Tobacco and Alcohol Use and the Impact of School Based Antitobacco Education for Knowledge Enhancement among Adolescent Students of Rural Kerala, India

Tobacco cessation by prescription - A 180 degree turn

Utilisation of tobacco is one of the most serious problems affecting human health worldwide, despite the fact that the early fatality caused by tobacco use are growing, regardless of the fact that it is avoidable tobacco consumption is very common, considerable resources have been allocated to this issue. On tobacco prevention, a range of strategies have been tested but the ratio of death due to tobacco and number of tobacco consumers is increasing day by day. Various impediments to tobacco quitting have been recognized, all of which contribute to the failure of various tobacco cessation programs and methodologies. Individuals in the India have attempted or considered quitting smoking at some point in their lives but ended in failure. Existing tobacco cessation programs have not out-turned in a decrease in the figure of tobacco users or deaths, necessitating a new strategy. Tobacco cessation on prescription, developed from physical activity on prescription (PAP), can be a useful method in terms of public health. But yet no studies have ever been conducted over this. Further studies on this can explore results of tobacco quitting after prescription from general physician or other medical practitioner, evaluative beliefs about tobacco consumption and barriers in quitting even after prescription. Hence the present review was done with explore the outcomes for cessation of tobacco based upon utilization of tobacco cessation by prescription (TCP) methodology in Indian scenario. This review paper focuses on TCP as a need for newer approach pertaining to Indian perspective. Future study should look at whether raising the rate of stop attempts are improving the tobacco cessation rate in the general population after the implementation of TCP.

Alcohol use among adolescents in India: a systematic review

BACKGROUND

Alcohol use is typically established during adolescence and initiation of use at a young age poses risks for short- and long-term health and social outcomes. However, there is limited understanding of the onset, progression and impact of alcohol use among adolescents in India. The aim of this review is to synthesise the evidence about prevalence, patterns and correlates of alcohol use and alcohol use disorders in adolescents from India.

METHODS

Systematic review was conducted using relevant online databases, grey literature and unpublished data/outcomes from subject experts. Inclusion and exclusion criteria were developed and applied to screening rounds. Titles and abstracts were screened by two independent reviewers for eligibility, and then full texts were assessed for inclusion. Narrative synthesis of the eligible studies was conducted.

RESULTS

Fifty-five peer-reviewed papers and one report were eligible for inclusion in this review. Prevalence of ever or lifetime alcohol consumption ranged from 3.9% to 69.8%; and prevalence of alcohol consumption at least once in the past year ranged from 10.6% to 32.9%. The mean age for initiation of drinking ranged from 14.4 to 18.3 years. Some correlates associated with alcohol consumption included being male, older age, academic difficulties, parental use of alcohol or tobacco, non-contact sexual abuse and perpetuation of violence.

CONCLUSION

The evidence base for alcohol use among adolescents in India needs a deeper exploration. Despite gaps in the evidence base, this synthesis provides a reasonable understanding of alcohol use among adolescents in India and can provide direction to policymakers.

Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort

BACKGROUND

Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse.

METHODS

Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and family structure.

RESULTS

1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males report more of every individual childhood adversity and are more likely to report misusing substances compared with females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5-11.7) and collective level ACEs (adj OR 6.6, 95% CI 1.4-31.1) show associations with substance misuse whilst in young adults, child level ACEs such as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1-3.5).

CONCLUSION

ACEs such as abuse and domestic violence are strongly associated with substance misuse, most commonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACE resilience programmes and 'trauma-informed' approaches to tackling longer-term impact of ACEs in India.

FUNDING

Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and the Indian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).

