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

ABSTRACT 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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: 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.
    Health Education Research 07/2012; · 1.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this paper is to provide a comprehensive evidence based model aimed at addressing multi-level risk factors influencing tobacco use among children and adolescents with multi-level policy and programmatic approaches in India. Evidences around effectiveness of policy and program interventions from developed and developing countries were reviewed using Pubmed, Scopus, Google Scholar and Ovid databases. This evidence was then categorized under three broad approaches: Policy level approaches (increased taxation on tobacco products, smoke-free laws in public places and work places, effective health warnings, prohibiting tobacco advertising, promotions and sponsorships, and restricting access to minors); Community level approaches (school health programs, mass media campaigns, community based interventions, promoting tobacco free norms) and Individual level approaches (promoting cessation in various settings). This review of literature around determinants and interventions was organized into developing the IMPACT framework. The paper further presents a comparative analysis of tobacco control interventions in India vis a vis the proposed approaches. Mixed results were found for prevention and control efforts targeting youth. However, this article suggests a number of intervention strategies that have shown to be effective. Implementing these interventions in a coordinated way will provide potential synergies across interventions. Pediatricians have prominent role in advocating and implementing the IMPACT framework in countries aiming to prevent and control tobacco use among adolescents and children.
    The Indian Journal of Pediatrics 05/2012; · 0.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: There is no study on the association between oral health education and oral health quality of life (OHQoL). AIM: To assess the relationship between oral health education activities integrated into primary care services and OHQoL in adolescents. DESIGN: A retrospective observational survey was conducted on 300 randomly selected 12-14 years-of-age adolescents living in two publicly funded health service administrative areas in Manaus, Brazil. Between 2006 and 2008, dental treatment and oral health education were offered in one area (DT/OHE group), whereas in the other area, only dental treatment was provided (DT group). Collected data included socio-demographic characteristics, health services use, health-related behaviours, dental pain, dental caries and Child-OIDP. Independent variables were compared between groups by Mann-Whitney and chi-square tests. The association between one or more OIDP (Child-OIDP ≥ 1) and DT group tested using multivariate logistic regression. RESULTS: Caries, use of dental services and health-related behaviours did not differ between groups (P > 0.05). Child-OIDP ≥ 1 was higher in DT group (90.0%) compared with DT/OHE group (79.3%) (P = 0.01). Child-OIDP ≥ 1 was independently associated with DT group [OR = 4.4 (1.1; 17.0)]. CONCLUSIONS: Adolescents living in an area where OHE and DT were provided had better OHRQoL than those living in an area where only DT was provided.
    International Journal of Paediatric Dentistry 10/2012; · 0.92 Impact Factor


Available from
Jun 10, 2014