Tracking intervention delivery in the 'Tobacco-Free Teachers/Tobacco-Free Society' program, Bihar, India.

In health education and behavior change interventions, process tracking monitors the delivery of an intervention and its receipt to the intended audience. A randomized controlled trial in the state of Bihar, India was conducted to help school teachers become tobacco free through appropriately designed intervention program and delivery system. We describe the results from process tracking of this intervention delivery. The intervention program was centred on six topics delivered in each school through 12 sessions over 6 successive months. The program deliverers recorded the process measures as total number of sessions and program-components implemented (fidelity); time spent conducting sessions (dose) and proportion of teachers attending at least one session (reach). The outcome measures (teachers' exposure to intervention messages and tobacco policy adoption) were assessed post-intervention. All 12 sessions were delivered in 33 out of 36 schools. Thirty-one schools implemented all six program components. In 18 schools, ≥95% of the teachers participated in one or more sessions. Thirty-three schools received 12 or more hours of dose. In 29 schools, 100% teachers reported exposure to all program messages. Tobacco policy was adopted by all schools. Thus, the intervention was generally delivered as planned and it had a positive impact on teachers and schools.

Improvement in prevalence of tobacco use among teachers in Bihar after COTPA.

CONTEXT: A high prevalence of tobacco use, even among educated professionals like teachers, has been reported from Bihar. After passing of the Cigarette and Other Tobacco Products Act (COTPA) in 2003, there have been major improvements in tobacco control nationwide. AIMS: To compare tobacco use prevalence among school teachers in Bihar reported in 2000 with a survey in 2008 and investigate correlates of current and past tobacco-use. METHODS: Data from the baseline survey of a cluster random sample of 72 government schools conducted during the beginning of two consecutive school years was analyzed. RESULTS: The prevalence of current tobacco use was 35.5% and past use, 11.3%. Likelihood of current use compared with no use increased with age (odds ratio [OR] =3.27 for > 50 years compared to < 30, 95% confidence interval [CI]: [1.50, 7.13]); whereas that of past use compared to current use decreased (OR = 0.25, 95% CI: [0.09-0.68] for age > 50 years compared to < 30 years). DISCUSSION: Compared to the tobacco use prevalence among Bihar school teachers reported from a survey in the year 2000 (77.4%), the prevalence in this survey in 2008 was much lower and past use, much higher. In the earlier survey, lal dantmajan was counted as a tobacco product. If we do the same in the current survey, and consider ever use, the prevalence even then was 53.9%, lower than the earlier figure. Although the tobacco use among teachers in Bihar is still high, it has decreased after the implementation of COTPA and the cessation has increased.

Primary prevention trial of oral cancer in india: a 10-year follow-up study.

Oral cancer is caused by chewing and smoking of tobacco. To assess the feasibility of primary prevention of oral cancer, two cohorts were studied in base-line surveys and then followed up annually for 10-yr in Ernakulam district of Kerala state. The intervention cohort consisted of 12212 tobacco users aged 15 yr and over, who were exposed to a concentrated program of education against tobacco use. The control cohort was a non-concurrent cohort of 6075 tobacco users studied using similar methods but with a minimal amount of advice against tobacco use. The stoppage of tobacco use increased and the incidence rate of leukoplakia decreased significantly and substantially in the intervention cohort compared to the control cohort. The decrease in the incidence of leukoplakia was indicative of the decrease in the risk of oral cancer since the two were intimately related. This study demonstrated feasibility of primary prevention of oral cancer.

Intervention study for primary prevention of oral cancer among 36 000 Indian tobacco users.

