Smoking and children

Tobacco use among in-school young adolescents in Indonesia: Exploring availability, affordability, and accessibility

The research on Indonesian adolescents' perception of tobacco control in schools is limited. This study aimed to explore the availability, affordability, and accessibility of tobacco among young adolescents in Yogyakarta Municipality, Indonesia, with a focus on advocating for school teenagers. Focus groups, comprising participants from diverse backgrounds and stakeholders, were conducted in Yogyakarta, Indonesia, to systematically collect varied data. The subsequent analysis employed a robust thematic approach, combining both inductive and deductive processes to ensure a nuanced exploration of emerging patterns and pre-existing frameworks. In addition to focus group data, the study incorporated insights from extensive field observations and research group discussions. The multifaceted approach enhanced the depth of analysis but also facilitated a comprehensive understanding of the complex dynamics. The findings of this study revealed that young adolescents found it extremely easy to purchase cigarettes from local markets. The smoking prevalence among young adolescents was relatively low, with only 10% of the respondents admitting to smoking. Although the Indonesian government has increased surveillance and regulations regarding smoking among young individuals, the actual implementation and effectiveness of these measures remain questionable. The existing anti-smoking approaches in Indonesia have been unsuccessful in curbing smoking among Indonesian school students. The study argues that it is crucial to recognize and value students' perceptions of smoking, as their knowledge of smoking is actively constructed. To address this issue, future anti-smoking education in schools should incorporate interactive sessions rather than solely relying on didactic approaches that highlight the harms of smoking. By engaging students in interactive discussions, they can actively participate in constructing their understanding of the consequences of smoking. Additionally, efforts should be made to enhance the implementation of tobacco control measures within schools and extend the reach of these measures to off-campus environments.

Factors influencing tobacco use behaviour initiation - From the perspective of the Capability, Opportunity, Motivation- Behaviour (COM-B) Model

Introduction

Non-communicable diseases such as ischemic heart disease, cancer, diabetes, and chronic respiratory diseases are the leading causes of death worldwide, and are associated with tobacco use. The ultimate goal of health professionals and researchers working to combat smoking's extremely harmful health effects is to prevent smoking initiation. Nearly 5500 new smokers are added each day, for a total of almost 2 million new smokers each year. The COM-B model's primary goal is to determine what needs to be done for a behaviour change to occur. Behaviour modification requires an understanding of the factors that drive behaviour.

Aim

The current qualitative study intends to explore the factors affecting tobacco use initiation (TUI) using the COM-B model, given the relevance of investigating the factors affecting TUI and the model.

Methods

The present qualitative study has used a directed content analysis approach. Seventeen participants who reported having started any kind of tobacco in the last six months were recruited in the study using a purposive sampling method to understand the factors affecting TUI. The data was collected through interviews, and all of the participants were from the Hyderabad-Karnataka region of Karnataka, India (a state which has been reported as having the highest prevalence of cigarette smoking in India).

Results

Directed content analysis revealed six categories: psychological capabilities affecting TUI (lack of knowledge about adverse health effects of tobacco, behavioural control, and poor academic performance), physical capabilities affecting TUI (lack of better physical resilience), physical opportunities favouring TUI (tobacco advertisements, easy access of tobacco products, and favourite star smoke on screen), social opportunities favouring TUI (peer influence, tobacco use by parents, tradition of hospitality, tobacco use as a normal behaviour, and toxic masculinity), automatic motivation causal factors of TUI (affect regulation, risk taking behaviours and tobacco use for pleasure) and reflective motivation causal factors of TUI (perceived benefits of tobacco, risk perception, perceived stress, and compensatory health beliefs).

Conclusion

Identifying the factors that influence TUI may help to limit or prevent people from smoking their first cigarette. Given the importance of preventing TUI, the findings of this study indicated the factors that influence TUI, which can be valuable in improving behaviour change processes.

Evaluating the Role of Media in Implementation of 85% Graphic Warnings on Tobacco Products in India

Background: In common with many countries globally, India has a history of graphic health warnings (GHWs) being weakened or delayed due to tobacco industry influence. If tobacco is eliminated from society, nearly 30% of all cancers can be prevented. Objectives: This study examines the role of the media in the recent changes to the 85% GHWs implementation in India. Materials and Methods: Media articles from the date of notification of 85% GHW (October 15, 2014) to the date of its implementation (April 1, 2016) were collected and coded as pro, anti, or neutral. These were compared, correlated to significant government actions during the time period to determine if media influenced the government actions on the implementation of GHWs. Results: A total of 3301 media articles regarding 85% GHWs were found during the study period, of which 2961 were pro, 333 were anti, and seven were neutral. The results showed that there was a positive correlation of media on the implementation of GHWs. Conclusion: Media coverage of the issue did appear to have an impact.