A systematic review report on tobacco products and its health issues in India

India is the second country in tobacco production in the world. Smoking tobacco products included Hookah, Cohutta, Chillum, Chillum, ganja, Beedi, Mava, Cigarettes, and cigar etc. Various types of smokeless tobacco like betel quid, khaini, mishri, snuff, gutkha are used. Fifty percent of them are addicted to smokeless tobacco. Sixty eight smokeless tobacco products were available in 2010; most of them included the risk of cancer warning except for loose tobacco products. Women mostly prefer 8 out of 29 gutkha brands. Out of these 29 gutkha brands, 15 were loose tobacco packets. India is the second-largest tobacco consumer, comprises of 27.5 crore consumers which altogether greater than the population of Western Europe. From among these 27.5 crore consumers, 16.4 crore people are smokeless tobacco in takers, 6.9 crore people are exclusive smokers and 4.2 crore people are both tobacco in takers and exclusive smokers. If we take this data into consideration early mortality of 45 crore people is expected by 2050 worldwide. Female basically are prone to fewer cigarettes per day as compared to males. On the other hand, a cigarette that is consumed by females has lower nicotine content as compared to males. In developing countries, the female population has less prevalence of smoking because the level of employment is low, socio-cultural norms, and health and beauty concerns. According to the estimation by the South East Asia Region (SEAR) in the year 2000 basically from India, we encounter death of about 18% men and about 3% of women due to tobacco. Various policies have been set up to control the use of tobacco. So that threat to public health is reduced. Policies like tobacco control policy, pro-health policy are set up for this purpose. Talking about the effects on a longer-term usage of water pipe can add up to the risk of getting affected by cancers of lungs, mouth, bladders, atherosclerosis, cardiovascular and pulmonary diseases, tooth extraction, etc.

Prevalence and risk factors associated with substance use in children: A questionnaire-based survey in two cities of Uttar Pradesh, India

BACKGROUND

There is a sharp increase of substance use, particularly tobacco and alcohol, among schoolchildren.

AIMS

A study was undertaken to assess the prevalence, age of initiation, and determinants for the uptake of tobacco and alcohol habits among ever-user students.

SETTINGS AND DESIGN

This was a cross-sectional study conducted among school students.

MATERIALS AND METHODS

Information on alcohol and tobacco use, age at initiation, peer influence, reason of initiation, etc., was collected from students of class 7^th-12^th(ages: 11-19 years) studying in schools of Noida and Ghaziabad cities, through a pretested self-administered questionnaire through multistage sampling design. Univariate analysis was done to assess the significance of various determinants.

RESULTS

"Ever use of substance" (alcohol or tobacco) was found in 14.3% students and was 1.2 times more among boys in comparison to girls (P < 0.05). About 29.5% of these students initiated the habit before 11 years of age and its prevalence was significantly more among boys from government schools as compared to private schools. The habits were 2.2, 3.8, and 4.6 fold higher among students if the father, mother, siblings, or friends also used substances. Substance use was less frequent among children of white-collared father and more educated parents. One-third of students up took the habit to make friends.

CONCLUSION

The rising prevalence of substance use among students is a threat to the society. Introducing a "substance use prevention policy" in schools to educate students about various adverse effects and refusal skills may help curb this menace.

Effectiveness of a School Based Smokeless Tobacco Intervention: A Cluster Randomized Trial

To assess the effectiveness of intervention in improving knowledge, attitude and perception regarding smokeless tobacco (SLT) use and its harmful effects and intention to quit SLT among school going adolescents. A school-based cluster randomized control trial was carried out in 18 secondary schools targeting male and female students from grades 6 to 10 in Karachi. Primary outcome was knowledge about hazards of smokeless tobacco (SLT) and secondary outcomes were attitude and Perception about hazards of SLT, and intention to quit SLT. We enrolled 738 participants in intervention group and 589 in the control group. Mean score of knowledge significantly improved in intervention as compared to control group (P value < 0.01). Intention to quit was found to be proportionately higher (33%) in the intervention group as compared to control group. Generalized estimating equations were used to assess the association of factors with knowledge regarding harmful effects of SLT use. Significant predictors of increase in knowledge score were found in children: who had seen any anti SLT messages on social media in the past 30 days, who were getting information regarding harmful effects of SLT use in school or textbooks and who had friends using SLT. A school-based intervention was effective in increasing knowledge regarding the harmful effects of SLT use and intention to quit SLT use among school adolescents. Introduction of such educational programmes on a regular basis in schools or as part of school curriculum can have an impact on reducing prevalence of SLT use.Trial Registration NCT03418506. https://register.clinicaltrials.gov/NCT03418506 .

The effect of self-care education regarding high-risk behaviors of acquired immune deficiency syndrome and smoking on knowledge and attitude of adolescent girls: An experimental study to health promotion

BACKGROUND

The vulnerability of the youth to acquired immune deficiency syndrome (AIDS) and smoking is one of the most important public health issues around the world. Adequate knowledge about AIDS and smoking is a powerful tool for promoting positive attitudes and safe behaviors.

