Implementation of school tobacco policies: The advocacy coalition approach. Protocol of the ADHAirE study, a cluster randomized controlled trial.

Secondary schools still struggle to enforce their tobacco policy and to keep their learning environment smoke-free. Yet, enforcement is the key to improve the effectiveness of those policies. This article describes the ADHAirE study which aims to reduce smoking at school through an improved enforcement of the school's tobacco policy. The ADHAirE study will be carried out during 2 years in 20 Belgian secondary schools. Schools will be randomized either in the experimental or the control group. Schools in the experimental group will create an advocacy coalition involving students, staff and the principal. Those schools will also be linked to the others to share best practices about their school tobacco policy. Members of the advocacy coalition will share beliefs and values about the tobacco policy and about the school's role in tobacco prevention. This randomized controlled trial will assess the effectiveness of the advocacy coalition to enforce the school tobacco policy. The ADHAirE study is based on the latest research and recommendations on school tobacco prevention. Following the social norm theory, this study goes further than many others before which only focused on health education, targeting the individual and not the social environment in which smoking occurs. Through the advocacy coalition, ADHAirE will initiate a community-level intervention that will ensure that all stakeholders are involved in decision-sharing about the rules, ensuring their acceptability, adoption and sustainability. The study is registered on the official website of ClinicalTrials.gov ID NCT06655038.