Determinants of Tobacco Use among Children of a Rural Village in India: An Exploratory Qualitative Study

BACKGROUND

Tobacco is one of the leading causes of preventable deaths. It is both a major social and health problem. According to National Sample Survey Organization of Government of India about 20 million children of ages 10-14 are estimated to be tobacco-addicted. There are grave consequences of tobacco both socially and also on health thus it is of utmost importance to understand the factors leading to its use and to plan strategies to reduce its intake. However, the health implications of this social issue in a rural context have not been explored.

AIMS AND OBJECTIVE

this study makes an attempt to explore the health and social implications of tobacco usage by the children below the age of 14 years in hamlet.

MATERIALS AND METHODS

  The present study employed a qualitative study design. Data was collected using focus group discussion and in-depth interview of key informants. Thematic analysis for exploring the explicit and implicit meanings within the data was done. The themes which emerged were knowledge about tobacco and the various products available, children and parents' tobacco use and habits, the health and social implication of tobacco use, reasons for tobacco use by the children.

RESULTS

It was found tobacco use by the children was very common in the community. Parent, peer pressure, sibling pressure were found to be playing important role in the initiation of tobacco habit by the child. Further illiteracy and lack of awareness was also lead to tobacco use among children.

CONCLUSION

The study identifies education and awareness of parents about the ill-effects of tobacco play an important role as parents act as role model for their children, thus equal stress should be laid in improving the parental habits. Even raising the prices of tobacco products can help in controlling this habit.
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A Study on Tobacco Use Among School Children

Tobacco use among school children is becoming a serious problem. The early age of initiation underscores the urgent need to intervene and protect this vulnerable group from falling prey to this addiction. The present study was undertaken to assess (i) the prevalence and pattern of tobacco use among school children in India (ii) relation of tobacco use prevalence and pattern with socio-economic status (SES) of student's family. This is a cross sectional 16 months study done in school going Indian students aged ≥ 6 years with sample size of 1460. The prevalence of tobacco use in children from lower SES families was 9.4% compared to 5.7% in children from middle SES families (p = 0.017). Among children who used tobacco, mean age of onset was younger among children from lower SES (9.97 year vs 11.85 year, p = < 0.01) and they were more likely to use smokeless tobacco only (79.1% vs 61.3%, p = .0.006). However there was no significant difference between two groups in factors which motivated them towards first experience of tobacco. Also there was no significant difference between family histories of two groups in terms of tobacco use. The high prevalence of tobacco consumption, especially smokeless tobacco among children highlights the need for early intervention like regular screening at school level. Also tobacco use cases need to be followed up with intensive treatment.

Potential roles of school administrators and community-residing adults in tobacco use prevention in Nigerian college students: a viewpoint

Tobacco use is a key risk factor for the development of non-communicable diseases such as coronary heart disease, stroke, and peripheral vascular disease. On May 31 every year, World No Tobacco Day is celebrated to draw attention to the health risks and other risks related to tobacco use and to campaign for effective policies to minimize tobacco use. In this paper, we address important issues related to tobacco use, and highlight the potential roles of school administrators and community-residing adults in supporting college students in Nigeria in refraining from tobacco use. We argue that various stakeholders, including school administrators and community-residing adults, have important roles to play in providing community- and school-level support to college students to enable them to refrain from tobacco use. However, research is needed to empirically measure whether and how school administrators and community-residing adults have helped to reduce tobacco use in college students in Nigeria.

The etiologic spectrum of head and neck squamous cell carcinoma in young patients

Head and neck squamous cell carcinoma (HNSCC), accounting for more than 80% in head and neck malignancies, kills thousands of people a year in the world. Despite most of the patients are more than 45, and the occurrences of head and neck cancer shows a decreasing trend; however, horribly, the incidences of the patients under 45 years old is steadily increasing. Hence, it's of vital importance to get more pathogen information about risk factors of HNSCC in children and young adults. This review outlines the etiologic spectrum of HNSCC, especially oral/oropharyngeal squamous cell carcinoma, in patients under 45 years of age.

An Informal School-based, Peer-led Intervention for Prevention of Tobacco Consumption in Adolescence: A Cluster Randomized Trial in Rural Gandhinagar

Background:

Tobacco use among adolescence is one of the important preventable causes of death as well as a leading public health problem all over the world. The present study was conducted with the objective of studying the effect of peer-led interventions on tobacco use among adolescents.

Materials and Methods:

Twenty schools were randomly selected and ten schools each were identified as cluster for intervention and control groups. A total of 402 students in intervention group and 422 in control group were studied.

Results:

About 48% and 41% of adolescents were consuming smokeless tobacco in any form in the intervention and control groups, respectively. Prevalence of consumption of smokeless tobacco was significantly high among boys as compared to girls. Pan masala was the most common form of consumption. After conducting A Stop Smoking in School Trial-like peer-led intervention, a significant reduction in tobacco consumption of any form was observed in the intervention group (48%–36%) during the follow-up (Z = 3.2, P < 0.01). A significant reduction in exposure to passive smoking in the intervention group (32%–29%) was also observed. All the students smoking initially had stopped smoking at the end of the follow-up in both the groups.