OBJECTIVE

This study aimed to determine the effect of self-care education on AIDS and smoking on the level of adolescents' knowledge and health attitude.

MATERIALS AND METHODS

This experimental study was conducted in the academic year of 2017-2018, and the participants were selected using randomized cluster sampling. These participants included 220 female students of the third grade of middle school in Isfahan (105 in the intervention group and 115 in the control group). Data were collected using a demographic questionnaire; a researcher-made questionnaire on knowledge about AIDS, knowledge about smoking, and attitudes toward smoking; and a standard questionnaire on students' attitude toward AIDS. After completing the pretest, the intervention group performed two training sessions and completed the posttest 1 month later. One month after completing the pretest, the control group completed the posttest and did not receive an intervention. Finally, the data were analyzed using descriptive statistics, statistical tests, and statistical software SPSS version 22.

RESULTS

The results showed that despite the similarity between the two groups at the beginning of the study, after self-care education, the knowledge level of AIDS (P < 0.001) and attitude toward AIDS (P < 0.001) and the knowledge level of smoking (P < 0.001) and attitude toward smoking (P < 0.001) in the intervention group were significantly higher than the control group. In intragroup analysis, it was also observed that the difference between the scores before and after was only significant in the intervention group.

CONCLUSION

It seems that education can promote the level of knowledge and attitude of adolescents toward AIDS.

Effectiveness of School based Awareness Programmes against Tobacco among Users and Non- Users- A Cross- Sectional Study from Rural Kerala, India

Background:

Known is the fact that adult tobacco users mostly had their initiation into the habit during the adolescence period. The current study was conducted to evaluate the impact of awareness programmes among adolescent students in rural Kerala, India, in terms of knowledge enhancement on tobacco hazards.

Methods:

A total of 10 high schools and higher secondary schools from one educational sub district were selected using multi stage sampling design. Male students in the age group 13-19 years studying in class IX and X (high school category) and class XI and XII (higher secondary school) were included in the study. The effectiveness was assessed using pre and post training evaluation forms based on mean knowledge scores.

Results:

1,114 students participated by filling both the forms (mean age 15.6, SD 1.3). The response rate was 92.8%. The prevalence of ‘current users’ in the study was 4.3% (95% CI 3.11- 5.49). Overall difference in mean knowledge scores among study subjects was evident when pre and post training responses were compared (p<0.001). The difference in knowledge scores was evident among ‘never users’ of tobacco before and after the awareness programmes (p<0.0001). However, no significant difference in mean scores was observed among ‘ever users’ of tobacco (p = 0.584), age groups of ever users (p=0.208), students of high schools (p = 0.242) and higher secondary schools (p= 0.994). Comparison of never, ever and current users revealed significant difference between ‘never’ and ‘current’ users (p = 0.001). However, no such difference was observed between ‘ever’ and ‘current’ users (p =0.138) and ‘ever’ versus ‘never’ users (p =0.099).

Conclusion:

The study was useful to improve knowledge among school students in general. However, newer strategies have to be tested to understand the best possible measures for tobacco awareness training among adolescent tobacco users.

Perception of tobacco use in young adults in urban India: a qualitative exploration with relevant health policy analysis

Tobacco is one of the biggest global health concerns of this century with a significant contribution to the increasing burden of cancers, chronic diseases and associated mortality. Tobacco-related cancers are one of the commonest causes of cancer-related mortality in low- and middle-income countries (LMICs). The tobacco epidemic is constantly on the rise, affecting LMICs in particular due to a lack of awareness in the population, insufficient health infrastructure and weak regulatory interventions. India is home to the world's largest youth population and a large percentage of them take up tobacco at a very young age, leading to subsequent habit formation. There is limited evidence in published research from India on young people's perceptions on the use and control of tobacco. This qualitative study has attempted to bridge that knowledge gap; a thematic analysis was used on the qualitative data gathered from young university students who participated in interviews and focus group discussions, which was then compared and contrasted with a critical analysis of India's national tobacco control measures. It employed a health policy analysis framework to understand how gaps in the national tobacco control initiatives contribute towards tobacco use in young people and what opportunities for policy reform exist. The main results revealed social and behavioural factors, peer dynamics and lack of awareness to be majorly influencing the tobacco debut and use in youth. Some other important findings emerged such as a lack of available support for tobacco cessation, leading to failure in quitting, a lack of understanding about the ill effects of tobacco and an overall lack of belief in the existing tobacco control measures. The qualitative results were further triangulated by the critical analysis of the national tobacco control policies, comparing them with the WHO Framework Convention on Tobacco Control. Juxtaposition of the qualitative research findings with the policy analysis reveals possible gaps in implementation of the tobacco laws. The findings from this study will inform health policymakers, public health professionals, clinicians, the government and other voluntary organisations to strengthen national tobacco control efforts.

