Adolescents' perceptions about smokers in Karnataka, India.

BACKGROUND: Prevalence of tobacco use among adolescents in India is very high. Despite many epidemiological studies exploring tobacco use among youth, there is no published data on adolescents' perceptions about smokers in Indian society and its implications on tobacco control. METHODS: A cross-sectional study was conducted using a stratified random sampling with probability proportional to school-type (government or private owned). Data was collected using a pretested, self-administered, anonymous questionnaire with a mix of close and open-ended questions from a sample of 1087 students. Chi-square test was used to measure associations. Qualitative data was analysed through inductive coding. RESULTS: The response rate for the study was 82.5% and the sample population had a mean age of 16.9 years (SD = 1.9) with 57.8% male students. Majority of respondents (84.6%) reported negative perceptions about smokers while 20.4% of respondents reported positive perceptions. Female students reported significantly higher disapproval rate (negative perceptions) for smoking compared to male students (89.7% Vs 71.6% in case of male smoker; 81.2% Vs 67.3% in case of female smoker). Dominant themes defining perceptions about smokers included 'hatred/hostility/Intolerance', 'against family values/norms', 'not aware of tobacco harms' and 'under stress/emotional trauma'. Themes like 'culture', 'character' and 'power' specifically described negative social image of female smoker but projected a neutral or sometimes even a positive image of male smoker. There was a significant association between adolescents' positive perceptions of smokers and tobacco use by themselves as well as their close associates. CONCLUSIONS: Adolescents' stereotypes of smokers, especially female smokers are largely negative. We suggest that tobacco control interventions targeting adolescents should be gender specific, should also involve their peers, family and school personnel, and should go beyond providing knowledge on harmful effects of smoking to interventions that influence adolescents' social construct of smoking/smoker.

Community health insurance schemes & patient satisfaction--evidence from India.

BACKGROUND & OBJECTIVES: Quality of care is an important determinant for utilizing health services. In India, the quality of care in most health services is poor. The government recognizes this and has been working on both supply and demand aspects. In particular, it is promoting community health insurance (CHI) schemes, so that patients can access quality services. This observational study was undertaken to measure the level of satisfaction among insured and uninsured patients in two CHI schemes in India. METHODS: Patient satisfaction was measured, which is an outcome of good quality care. Two CHI schemes, Action for Community Organisation, Rehabilitation and Development (ACCORD) and Kadamalai Kalanjiam Vattara Sangam (KKVS), were chosen. Randomly selected, insured and uninsured households were interviewed. The household where a patient was admitted to a hospital was interviewed in depth about the health seeking behaviour, the cost of treatment and the satisfaction levels. RESULTS: It was found that at both ACCORD and KKVS, there was no significant difference in the levels of satisfaction between the insured and uninsured patients. The main reasons for satisfaction were the availability of doctors and medicines and the recovery by the patient. INTERPRETATION & CONCLUSIONS: Our study showed that insured hospitalized patients did not have significantly higher levels of satisfaction compared to uninsured hospitalized patients. If CHI schemes want to improve the quality of care for their clients, so that they adhere to the scheme, the scheme managers need to negotiate actively for better quality of care with empanelled providers.

Tobacco use and related factors among pre-university students in a college in Bangalore, India.

BACKGROUND: Tobacco use imposes a huge burden of disease in India. Most studies on the use of tobacco among students in India have focused on secondary school students with a few studies investigating younger children and university students. We aimed to ascertain tobacco use among pre-university college students in Bangalore. METHODS: A cross-sectional study was conducted among 300 students of a purposively selected boys-only, pre-university college in Bangalore. All the students from 4 of 10 randomly selected classes were enrolled in the study. An anonymous self-administered questionnaire was used to collect information on the extent and pattern of tobacco consumption, factors associated with use/non-use of tobacco products, and awareness of the harmful effects of tobacco use. RESULTS: The prevalence of 'ever use' of tobacco was 15.7% (95% CI: 11.7-20.3) of which 5.3% (95% CI: 3.1-8.7) were current users of tobacco. The mean (SD) age of initiation of tobacco use was 14.7 (2.05) years; 78.3% of users were aware that tobacco was harmful. The most common reasons by ever users to start using tobacco included peer pressure, having fun/enjoyment, and curiosity. 'Never users' abstained from usage because of awareness of the negative health implications of tobacco use, a dislike for tobacco products, and the negative social implications of tobacco use. CONCLUSION: Interventions need to be designed to reduce the use of tobacco among students. Such Interventions should raise awareness on the social and economic implications of the use of tobacco, equip students to overcome peer influence and provide counselling to quit using tobacco.

An outbreak of leptospirosis in Orissa, India: the importance of surveillance.

OBJECTIVE: To demonstrate the importance of surveillance systems in detecting emerging diseases and highlighting the strengths and weaknesses of an existing one. METHODS: The Orissa multi-disease surveillance system (OMDSS) was introduced in November 1999. Reporting units from the periphery send data to the district on a weekly basis. These reports are analysed regularly. A district task force (DTF) was available to intervene in the event of an outbreak. The OMDSS detected an increasing number of cases with fever and jaundice in June 2002. The DTF investigated this outbreak using clinical, epidemiological and laboratory tools to identify its cause. RESULTS: This outbreak, in a remote corner of India, was detected within 4 days by an existing surveillance system. Action was initiated within 24 h, but it took approximately two more weeks for the causative agent to be diagnosed. A total of 143 people were suspected to have leptospirosis between 23 June 2002 and 31 July 2002. The attack rate was 5.95% and the case fatality ratio (CFR) was 7.69%, both lower than outbreaks reported elsewhere in India. While males were infected more often than females, the CFR was higher among females and among the 6-15 year age groups. Exposure to infected water in a canal was the probable cause of the outbreak. IgM antibodies were positive in 33 of the patients and six patients tested positive for PCR and culture. Leptospirosis interrogans serovar canicola, Leptospirosis interrogans serovar pomona and Leptospirosis interrogans serovar hebdomadis were isolated. CONCLUSIONS: Leptospirosis is a new disease in this region of India. This outbreak was detected and diagnosed because of the surveillance system. The prompt response helped in containing the outbreak early enough. However, the morbidity and mortality could have been further mitigated if the delays in transmitting information had been minimized. An adequate laboratory support would have also helped considerably. We conclude stressing the importance of surveillance as a public health tool.