In a house-to-house survey, 36 471 tobacco chewers and smokers were selected from the rural population in three areas of India. These individuals were interviewed for their tobacco habits and examined for the presence of oral leukoplakia and other precancerous lesions, first in a baseline survey, and then annually over a 5-year period. By personal advice and via the mass media they were encouraged to give up their tobacco habits. The follow-up rate was 97%. The control cohort was provided by the first 5-year results from a 10-year follow-up study conducted earlier in the same areas with the same methodology but on different individuals without any educational intervention. In Ernakulam district (Kerala) and Srikakulam district (Andhra) substantially more people stopped their tobacco habit and reduced the frequency of tobacco use in the intervention cohort than in the control cohort; in Bhavnagar district (Gujarat) the intervention group showed only a slightly higher proportion stopping their tobacco habits and no difference in the proportion reducing them. The 5-year age-adjusted incidence rate of leukoplakia in Ernakulam district was 11.4 in the intervention group versus 47.8 among men, and 5.8 versus 33.0 among women; and for palatal lesions in Srikakulam district the corresponding figures were 59.8 versus 260.8 among men and 289.5 versus 489.5 among women. In Bhavnagar the incidence rate of leukoplakia did not differ between the cohorts. Since most oral cancers are preceded by precancerous lesions, education on tobacco habits should be a feasible and effective approach to primary prevention of oral cancer.

An intervention study of tobacco chewing and smoking habits for primary prevention of oral cancer among 12,212 Indian villagers.

In a house-to-house screening survey, 12,212 tobacco chewers and smokers were selected from the rural population in the Ernakulam district, Kerala state, India. These individuals were interviewed for their tobacco habits and examined for the presence of oral cancer and precancerous lesions, first in a baseline survey, and then annually, over a five-year period. They were educated using personal and mass media communication to give up their tobacco habits. The control group was provided from the results of the first five years of a 10-year follow-up study conducted earlier by the authors in the same area with the same methodology but on different individuals without any educational intervention. The stoppage of the tobacco habit was substantially higher in the intervention group (9.4%) compared to the control group (3.2%). A logistic regression analysis showed that the behavioural intervention was helpful to all categories of individuals, however, the effect was different for different categories: intervention was more helpful to men, chewers, and those with a long duration of the habit. These individuals rarely quit their habit without intervention.

Intervention in the tobacco habits of rural Indian women.

PIP: This report of the Smoking Intervention Project pertains to women in Kerala and Andhra, India. The typical woman in Kerala is a fulltime housewife who also works in the fields, growing, tending, and harvesting a paddy. The rural woman is somewhat literate, and she is alert, independent, and individualistic. She chews tobacco with betel leaf and areca nut, has her own private supply of chewing material, and uses it whenever she wants. Her counterpart in Andhra is less literate, probably has more children, seems poorer, and may chew tobacco but smokes a locally made cigar/cheroot called a chutta. She lights it and when well lit puts the glowing end inside her mouth. The Kerala woman typically suffers from precancerous lesions in right or left buccal mucosa, buccal groove, on or under the tongue. The Andhra woman also has lesions on the palate. Both are totally unaware of the ill effects of tobacco. Oral cancer may be called the national cancer of India. More suffer from it than from any other cancer. The Smoking Intervention Project is divided into 3 phases: phase 1 -- a cross sectional field survey, determined the prevalence rates of oral precancerous lesions and their association with tobacco habits in a population of 50,915; phase 2 -- a 10 year follow-up study of 3/5 of the original study population, which indicated that oral cancer and precancerous lesions occurred almost solely among those who smoked or chewed tobacco and oral cancer was almost always preceded by some type of precancerous lesions; and phase 3 -- the intervention part of the project is to make people give up tobacco and to investigate any effect this might have on incidence and regression rate of precancerous lesions. The intervention program outlined a timetable for employing different communication media and regulating the information flow so as not to overwhelm the target population and to make the message more easily understandable, if necessary. Intervention strategies have been continually evolving. They are reassessed and modified annually and pretested on the study population to determine suitability and effectiveness. Strategies employed to wean people away from tobacco include: 1 to 1 interaction or personal communication; production of a film to create an awareness, give information on the close link that exists between tobacco habits and oral cancer, and to lead to change in attitude toward consuming tobacco; the use of posters; newspaper articles; folk drama; radio programs; and slides. The effectiveness of these strategies is being assessed. The 6th follow-up is in progress. It is possible to intervene in the tobacco habits of people even though they seem psychologically and physically dependent on them. Personal communication is the most effective technique in convincing people about the dangers of smoking, followed by film and burrakatha. In Andhra conventional smoking is eaier to give up than reverse smoking. In Kerala results indicate that chewing is easier to reduce or give up than smoking.^ieng