Promoting Smoking Cessation for Female Smokers in Hong Kong Through Training Female Youth SCRA

Phase I: Increase public awareness of the beneficial effects of smoking cessation on female smokers Five thousand leaflets on woman smoking cessation will be distributed to the Girl Guide, the University of Hong Kong and 40 secondary schools. For those who are not ready to join the training, they will be encouraged to help to increase the awareness of the importance of promoting smoking cessation by disseminating the leaflets to others, especially female smokers in the population.

Phase II: Deliver a smoking cessation training curriculum for the female youth recruited through the Hong Kong Girl Guides Association, the University of Hong Kong and 40 secondary schools.

The investigators aim to train 120-150 female youth (with the priority given to the Hong Kong Girl Guides Association) to be SCRA with better understanding on the needs and feelings of female smokers.The investigators will deliver a half-day SCRA training workshop to the female youth. In addition to the leaflets above, the investigators shall publicize the training workshop and recruit participants via bulk emails, newsletters and the homepage of the Hong Kong Girl Guides Association, the University of Hong Kong and 40 secondary schools. The investigators will draw on our experience in conducting smoking cessation training programmes for our existing projects such as Youth Quitline and Quit to Win Contests. In addition, the investigators shall train and empower participants how to deliver a brief smoking cessation advice to female smokers. For those who do not want to quit, they will be advised to reduce smoking as the first step towards quitting. Throughout the training, participants will be taught to deliver the "AWARD" approach: 1) Ask about smoking, 2) Warn the smokers that at least half will be killed by smoking, and the female specific harms due to smoking, 3) Advise to quit (or reduce) as soon as possible, 4) Refer to a cessation clinic or hotline, and 5) Do it again until they quit.7 At the end of the training workshop, participants should be capable of delivering brief smoking cessation and reduction advice to female smokers, and a referral system will be set up so that women who accept more intensive counselling can be referred to our and other more specialised smoking cessation services. Upon completion of the training, a certificate of attendance will be awarded to the participants.

The outcomes of the training will be evaluated before and immediately afterwards, and 3- and 6-month post training. A smoking-, tobacco control-, and smoking cessation and reduction-related knowledge, attitudes and practice (KAP) survey, 15 using a modified version of previous questionnaires which have been used to assess other smoking cessation training workshop,16 will be conducted.

Additionally, there is increasing evidence that the Health Action Process Approach (HAPA) is helpful in explaining the psychological mechanisms in bridging the gap between intention and actual change in health behaviour.17 According to HAPA model, an individual's intention either to engage in a preventive measure or to modify risky behaviour in favour of a healthy practice, action plans and action control help the individual to structure a strategy for maintaining healthy practices and defeating other conflicting ideas.18 Adopting the HAPA model,17 intention, self-efficacy, and planning to provide smoking cessation and reduction advice will also be assessed.

Phase III: Deliver a age and gender-specific smoking cessation advice

The trained female SCRA will be encouraged to deliver "AWARD" to at least 2 female smokers to advise them to reduce and quit smoking. Self-help smoking cessation booklet designed by Hong Kong Council on Smoking and Health, a partner of our smoking cessation research team, will be provided. The trained youth ambassadors can identify and reach the target female smokers in the following ways:

1. from their family members, relatives, friends, peers, schoolmates, or colleagues in workplaces;
2. If the trained youth ambassadors cannot identify and reach target female smokers from (1), the investigators can refer female smokers to them through our other smoking cessation projects, such as Youth Quitline or Quit to Win project with the consensus from the female smokers