Effectiveness of Comics to Promote Tobacco-related Knowledge, Attitudes and Behaviours Among Primary School Students

Students reported their opinions towards 5 statements in both pre-test and post-test:

• Smoking accelerates skin ageing; 2) Secondhand smoke can trigger asthma and middle ear infections in children; 3) Opening windows or using a fan can eliminate the effects of thirdhand smoke; 4) E-cigarettes with added flavors are harmless to the body; 5) Hong Kong prohibits smoking while queuing for public transport.

Questions may be subject to change, as they will be adjusted according to the leaflets/comics, while maintaining a similar format.

Students' knowledge will be assessed using a 3-point Likert scale, with each item rated on a 3-point Likert scale ranging from -1 (wrong) to 1 (correct).

Students will report their opinions towards 5 statements: 1) Banning smoking in all places would harm smokers' rights; 2) I will actively avoid secondhand smoke; 3) Using e-cigarettes is safer than smoking traditional cigarettes; 4) Tobacco companies use various methods to encourage people to smoke; 5) The government should ban the sale of flavored smoking products.

Questions may be subject to change, as they will be adjusted according to the leaflets/comics, while maintaining a similar format.

Students' attitudes will be assessed using a 5-point Likert scale, with each item rated on a 5-point Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). Item scores will be recoded as appropriate, so that higher scores consistently reflect more negative attitudes.

Students were asked: If one of your good friends offers you a traditional cigarette, e-cigarette or heated tobacco product, ask you to have a few puffs, and no one will know about this as no more smoking in the future. Will you use them?

Students' intention will be assessed using a 5-point Likert scale, with each item rated on a 5-point Likert scale ranging from 1 (Definitely no) to 5 (Definitely yes). Lower scores indicate a lower intention to use ASPs.

Students were asked: In the past 7 days, how many days (0-7) 1) was someone smoking next to you when you were at home? 2) do you smell secondhand smoke drifting in from outside when you were at home? 3) was someone smoking next to you when you were outside home? 4) you can smell cigarette smoke on objects or people when you are at home and no one is smoking, and you don't see any smoke?

Each item was rated on an 8-point scale ranging from 0 (0 days) to 7 (7 days), with higher scores indicating more frequent exposure to secondhand smoke (i.e., a worse outcome).

Students were asked: 1) Which of the following tobacco products have you ever used? 2) In the past 30 days, which of the following tobacco products have you used?

Students will report their adherence to the intervention. Students were asked: In the past two weeks, how many comics / leaflets did you read in total?

Students were aksed:

• Do you find the content of the comics / leaflets engaging?
• Do you think the content of the comics / leaflets is easy to understand?
• What do you think about the length of the comic/leaflet?
• If the comics / leaflets include more new information about tobacco in the future, would you like to read them?