DEVELOPMENT OF TOBACCO CONTROL EDUCATIONAL MATERIALS: POSTERS AND NOTEBOOKS AMONG ADOLESCENTS IN NIGERIA

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Omotayo F. Fagbule^1,2, Mary E. Osuh^1,2, Folake B. Lawal^1,2, Olushola Ibiyemi^1,2

1. Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
2. Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria.

Abstract

Background: Tobacco use is a leading preventable cause of morbidity and mortality and poses a significant burden on fragile health systems in low- and middle income countries (LMICs), including Nigeria. Adolescents are particularly at risk of starting to use tobacco due to factors such as misinformation and insufficient knowledge about its harmful effects. There is an urgent need for culturally appropriate, acceptable, and sustainable interventions to enhance knowledge, correct misconceptions, and promote positive behavior change regarding tobacco use. This study describes the development and validation of culturally tailored, Health Belief Model (HBM)-based educational materials (posters and notebooks) for tobacco-related health education among adolescents in Nigeria.

Methodology: The Design-Based Research (DBR) approach was used to develop posters and notebooks featuring tobacco-related messages. These messages were adapted from the World Health Organization’s (WHO) Tobacco Control Manual for Schools, based on the HBM constructs, and tailored to fit the Nigerian context. The materials underwent validation through reviews by a multidisciplinary panel of experts who assessed their clarity, cultural relevance, and theoretical alignment. Subsequently, they were pre-tested among 150 adolescents from public and private schools in Ibadan, Nigeria. Feedback from the adolescents guided iterative refinements, culminating in the development of the final versions of the materials.

Results: The educational materials conveyed information on different tobacco forms, the harmful constituents, health effects, and skills to avoid tobacco use. Expert reviewers confirmed the materials’ alignment with HBM constructs.
Participants in the pre-test rated the materials highly, with 89.3% describing the information as “very good” and 80.7% supporting their integration into the school curriculum.

Conclusion: The tobacco control educational posters and notebooks were found to be contextually appropriate and addressed gaps in tobacco-related knowledge and behavior change strategies. They offer a scalable model for school-based interventions in LMICs and could contribute to broader public health education efforts.

Keywords: Africa, Health-promoting schools, Smoking cessation, Teenagers, Tobacco prevention.

Introduction

Globally, tobacco use causes over eight million deaths annually, the majority occurring in low- and middle income countries (LMICs), including Nigeria.¹ Tobacco use in Nigeria remains a public health problem, particularly among adolescents, with prevalence estimates ranging from 0.2% to 32.5%.^2,3. Adolescents are particularly vulnerable to tobacco use uptake, with most adult smokers initiating tobacco use during adolescence.^4–6 Several factors promote tobacco use initiation, including insufficient knowledge of its health risks, perception of tobacco use as normal, lack of resistance skills, low refusal self-efficacy, prior use or intention to use, and the belief that tobacco use is glamorous.^7–9 Addressing these factors requires sustainable, cost-effective interventions tailored to the local context.

Tobacco-related health education improves knowledge and reshapes perceptions, reduces susceptibility, intention to use, and eventual uptake of tobacco.^10–12 Effective interventions often use behavioral models such as the Health Belief Model (HBM), which emphasizes key constructs like perceived risks, benefits, barriers, severity, cues to action, and selfefficacy.¹³ HBM-based educational interventions have been successfully used to reduce the prevalence of tobacco use¹⁴, including improving the knowledge, attitudes, and intention to quit tobacco use among school-going adolescents in Nigeria.¹⁵

Health education can be delivered through various methods, including expert-led sessions, teacher-led initiatives, peer-led approaches¹⁶, and other strategies such as the use of songs and folktales.^17–19 Additionally, self-directed learning is increasingly recognized as a valuable method, enabling individuals to independently engage with structured educational materials.²⁰ Some of the common educational materials used in health related interventions are posters and notebooks. Posters and notebooks are particularly useful as visual aids for lectures, enhancing retention and engagement. Both offer an innovative approach to self-directed learning, empowering individuals to access and revisit critical health messages at their own pace. This makes them versatile tools for health education interventions. It would then be of immense benefit if these two educational materials could be developed suited to tobacco control among adolescents who are vulnerable based on local context and validated by experts and the target audience for their suitability before use in an intervention.

This study documents the development of educational posters and notebooks designed to address tobacco use among adolescents in Nigeria as part of an educational intervention on tobacco control.