Conclusion:

It was found that peer-led intervention was effective in reducing the consumption of smokeless tobacco in any form. The rate of reduction was more in the first follow-up as compared to the end of the intervention. Sustained intervention in the form of retraining is needed for the long-term effect.

Factors Associated with Tobacco Use in Students Attending Local Government Schools in Mumbai, India

Purpose: Factors associated with ever-use and differences between ever-users and non-users of tobacco among adolescent school students from low income families in Mumbai were assessed. Materials and Methods: A self-administered questionnaire, completed by 1918 students from grades 7, 8 and 9 in 12 schools managed by the city municipal corporation in July 2015, gathered data on socio-demographic characteristics, tobacco use and tobacco-related knowledge, attitudes and beliefs. Results: Although only 1% of respondents thought tobacco was cool, nearly 35% were unaware of associations between tobacco use and health problems. Male students were almost twice as likely (OR=2.5, P <= 0.05) to have ever used tobacco compared to females and Supari (areca nut) users were eight times more likely (OR=8.99, P < 0.001) than Supari non -users. Tobacco-users were more likely to agree with statements: ‘People who use tobacco have more friends’ (OR=2.8, P = 0.004), ‘Smoking relieves stress’ (OR=5.6, P = 0.002) and ‘It is possible to purchase any tobacco product within 100 yards of school’ (OR=10.8, P < 0.001). Conclusion: This study highlights the gains made by tobacco prevention campaigns in that almost all students did not consider tobacco as cool or a stress reliever. However, they still need education about health consequences of tobacco-use. In addition, Supari use has to be addressed in school-based tobacco prevention and cessation initiatives. Furthermore, programs must also address perceptions and norms related to peers and tobacco use and ensure active implementation of existing laws. Such integrated measures will help ensure tobacco-free spaces around schools.

Knowledge, Attitude and Practice of Chewing Gutka, Areca Nut, Snuff and Tobacco Smoking Among the Young Population in the Northern India Population

Objective: The objective of the study was to determine the Knowledge, Attitude and Practice of chewing gutka,areca nut, snuff and tobacco smoking among the young population in the Northern India Population between the age of 15 to 22 years. Methods: The study was approved by the ethical committee. A total of 10 school and colleges located in the rural and urban areas was selected. A total of 1500 young individuals aged between 15 to 22 years were selected . A self-administered questionnaire was designed comprised of 14 closed ended questions about Knowledge, Attitude and Practice towards consumption of areca nut , gutka and tobacco smoking that were filled by the participants. Descriptive statistics were obtained and mean, standard deviation, frequency and percentages were calculated. Data was analyzed by using SPSS. Result: A total of 1050 out of 1500 students responded to the questionnaire. A total of 227 subjects agreed that they are consuming the tobacco. Out of this, 196 (86.34%) were boys and 31 (13.65%) were girls who agreed in consumption of tobacco product. Out of 196, 150 boys (76.5%) practices the habit of smoking 1 -5 times a day and 46 (23.4% ) practice the habit of chewing areca nut and gutkha 1 - 5 times a day. Out of 31 girls, 25 girls (80.6%) practices the habit of smoking 1 -5 times a day and 6 (19.4%) practice the habit of chewing areca nut and gutkha 1 - 5 times a day. Out of 740 subjects, 530 were boys and 210 girls have full knowledge of deleterious long term effects of tobacco consumption. Conclusion:The present study concluded that young population of North India lack Knowledge, Attitude and Practice regarding consumption of areca nut, gutka and tobacco smoking. Here is an urgent need to take effective steps, especially on launching community awareness programs for the school children and public to educate them about the consequences of tobacco use, and on assessing their effectiveness in curbing the problem.

Indian Youth Speak About Tobacco: Results of Focus Group Discussions With School Students

This article discusses the findings of Focus Group Discussions (FGDs) that were conducted as a formative assessment for Project MYTRI (Mobilizing Youth for Tobacco Related Initiatives in India), a randomized, multicomponent, school-based trial to prevent and control tobacco use among youth in India. Forty-eight FGDs were conducted with students ( N = 435) in sixth and eighth grades in six schools in Delhi, India. Key findings include: (a) students in government schools reported as “consumers” of tobacco, whereas students in private schools reported as “commentators”; (b) parents and peers have a strong influence on youth tobacco use; (c) chewing gutkha is considered less harmful and more accessible than smoking cigarettes; (d) schools are not promoting tobacco control activities; and (e) students were enthusiastic about the role government should play in tobacco control. These findings are being used to develop a comprehensive intervention program to prevent and control tobacco use among Indian youth.

