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

HRIDAY, New Delhi, India.
Health Promotion International (Impact Factor: 1.94). 02/2010; 25(2):143-52. DOI: 10.1093/heapro/daq008
Source: PubMed


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.

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    • "Researchers in India were trained through three two-hour Skype interactions . It was felt that in-person extensive training would not be necessary since they had been involved in extensive tobacco use prevention research previously (e.g., Arora et al., 2010). They were trained by the researchers in India (one of whom had translated the curriculum to Hindi) to deliver Project EX-India. "
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    ABSTRACT: 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 motivationenhancement (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 programcondition 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.
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    • "The communities for participation in the trial were selected using certain eligibility criteria with non-random sampling methods. However, assignment to intervention or control condition, as well as selection of households with youth for interviewing was randomized (Arora et al., 2010). Tobacco smoking within the seven days preceding sample collection is generally considered to be the cut-point at which cotinine can be detected (Benewitz et al, 2002). "
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