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To prepare qiwam, the midribs and veins of tobacco leaves are removed, and the remaining matter is boiled in water

These strategies align with the Theoretical Domains Framework, which emphasises reducing environmental resources that enable risky behaviours ( Peer influence plays a central role in shaping adolescent behaviour ( Encouraging and recognising pupils who advocate for non-smoking was strongly recommended for helping to foster a culture in which abstaining from smoking is socially valued and is a strategy shown to be effective in LMIC contexts ( Strengthening reflective motivation: persuasion and conscious decision-making To support reflective motivation, pupils need opportunities to weigh the pros and cons of smoking and to critically evaluate their beliefs

These include tar, lead, and carbon monoxide

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