Project EX-India: A classroom-based tobacco use prevention and cessation intervention program

Tobacco use experimentation is most frequent between the ages of 15–24 in India. Therefore, programming to counteract tobacco use among adolescents is needed. There is a lack of evidence-based teen tobacco use prevention and cessation programs. The current study provides an outcome evaluation of the Project EX tobacco use prevention and cessation program among Indian adolescents (16–18 years). An eight-session classroom-based curriculum was adapted to the Indian context and translated from English to Hindi (local language). Next, it was tested using a quasi-experimental design with 624 Indian students at baseline, involving two program and two control schools, with a three-month post-program follow-up. Project EX involves motivation enhancement (e.g., talk shows and games) and coping skills (e.g., complementary and alternative medicine) components. Program participants rated complementary and alternative medicine (CAM) activities like meditation, yoga and healthy breathing higher than talk shows and games. Compared to the standard care control condition, the program condition revealed a prevention effect, but not a cessation effect. Implications for prevention/cessation programming among Indian teens are discussed. This study was approved by the Independent Ethics Committee, Mumbai.

Knowledge, attitude and behavioral determinants of tobacco use among 13-15 year old school children

Background:

The epidemic of tobacco use is one of the greatest threats to global health today. Tobacco attributable deaths in India currently range from 800,000 to 900,000 per year. Adolescents are among the most vulnerable group to start tobacco use. Information on tobacco use among the youth is necessary to establish control measures against it.

Objectives:

To assess the knowledge, attitude, and behavioral determinants of tobacco use among high school students (age13–15 years) in Bangalore.

Materials and Method:

A cross-sectional study was conducted over a period of 3 weeks in the month of September 2012. A structured, pretested questionnaire was administered randomly to 500 high school students in Bangalore to assess the knowledge, attitude, and behavioral determinants of tobacco use.

Results:

Majority of the study population [94.4% (472/500)] believed that smoking is definitely harmful to our health. Also, 39.0% of the participants of age 13 years believed that smoking does not help in socializing and 92.2% of study subjects had negative attitude toward starting the habit. Most of them (83.9%) had a negative perception about smokers that they lack confidence. However, less than 1% of the study population had a habit of smoking at this young age.

Conclusion:

Awareness of the harmful effects of smoking was high among the study population. The study provides insight into the factors to consider while planning adolescent anti-smoking programs in this and similar settings.

Message formats and their influence on perceived risks of tobacco use: a pilot formative research project in India

In India, tobacco kills 900,000 people every year though the burden of tobacco is faced disproportionately in poorer states such as Bihar. Teachers may be a particularly influential group in setting norms around tobacco use in the Indian context. However, tobacco use among teachers remains high and perceptions of tobacco-related health risks are unexplored. To qualitatively explore perceptions about tobacco use among teachers in Bihar and to examine how risk information may be communicated through a variety of message formats, 12 messages on tobacco health risks varying in formats were tested in focus groups with teachers from Bihar. Participants stated that teachers were already aware of tobacco-related health risks. To further increase awareness of these risks, the inclusion of evidence-based facts in messages was recommended. Communicating risk information using negative emotions had a great appeal to teachers and was deemed most effective for increasing risk perception. Messages using narratives of teachers' personal accounts of quitting tobacco were deemed effective for increasing knowledge about the benefits of quitting. To conclude, messages using evidence-based information, possibly with negative emotions, testimonials with role models and those messages emphasizing self-efficacy in the format of narratives appear to appeal to teachers in Bihar.

Discussions with adults and youth to inform the development of a community-based tobacco control programme

Project Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth (ACTIVITY) is a community-based group randomized intervention trial focused on disadvantaged youth (aged 10-19 years) residing in 14 low-income communities (slums and resettlement colonies) in Delhi, India. This article discusses the findings of Focus Group Discussions (FGDs) conducted to inform the development and test the appropriateness of Project ACTIVITY's intervention model. The findings of the FGDs facilitated the understanding of factors contributing to increased tobacco uptake and cessation (both smoking and smokeless tobacco) among youth in this setting. Twenty-two FGDs were conducted with youth (10-19 years) and adults in two urban slums in Delhi. Key findings revealed: (i) youth and adults had limited knowledge about long-term health consequences of tobacco use; (ii) socio-environmental determinants and peer pressure were important variables influencing initiation of tobacco use; (iii) lack of motivation, support and sufficient skills hinder tobacco cessation and (iv) active involvement of community, family, religious leaders, local policy makers and health professionals is important in creating and reinforcing tobacco-free norms. The results of these FGDs aided in finalizing the intervention model for Project ACTIVITY and guided its intervention development.

A Qualitative Mediation Study to Evaluate a School-Based Tobacco Prevention Program in India (Project MYTRI)

Causal mediating processes were examined using qualitative methods to evaluate a tobacco-use prevention program for adolescents in India, Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India). Interviews were conducted with Project MYTRI leaders and staff persons. The focus of the interviews was to learn about the program implementation and to characterize how Project MYTRI classroom sessions altered student-level psychosocial risk factors (mediators) to prevent or reduce tobacco use among students in intervention schools in Delhi and Chennai. From qualitative analysis, key mediating variables were identified (students' tobacco knowledge, skills development, beliefs about tobacco, intentional beliefs, advocacy beliefs, and self-efficacy beliefs), a qualitative mediation path model was drawn, causal processes were described, and contextual influences (potential moderators) were explained. The qualitative findings complemented the results of statistical mediation analysis, yielding a detailed and contextualized description of how Project MYTRI affected students.

