Psychosocial Mediators of a School-Based Tobacco Prevention Program in India: Results from the First Year of Project MYTRI

Abstract

Each day in India, an estimated 5,500 youth initiate tobacco use, contributing to predictions that by 2020, tobacco will account for 13% of all deaths in India. Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) is a multi-component school-based intervention designed to prevent and reduce tobacco use among adolescents in Delhi and Chennai, India. The intervention was implemented over the 2004-2006 school years and involved 6 th and 8 th grade students in 32 classrooms. Students participated in peer-led classroom activities involving games, competitions, and other activities intended to target a number of psychosocial risk factors believed to prevent tobacco use among urban Indian youth. To more fully understand how Project MYTRI influenced students' intentions to smoke or chew tobacco, the current study used mediation analysis to investigate whether Project MYTRI altered the psychosocial risk factors as intended, and whether the changes in psychosocial risk factors were, in turn, responsible for altering students' tobacco-use intentions. Multi-level mediation models were estimated using student data from baseline and one-year followup surveys. Results indicated that the psychosocial risk factors Knowledge of Health Effects, Normative Beliefs, Reasons to Use Tobacco, and Perceived Prevalence were significant mediators between the intervention activities and students' tobacco use intentions. Evidence of inconsistent mediation was observed for the Perceived Prevalence factor. These findings, combined with those from qualitative research and the second-year student data, will help to illuminate the impact of Project MYTRI on participating youth.

Comparing effects of tobacco use prevention modalities: need for complex system models

“…Very few program mediation analysis studies have been reported, but might provide direction on how to combine modalities efficaciously. Among the few studies that have been completed, norms manipulation (of prevalence or acceptability) and outcome expectancies manipulation (such as personally relevant consequences) have been found to mediate program effects (e.g., [72,73]).…”

Online cognitive-based intervention for depression: exploring possible circularity in mechanisms of change

“…A two-sided significance level of p = 0.05 was used. Mediation proportions for each mediator were computed by dividing the absolute value of the indirect effect, ABS(a 1 *b 1 ), by the total effect, ABS(c) + ABS(a 1 *b 1 ) + ABS(a 2 *b 2 ) (Bate et al 2009). In the mediation models, the a-path refers to the effect of the independent variable on the mediator, the b-path represents the effect of the mediator on the dependent variable after controlling for the effect of the independent variable, and the c-path refers to the direct effect of the independent variable on the dependent variable after controlling for mediators (see Figs 2-4).…”

A review of validated youth prevention and positive youth development programs in Asia

“…Although the intervention had no demonstrable effect on smoking behavior, students in the experimental group showed better attitudes towards resisting smoking than the control group. In India, a 2-year multicomponent school-based intervention was designed to reduce tobacco use rates among adolescents in 16 schools in Delhi and 16 schools in Chennai, in which four primary components were involved, including classroom curriculum, school posters, postcards to parents, and peer-led health activism at school, home, and community levels (32,33) . Findings showed that students in the intervention group were signifi cantly less likely than were students in the control group to exhibit increased cigarette smoking behaviors over the 2-year study period.…”