Background:
Tobacco use is one of the biggest public health threats the world has ever faced. Tunisia is one of the countries suffering from the heavy burden of tobacco use. It is in this context that the Chronic Disease Prevention Research Center in Sousse established a school based intervention for tobacco control and prevention. Our objective was to evaluate the feasibility and effectiveness of our intervention in tobacco control and prevention by the evaluation of smoking behavior among schoolchildren at pre and post assessment in both intervention and control groups.

Methods:
We conducted a three years school based quasi-experimental study with an intervention and a control groups. We enrolled a representative sample of schoolchildren from all colleges of intervention and control areas. We have carried out a pre-assessment before the intervention in 2009-2010 and a post assessment of the same parameters at the end of the intervention in both groups in 2013-2014. We used a pre tested self administered questionnaire to assess tobacco use.

Results:
Overall, 4003 schoolchildren were included: 1929 in the intervention group and 2074 in the control group. After the intervention, 4275 schoolchildren participated in the evaluation with respectively 2170 and 2105 in each group. The age of the schoolchildren varied between 11 and 16 years. There was a decrease in tobacco use in the intervention group from 5.7% to 4.8% contrary to an increase in the control group from 7.5% to 9.2%. Among boys, the prevalence of tobacco use decreased in both groups. However, among girls, in the intervention group a decrease was noticed in the contrary to the control group where a significant increase was observed from 1.1% to 5.2%.

Conclusions:
Tobacco prevention needs multi-sectored approach and an extended intervention to be effective. That's why a political will is important for such interventions.