Reaching Jewish ultra-orthodox adolescents: Results from a targeted smoking prevention trial

Background: Ultra-orthodox, Jewish adolescent boys are considered to have relatively high smoking rates, but are generally not targeted by Israel ' s smoking prevention programs. Objective: The objective of this trial was to test the effectiveness of a religion-based tobacco control intervention in reducing smoking prevalence among these youth. Methods: The study population participants were 340 boys from 63 religious boys ' schools in Jerusalem. The intervention consisted of a mailing that included a pamphlet describing the health effects of and rabbinical prohibitions on smoking. A cluster randomized trial was conducted between March and May, 2005. The primary endpoint was current smoking status. Secondary endpoints were future intent to smoke and attitudes towards smoking. Generalized estimating equations and mixed models of analysis of variance were used to perform the analyses. Results: The intervention did not significantly affect current smoking, intent to smoke or attitudes towards smoking. Prevalence of smoking and future intent to smoke were higher in schools without enforced smoking regulations [odds ratio (OR) 2.74, p = 0.026, OR 3.38, p = 0.018]. Increased smoking prevalence was associated with a high prevalence of smoking among friends (p = 0.031) and not finding smoking repulsive (p = 0.024). Conclusions: This study adds to the public health literature linking smoke-free schools and peer influences to adolescent smoking. Pamphlets containing rabbinic prohibitions on smoking initiation did not affect smoking behavior or intent to smoke.