Ethics of cancer care: beyond biology and medicine

Treatable cancers are on the rise due to improved early diagnosis and more innovative treatments, and preventative strategies against cancer are becoming a global concern. With the rapidly increasing complexity of cancer treatment, a clear definition of what constitutes ethical cancer care has become a matter of great debate. This situation is more complex in a developing country where healthcare resources are limited. Doctors, nurses and public health professionals engaged in the prevention, screening, diagnosis, treatment and research of cancers are often posed with ethical dilemmas while making complex choices. With a special focus on low- and middle-income countries, this paper is intended to highlight these real-world ethical concerns facing those involved in the management of cancer patients. While taking a neutral view, this paper has adopted a theme-wise approach to discuss barriers in cancer care.

A Comparison of Gender Differences in Smoking Behaviors, Intention to Quit, and Nicotine Dependence among Thai University Students

Background

Smoking is the leading cause of preventable death. In Thailand, the prevalence of smoking is about 15-20 times higher among men than women. This study aimed to investigate gender differences among university students concerning smoking behaviors, nicotine dependence, and intention to quit smoking.

Methods

A self-administered questionnaire was used to collect information from participants who were current smokers studying at a university in northern Thailand. Snowball sampling was used to recruit participants.

Results

Of 364 participants, there were 321 males and 43 females. This study showed higher smoking behaviors among males than females; males were more likely to smoke every day than females (67.0 and 41.9%, respectively, p value=0.002), and the average number of cigarettes daily was higher among males than females (8.4 and 5.5, respectively, p value=0.006). The sources of cigarettes differed between males and females. The nicotine dependence level, as measured by the Fagerstrom Test for Nicotine Dependence, was quite low in both male and female smokers and did not differ significantly (mean score of 2.3±2.2 for males, 1.8±1.8 for females; p value=0.123). Females were more likely than males toward intention to quit in the next 30 days (51.2 and 34.0%, respectively, p value=0.041). The most common reason for intention to quit was awareness of harm to health, for which females were more concerned than males.

Conclusion

Male and female university students who smoked differed in smoking behaviors and intention to quit, but not in nicotine dependence level. The university should provide health promotion to help students quit smoking.

Prevalence of Exposure to Secondhand Smoke among Higher Secondary School Students in Ernakulam District, Kerala, Southern India

Introduction:

The association between secondhand smoke and health outcomes, such as frequent respiratory infections, ischemic heart disease, lung cancer, asthma, and stroke, has long been established. The study aimed to estimate the prevalence of secondhand smoking exposure among higher secondary school students in Ernakulam district, Kerala, Southern India.

Materials and Methods:

A structured questionnaire was administered to all students from four randomly selected higher secondary schools in Ernakulam district. Descriptive statistics was done using frequencies and percentages. Univariate and multivariate analyses were done for factors associated with household exposure to tobacco smoke generating odds ratios (ORs) and 95% confidence intervals (CIs).

Results:

A total of 629 students participated in the study. The prevalence of ever smokers was 11.9% and of current smokers was 5.2%. Among the study participants, 23.2% were exposed to secondhand smoking from a family member and 18.8% from friends. Lower educational status of father was associated with the household exposure to secondhand smoke (adjusted OR 4.51 [95% CI 1.66–12.22]). More than half of the study participants (56.3%) reported that they were exposed to cigarette smoke in past 1 week in a public place and 10.2% in closed public places. Nearly one-third of the students reported that they have seen somebody smoking inside school campus in the past 30 days.

Conclusion:

Exposure to secondhand smoke at home, schools, and public places was higher among the late adolescent higher secondary school students in Ernakulam district. The findings underscore the urgent need for increased efforts to implement the strategies to reduce secondhand smoke exposure among adolescents.