series of five comics are developed specifically for this study. The comics will address five key themes which we found could be reinforced based on our previous project. This includes [1] the harms of tobacco use, [2] secondhand smoke (SHS), [3] thirdhand smoke (THS), [4] alternative smoking products (ASPs), and [5] the tobacco industry and tobacco-related policies in Hong Kong and worldwide.
Active Comparator: Control; Control group students will receive five conventional health leaflets or related educational materials.	Other: Conventional health leaflet; The selected leaflets will be based on information from existing tobacco prevention leaflets routinely distributed by the Tobacco and Alcohol Control Office and the Student Health Service and specifically targeting students.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 12-16th days.
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 both pre-test and post-test: 1) Smoking accelerates skin ageing; 2) Secondhand smoke can trigger asthma and middle ear infections in children; 3) Opening windows or using a fan can eliminate the effects of thirdhand smoke; 4) E-cigarettes with added flavors are harmless to the body; 5) Hong Kong prohibits smoking while queuing for public transport. Questions may be subject to change, as they will be adjusted according to the leaflets/comics, while maintaining a similar format. Students' knowledge will be assessed using a 3-point Likert scale, with each item rated on a 3-point Likert scale ranging from -1 (wrong) to 1 (correct).	Right before the intervention and at 12-16th 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) Banning smoking in all places would harm smokers' rights; 2) I will actively avoid secondhand smoke; 3) Using e-cigarettes is safer than smoking traditional cigarettes; 4) Tobacco companies use various methods to encourage people to smoke; 5) The government should ban the sale of flavored smoking products. Questions may be subject to change, as they will be adjusted according to the leaflets/comics, while maintaining a similar format. 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 12-16th days.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 12-16th days.
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 12-16th days.
Adherence to the 5-day intervention	Students will report their adherence to the intervention. Students were asked: In the past two weeks, how many comics / leaflets did you read in total?	At 12-16th days
Satisfaction of students towards intervention	Students were aksed: Do you find the content of the comics / leaflets engaging?; Do you think the content of the comics / leaflets is easy to understand?; What do you think about the length of the comic/leaflet?; If the comics / leaflets include more new information about tobacco in the future, would you like to read them?	At 12-16th 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 20, 2026
• Primary Completion (Estimated): July 31, 2026
• Study Completion (Estimated): August 31, 2026

Study Registration Dates

• First Submitted: February 27, 2026
• First Submitted That Met QC Criteria: February 27, 2026
• First Posted (Actual): March 6, 2026

Study Record Updates

• Last Update Posted (Actual): May 4, 2026
• Last Update Submitted That Met QC Criteria: April 28, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Children; Health literacy; Tobacco prevention; Non-pharmaceutical intervention
• Other Study ID Numbers: coshrct2526

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