While the control group selleck inhibitor showed no change in this respect, the intervention group was 2 times more likely to have smoked shisha in the last month before the intervention than in the follow-up. Study Strengths and Limitations Regarding strengths of this study, the design for randomization and recruitment proved very successful. The randomization process reduced selection bias and yielded groups with very similar baseline data. The recruitment process had high overall participation/retention rates and the same retention rate in each group, another indication of parity. Regarding intervention implementation, all activities in the five prongs were carried out by locals, trained and supervised by our teams, in order to foster a sense of intervention ownership.

This study followed the intention-to-treat analysis by including all randomized subjects in the analysis regardless of their self-reported participation in any of the intervention activities. The data analysis approach to the paired data pre- and postintervention produced a highly efficient statistical analysis; allowing the measurement of differences in behavior between groups when adjusted for potential confounders in the pairwise multivariate analysis. In terms of the limitations of this study, several methodological issues should be considered in evaluating the results. One of the weaknesses was our resource-intensive (both financially and personnel wise) approach that simultaneously targeted elementary schools, preparatory and secondary schools, youth clubs, mosques, homes, and primary health care clinics, with the intention of reaching all members of the community.

This study was not designed to identify which of the prongs was the most effective in changing knowledge, behavior, and attitudes, but rather to assess the effectiveness of the entire campaign. A smaller scale, more targeted method (e.g., a household visit) might have been equally effective and reached most members of the community. Such an approach would be applicable to similar lower income societies. Also, many of the knowledge-gain questions were only asked in the postintervention survey, so change could not be measured. Finally, a second follow-up survey administered at a certain interval of time following the intervention would have provided information on the long-term effectiveness of the intervention��s message on the hazards of smoking and ETS exposure. However, such a survey was not within the scope of the original study proposal and no such survey is currently planned. While improvements in a control group are not uncommon, the exact reason in this study is difficult Dacomitinib to pinpoint.