Introduction:
Arabic male adolescents have a high smoking prevalence. Introduction of “Class smoke-free” pledges have been successful amongst European adolescents but have not been evaluated using objective valid measures. We tested the impact of adding a smoke free pledge strategy to a proven peer–led asthma and smoking prevention program on breath carbon monoxide level (BCO) in male high-school students in Jordan.

Material and Methods:
We enrolled male students from four high-schools in Irbid, Jordan. Schools were randomly assigned to receive either TAJ (Triple A in Jordan, n= 218) or TAJ-Plus (with added class smoke-free pledge, n=215). We hypothesized that students receiving TAJ-Plus would have greater reduction in BCO levels than those only receiving the TAJ intervention. Asthma and smoking status were assessed by self-administered questionnaires. Smoking outcomes were collected using a BCO Monitor.

Results:
Both groups had significant reductions in BCO levels post-intervention (p<0.0001), however, decreases were greater in TAJ-Plus group (3.9±0.2 vs 4.8±0.2, p<0.0001). Intervention effects on BCO over time did not vary by smoking status (p=0.085), asthma status (p=0.602), or a combination of the two (p=0.702).

Conclusions:
An added smoke-free pledge strategy to a proven peer-led asthma education program appears to be a promising approach to motivate adolescents to abstain from smoking in Jordan. Future research is required to determine if these results can be extended to Jordanian adolescent females.

Funding:
The Deanship of Scientific Research at Jordan University of Science and Technology provided financial support for this study (Fund No.96/2012).