Evaluation of a school-based tobacco control intervention in India

Abstract

Objective: To understand tobacco use patterns and the context, implementation and reception of a 2-year school-based behavioural intervention to promote awareness and support for tobacco control policies. Design: Qualitative exploration of participating students’, parents’ and teachers’ perspectives, experiences and observations related to tobacco use and the school-based intervention, as well as suggestions for the more effective prevention of tobacco use. Setting: 1,440 schools (720 intervention, 720 control) in two districts of Andhra Pradesh and five districts of Gujarat, India, participated in the study. Method: Forty-six focus group discussions were conducted with 94 teachers, 105 parents and 138 students in the intervention schools. Results: Evaluation findings signal the influence of the social, economic and cultural context on the initiation and perpetuation of tobacco use. Positive health beliefs, the economic importance of tobacco and cultural practices related to tobacco use were at variance with mounting evidence on the adverse outcomes of tobacco use. Health behaviour change related to tobacco use was observed in participating students, teachers and their families. However, the wider community was not as much influenced. Analysis of the intervention revealed various inputs and gaps in the implementation of the intervention associated with low impact on tobacco use in the community. Conclusion: School-based interventions can effect significant perceived health behaviour change among students and families. Health promotion interventions need to acknowledge, harness and address cultural norms, economic pressures and policy implementation with respect to the initiation and perpetuation of tobacco use health behaviours.

A public policy analysis with key stakeholders’ insights to understand India’s compliance with the WHO framework convention on tobacco control

“…Additionally the sale of loose cigarettes and SLTs attract young users [ 19 , 26 , 31 ]. 625,000 children in India between the age of 10 to 14 use tobacco in some form as per the WHO Tobacco Atlas [ 10 ]. Studies have reported that today’s adolescents and youth are able to purchase tobacco products easily within close proximity to their schools and colleges without having to show any proof of age [ 19 , 51 ].…”

“…The widespread use of tobacco in the developing world is attributed to its low price, variations in form, lack of awareness on harmful effects, unregulated aggressive marketing by the tobacco industry and lack of public health policies advocating for its complete ban. India is home to approximately 266.8 million tobacco users and is the second largest consumer of tobacco in the world [ 8 , 10 ]. India’s tobacco landscape is more complex due to the extensive production facilities and use of many smokeless forms of tobacco.…”

“…A vast majority of the users (87%) debut tobacco use before the age of 18 years [ 8 ]. Furthermore, according to the WHO Tobacco Atlas, 625,000 children between the age of 10 and 14 years use tobacco in some form in India [ 10 ]. Due to the massive use of smokeless tobacco which is often homemade, India has one of the highest rates of oral cancer in the world with an annual incidence as high as 14.8 per 100,000 among males [ 11 ].…”