Promoting life skills and preventing tobacco use among low-income Mumbai youth: effects of Salaam Bombay Foundation intervention

Background

In response to India's growing tobacco epidemic, strategies are needed to decrease tobacco use among Indian youth, particularly among those who are economically disadvantaged. The objective of this study was to assess the effectiveness of a school-based life-skills tobacco control program for youth of low socio-economic status in Mumbai and the surrounding state of Maharashtra. We hypothesized that compared to youth in control schools, youth exposed to the program would have greater knowledge of effects of tobacco use; be more likely to take action to prevent others from using tobacco; demonstrate more positive life skills and attitudes; and be less likely to report tobacco use.

Methods/Findings

Using a quasi-experimental design, we assessed program effectiveness by comparing 8^th and 9^th grade students in intervention schools to 8^th grade students in comparable schools that did not receive the program. Across all schools, 1851 students completed a survey that assessed core program components in early 2010. The program consisted of activities focused on building awareness about the hazards of tobacco, developing life skills, and advocacy development. The primary outcome measure was self-reported tobacco use in the last 30 days.

Findings indicate that 4.1% of 8^th grade intervention students (OR = 0.51) and 3.6% of 9^th grade intervention students (OR = 0.33) reported using tobacco at least once in the last 30 days, compared to 8.7% of students in the control schools. Intervention group students were also significantly more knowledgeable about tobacco and related legislation, reported more efforts to prevent tobacco use among others, and reported stronger life skills and self-efficacy than students in control schools. Limitations to the study include schools not being randomly assigned to condition and tobacco use being measured by self-report.

Conclusions

This program represents an effective model of school-based tobacco use prevention that low-income schools in India and other low- and middle-income countries can replicate.

Childhood cardiovascular risk factors in South Asians: A cause of concern for adult cardiovascular disease epidemic

Cardiovascular risk factors in children are increasing at an alarming rate in the western world. However, there is limited information regarding these in the South Asian children. This review attempts at summarizing such evidence. South Asians are remarkable for the earlier onset of adult cardiovascular disease (CVD) by almost a decade compared to the Caucasians. We identified published literature, mainly on PubMed, Embase and Cochrane library using specific search terms such as lipid abnormalities, high blood pressure, hyperglycemia, tobacco use, obesity, physical inactivity, and unhealthy dietary practices. Atherosclerotic CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposure. 80% of adult CVD burden will fall on the developing nations by 2020. The concept of primordial prevention is fast emerging as a necessary prevention tool to curb adult CVD epidemic. Established guidelines and proven preventive strategies on cardiovascular health exist; however, are always implemented half-heartedly. Composite screening and prediction tools for adults can be adapted and validated in children tailored to South Asian population. South Asian children could be at a greater risk of developing cardiovascular risk factors at an earlier stage, thus, timely interventions are imperative.

A mediation analysis of a tobacco prevention program for adolescents in India: how did project MYTRI work?

This article presents the results of a mediation analysis of Project MYTRI (Mobilizing Youth for Tobacco Related Initiatives in India), a randomized, controlled trial of a multiple-component, school-based tobacco prevention program for sixth- to ninth-graders (n = 14,085) in Delhi and Chennai, India. A mediation analysis identifies how an intervention achieves its effects. In MYTRI, changes in students' (a) knowledge about the negative health effects of tobacco, (b) beliefs about its social consequences, (c) reasons to use tobacco, (d) reasons not to use tobacco, (e) advocacy skills self-efficacy, and (f) normative beliefs about tobacco use were significantly associated with reductions in students' intentions to use tobacco and tobacco use behaviors. In contrast, changes in students' perceptions of the prevalence of smoking and chewing tobacco were significantly related to increases in students' intentions to use and use of tobacco. Implications for intervention design are considered.

[Profile of tobacco use among the teachers of Sousse, Tunisia]

OBJECTIVE

To examine the prevalence of tobacco use among the teachers in the region of Sousse (Tunisia) and to identify the factors, which determine this behavior.

PATIENTS AND METHODS

It is a transactional study; using a self-administered and pre-tested questionnaire to 800 teachers.

RESULTS

The population being studied was made up of 739 teachers including 50.6% of professors. The sample was 35.4% male and the average age was of 45.3±8.1 years. The total prevalence of tobacco use was 17.8% (41.4% among men and 4.7% among women). Half of these teachers smoked in their school establishments and in the presence of their pupils. The multivariate analysis had made it possible to identify four factors, which determine the profile of tobacco use in our teachers; these factors were: the sex, the age, knowledge and attitudes.

CONCLUSION

It's necessary to intervene with the teachers of the town of Sousse with specific trainings on the topic of the tobacco use and dispose their adapted tools which will be used in the educational programmes of tobacco use prevention in schools.

Community-based model for preventing tobacco use among disadvantaged adolescents in urban slums of India

Tobacco consumption in multiple forms presents an emerging, significant and growing threat to the health of Indian adolescents, especially those from low socio-economic communities. Research in two phases was undertaken among economically disadvantaged adolescents in two urban slums of Delhi. In phase I, qualitative research methods such as focus group discussions and in-depth interviews were used to explore and understand the determinants influencing tobacco use among these adolescents. Prevalence of tobacco use was higher among boys than girls. Adolescents reported using tobacco in multiple forms, chewing tobacco being the most popular. Peer pressure, easy availability and affordability were important reasons associated with tobacco initiation and continued use. Though they had some knowledge about the harmful effects of tobacco, this was not sufficient to motivate them to abstain or quit. The community-based intervention model developed on the basis of the results of phase I was evaluated in phase II in a demonstration study with two slum communities. One was treated as the intervention and the other as control. A significant difference in current use of tobacco was observed between the study groups (p = 0.048), with the intervention group showing a reduction in use, compared with an increase in use among the control group. Post-intervention, the intervention group reported significantly lower fresh uptake (0.3%) of tobacco use compared with the control group (1.7%). No significant change was found for quit rate (p = 0.282) in the two groups. Community-based interventions can be effective in preventing adolescents from initiating tobacco use in a low-resource setting such as India.

Preventing tobacco use among young people in India: Project MYTRI

OBJECTIVES

We assessed the effectiveness of a 2-year multicomponent, school-based intervention designed to reduce tobacco use rates among adolescents in an urban area of India.

METHODS

Students from 32 schools in Delhi and Chennai, India, were recruited and randomly assigned to an intervention or control group. Baseline, intermediate, and outcome data were collected from 2 cohorts of 6th- and 8th-grade students in 2004; 14,063 students took part in the study and completed a survey in 2004, 2005, or 2006. The intervention consisted of behavioral classroom curricula, school posters, a parental involvement component, and peer-led activism. The main outcome measures were self-reported use of cigarettes, bidis (small hand-rolled, often flavored, cigarettes), and chewing tobacco and future intentions to smoke or use chewing tobacco.

RESULTS

Findings showed that students in the intervention group were significantly less likely than were students in the control group to exhibit increases in cigarette smoking or bidi smoking over the 2-year study period. They were also less likely to intend to smoke or chew tobacco in the future.

CONCLUSIONS

School-based programs similar to the intervention examined here should be considered as part of a multistrategy approach to reducing tobacco use among young people in India.

Pattern of tobacco use among school children in National Capital Territory (NCT)

OBJECTIVE

To study the prevalence, consumption patterns and correlates of tobacco use among adolescent SZI children in Government schools in the National Capital territory of Delhi.

METHODS

Thirty schools in National Capital Territory (NCT) of Delhi, India, were selected by two stage cluster random design and population proportionate to size sampling (PPS) methodology. A sample of 3,422 children in the age group of 10-18 years studying in the 30 middle and senior secondary Government schools in NCT of Delhi were studied. Each student was administered a pre-tested, semi-structured questionnaire.

RESULTS

Overall 9.8% of the study children had at least once experimented with any form of tobacco in their lifetime. The proportion of children who were current users of tobacco products was 5.4% (boys: 4.6%, Girls: 0.8%). Current users differed from abstainers in location of their schools, category of school, class, gender, hobbies, not having friends, having tobacco users in family and school etc.

CONCLUSION

Consumption of tobacco amongst adolescents is an emerging health problem in Delhi. A number of variables seem to differentiate between the current users and abstainers. Tobacco use in family and school environment is a mutable factor that should be focused in tobacco reduction campaigns. Encouraging friendship has a protective influence. There is a need for similar studies in other metropolitan cities of the country.

Intermediate outcomes from Project MYTRI: mobilizing youth for tobacco-related initiatives in India

The purpose of this article is to present the intermediate results for Project MYTRI, a school-based, multiple component intervention designed to prevent and reduce many forms of tobacco use (chewing tobacco, cigarettes, and bidis) among youth in India. The intervention is based on effective models in the United States "translated" for use in this context. The intervention targets two cohorts of students who were in the 6th and 8th grade when the study started. Thirty-two schools in Delhi (north India) and Chennai (south India) were randomized to receive the intervention (n = 16) or serve as a delayed intervention control (n = 16). Students in these schools were surveyed before the intervention began and at an intermediate point, 1 year into this 2-year intervention (n = 8,369). A test of the changes in risk factors for tobacco use between the baseline and intermediate surveys revealed that, compared with the control, students in the intervention condition (a) had better knowledge about the health effects of tobacco (P < 0.01); (b) believed that there were more negative social consequences to using tobacco (P = 0.04); (c) had fewer reasons to use tobacco (P < 0.01); (d) had more reasons not to use tobacco (P = 0.03); (e) were less socially susceptible to chewing (P = 0.04) and smoking (P = 0.03) tobacco; (f) perceived fewer peers and adults around them smoked (P < 0.01) or chewed (P < 0.01) tobacco; (g) felt that tobacco use was not acceptable, especially among their peers (P < 0.01); (h) were more confident in their ability to advocate for tobacco control (P = 0.03); (i) were more knowledgeable about tobacco control policies (P < 0.01); and (j) supported these policies, too (P = 0.04). Fewer students in the intervention condition reported having intentions to smoke tobacco in the next year (P = 0.02) or chew tobacco when they reached college (P < 0.01). No changes in actual tobacco use were observed at this stage of the study.

Uso de tabaco iniciado na infância: relatos de adultos em tratamento

OBJETIVO: Coletar e analisar relatos de adultos dependentes de tabaco que começaram a fumar na infância e sobre os fatores que consideram relacionados ao início de uso. MÉTODO: Pesquisa qualitativa com entrevistas semidirigidas gravadas com 11 pacientes em tratamento ambulatorial especializado para dependência de tabaco e que mencionaram início de uso antes dos 12 anos de idade; fechamento amostral por saturação teórica, transcrição do áudio e análise de conteúdo das entrevistas com triangulação de analistas. RESULTADOS: Quatro categorias agrupam os fatores mencionados pelos entrevistados ou inferidos pelos autores: normalidade sociocultural e familiar do ato de fumar tabaco; identificação e aprendizado com figuras parentais fumantes; condições adversas de vida, incluindo trabalho infantil e poucas atividades lúdicas; e escassez de informações, incluindo uso cultural de tabaco para finalidades diversas. CONCLUSÕES: Resultados permitem maior compreensão sobre os pontos de vista e vivências de pacientes com histórias semelhantes sobre a questão, o que pode colaborar para a efetividade das abordagens motivacionais e terapêuticas e da aliança terapêutica, ao minimizar dificuldades de interação clínico-paciente. Estudos etnográficos sobre uso de tabaco na infância são indicados para a atual população rural brasileira, visando o aperfeiçoamento de abordagens preventivas.

Why are urban Indian 6th graders using more tobacco than 8th graders? Findings from Project MYTRI

OBJECTIVE

To investigate why urban Indian 6th graders may be using more tobacco than urban Indian 8th graders.

DESIGN

Cross-sectional survey of students conducted in the summer of 2004, as the baseline evaluation tool for a group-randomised tobacco prevention intervention trial (Project MYTRI). Mixed-effects regression models were used to (1) examine the relationship between 15 psychosocial risk factors and current use of any tobacco, by grade; and (2) examine differences in psychosocial risk factors, by grade.

SETTING

Thirty-two private (high socioeconomic status (SES)) and government (low-mid SES) schools in two large cities in India (Delhi and Chennai).

SUBJECTS

Students in the 6th and 8th grade in these schools (n = 11642). Among these, 50.6% resided in Delhi (v Chennai), 61.4% attended a government school (v a private school), 52.9% were enrolled in 6th grade (v 8th), and 54.9% were male (v female).

MAIN OUTCOME MEASURE

Current (past 30 day) use of any tobacco, including chewing tobacco (for example, gutkha), bidis, or cigarettes.

RESULT

Almost all psychosocial factors were significantly related to tobacco use, for students in both grades. Some of the strongest correlates included social susceptibility to and social norms about use. Exposure to tobacco advertising was a strong correlate of tobacco use for 6th graders, but not for 8th graders. Sixth graders scored lower than 8th graders on almost all factors, indicating higher risk.

CONCLUSIONS

The "risk profile" of 6th graders suggests they would be vulnerable to use and to begin using tobacco, as well as to outside influences that may encourage use.

Tobacco and alcohol use in rural elderly Indian population

BACKGROUND

Tobacco and alcohol use are serious health problems. Studies focusing on problems associated with tobacco and alcohol use in the elderly are limited.

AIM

To find out the prevalence of tobacco and alcohol use among rural elderly population.

METHODS

This cross-sectional study was conducted in the intensive field practice area of the Comprehensive Rural Health Services Project in Ballabgarh in Faridabad, Haryana, a rural field practice area of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. The sample was selected using stratified random cluster sampling. The participants were >/=60 years of age at the time of interview. Data on tobacco and alcohol use pattern of 1117 elderly were collected during the interview.

RESULTS

The prevalence of smoking was 71.8% in men (n=490) and 41.4% in women (n=497). Among men smokers, 41.5% were light smokers (20 beedis/day). Among women smokers, 71.8% were light smokers, 23.8% were moderate smokers and 4.4% were heavy smokers. Regular alcohol intake was seen in 16.3% of the men compared with 0.8% of the women.

CONCLUSION

The finding of a high prevalence of smoking and alcohol consumption among men in this rural population of India is of serious concern and therefore needs remedial measures.

Teacher tobacco use and tobacco use prevention in two regions in India: results of the Global School Personnel Survey

BACKGROUND

This paper compares tobacco use patterns and tobacco use prevention efforts among teachers in two Indian states with high versus low prevalence of tobacco use.

METHODS

Data from the Global School Personnel Survey compared tobacco use patterns and tobacco use prevention activities among teachers from the Indian states of Maharashtra (N = 954) and Bihar (N = 524).

RESULTS

78% of teachers in Bihar and 31% from Maharashtra were current tobacco users. Tobacco control policies were virtually non-existent in schools in Bihar, while in Maharashtra, over one-fourth of teachers reported that tobacco use was prohibited among both students and teachers. Few teachers in Bihar taught their students about tobacco use prevention, while such teaching was more common in Maharashtra. In Maharashtra, teaching about tobacco use prevention was significantly associated with not currently using tobacco (P < 0.0001), having a policy specifically prohibiting tobacco use among students (P < 0.0001), and having a policy specifically prohibiting tobacco use among school personnel (P < 0.0001).

CONCLUSIONS

This study has clear implications for implementation of tobacco control policies in Indian schools and further underscores the need for infrastructure support for tobacco use prevention in developing countries such as India, where tobacco use threatens to contribute to a growing proportion of the burden of disease worldwide.

Access to pocket money and low educational performance predict tobacco use among adolescent boys in Kerala, India

BACKGROUND

Tobacco use is increasing among adolescents. We conducted this study to find prevalence and correlates of tobacco use among adolescent boys in Trivandrum city, Kerala.

METHODS

Using a two-stage cluster sampling technique, 1323 boys (12-19 years) were selected from 14 schools. Information on tobacco use, academic performance, pocket money, and other variables was collected using a questionnaire. Multivariate analyses were done to find associations between current use of tobacco and other variables.

RESULTS

Prevalence of current tobacco use was 11.3% (95% CI 9.6-13.0). Current tobacco use was 2.9 times higher among older boys compared to younger boys (OR 2.9, CI 1.6-5.3), 2 times higher among boys whose fathers used tobacco (OR 2.0, CI 1.3-3.1), 2.9 times higher among boys whose friends used tobacco (OR 2.9, CI 1.6-5.1) compared to their counterparts, 3 times higher among boys securing poor (<40% marks) grade compared to those securing excellent (>80% marks) grade (OR 3.0, CI 1.4-6.6), and 4 times higher among those who received pocket money compared to those who did not (OR 4.0, CI 2.2-7.4).

CONCLUSIONS

Health programs to quit tobacco are suggested in schools with special emphasis on poor performers, those receiving pocket money, and those whose fathers and friends use tobacco.

Tabagismo em amostra de adolescentes escolares de Salvador-Bahia

INTRODUÇÃO: O hábito de fumar em geral se inicia na adolescência. No Brasil, as estimativas da freqüência deste hábito entre adolescentes variam de 1% até 35%. OBJETIVO: Estimar a prevalência do tabagismo entre os adolescentes da oitava série do ensino fundamental à terceira série do curso médio, em escolas de Salvador - Bahia, Brasil. MÉTODO: Feito um estudo do tipo corte transversal de caráter exploratório. Foram aplicados 3.500 questionários a alunos matriculados entre a 8ª série do ensino fundamental e a 3ª série do ensino médio, em cinco escolas da região metropolitana de Salvador (BA). Análise estatística: medidas descritivas e de associação (razão de prevalência) e o teste t de Student e o do qui-quadrado. RESULTADOS: A prevalência do tabagismo entre adolescentes de Salvador (BA) foi de 9,6%, considerando-se os 3.180 questionários válidos, sendo maior no sexo masculino (14%) que no feminino (6%). À medida que aumentava a idade, elevava-se essa prevalência. A média de idade do início do tabagismo foi de 14 ± 2 anos. Dentre adolescentes, 46% experimentaram o cigarro e 20% destes continuaram fumando. Entre filhos de fumantes a freqüência foi maior. O número médio de cigarros consumidos por dia pelos adolescentes que fumavam diariamente (n = 132) foi de 7 ± 6, sendo maior no sexo masculino. CONCLUSÃO: A prevalência do tabagismo em uma amostra selecionada de adolescentes escolares de Salvador (BA) foi de 9,6%, sendo maior entre os indivíduos do sexo masculino. A experimentação e a influência dos pais foram associadas ao tabagismo nos adolescentes.

Tobacco use by Indian adolescents

Adolescents are the most vulnerable population to initiate tobacco use. It is now well established that most of the adult users of tobacco start tobacco use in childhood or adolescence. There has been a perceptible fall in smoking in the developed countries after realization of harmful effects of tobacco. The tobacco companies are now aggressively targeting their advertising strategies in the developing countries like India. Adolescents often get attracted to tobacco products because of such propaganda. There has been a rapid increase in trade and use of smokeless tobacco products in recent years in the country, which is a matter of serious concern to the health planners. It is important to understand various factors that influence and encourage young teenagers to start smoking or to use other tobacco products. The age at first use of tobacco has been reduced considerably. However, law enforcing agencies have also taken some punitive measures in recent years to curtail the use of tobacco products. This paper focuses on various tobacco products available in India, the extent of their use in adolescents, factors leading to initiation of their use, and the preventive strategies, which could be used to deal with this menace.