Tobacco control among disadvantaged youth living in low-income communities in India: introducing Project ACTIVITY.

OBJECTIVE: To provide an overview of Project ACTIVITY, a group randomized intervention trial designed to test the efficacy of a community-based, comprehensive approach to tobacco control for youth (10-19 years) living in low- income communities in India. In doing so, details regarding baseline characteristics of the study sample are provided. METHODS: Fourteen slum communities in Delhi, India were matched and randomized to intervention (n=7) and control (n=7) conditions. The intervention included multiple strategies to promote prevention and cessation of tobacco use among youth. A census was conducted in selected blocks in all study communities (n=78,133), as well as a baseline survey of eligible youth (n=6,023). Main outcomes measures on the survey included ever use, past six months use and current use of multiple forms of tobacco. Mixed effects regression models were used to examine differences between study conditions in (a) demographic characteristics and (b) the prevalence of tobacco consumption. RESULTS: Census data revealed that 31.9% of sampled population was in the age group of 10-19 years. No differences between study conditions in demographic characteristics (e.g. age, gender, religion, education, and occupation) among either adults or youth were noted (p> 0.05). The baseline survey data revealed the prevalence of ever tobacco use among youth was 7.99%, past six months use was 5.70%, and current use was 4.88%. No differences between study conditions in these prevalence rates were observed, either (p>0.05). CONCLUSION: The two study conditions in Project ACTIVITY are comparable. The evaluation should provide a robust test of this intervention's efficacy.

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

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.

Molecular genetic perspectives on the Indian social structure.

For historical reasons, the Indian subcontinent is endowed with enormous ethnic, cultural, and genetic heterogeneity of its people. In the process of understanding the dynamics and sociocultural complexity of Indian society, anthropologists have come up with a number of hypotheses involving certain social/cultural processes that may modulate evolutionary processes. In this article, we outline some of those hypotheses and present molecular genetic evidences, both published and unpublished, to demonstrate the effects of those social/cultural processes.

Mitochondrial DNA variation and substructure among the tribal populations of Andhra Pradesh, India.

We analyzed mtDNA HVR-I variation among six tribal populations-Andh, Pardan, Gond, Naikpod, Kolam and Chenchu--from Andhra Pradesh. These tribes belong to the Dravidian and Indo-European linguistic group. Except for Chenchu, the rest of the tribal samples were collected from two or more than two locations. The analysis of molecular variance (AMOVA) of the sequences yields a significant F(ST) value (0.045), suggesting a fair degree of genetic differentiation among these tribes. When the tribal samples collected from different locations were considered as subpopulations in AMOVA, it is found that the variation among the subunits within the tribal groups is smaller than among the tribes. However, when Chenchu is removed from the analysis, the magnitude of within and between groups diversity becomes similar. In the multidimensional scaling plot based on F(ST) distances the Chenchu is found to be the extreme outlier. Exclusion of Chenchu from AMOVA analysis and multidimensional scaling plot does not result in any specific pattern of population clustering. Mismatch distribution suggest that Chenchu might have undergone a bottleneck effect and does not show evidence of past demographic expansion as shown by the other five tribal groups. A comparison of AP tribes with some other caste and tribal populations of India suggests common maternal genetic heritage.

Growth among Tibetans at high and low altitudes in India.

In India, Tibetans have been living at different altitudes for more than 40 years. This study describes physical growth in terms of height, weight, sitting height, skinfold thickness at triceps and upper arm circumference of Tibetans born and raised at three Tibetan refugee settlements (3,521; 970; and 800 m) from the view point of the hypothesis that growth is retarded at high altitude. Samples consist of individuals between the ages of 2 and 40 years. Tibetans at high altitude in India show a growth pattern similar to that previously observed among Tibetans in Tibet. Tibetans at high altitude are taller and heavier compared to Andean highlanders. The general trends show that Tibetan children and adults of both sexes at low altitude in India are advanced in terms of height, weight, skinfold thickness at triceps and upper arm circumference compared to Tibetans at high altitude. Trunk length (sitting height) is similar at the two altitudes but relative sitting height is greater at high altitude. Greater relative sitting height and lesser leg length at high altitude than at low altitudes is discussed in terms of effect of altitude, temperature, and nutritional status.

Blood pressure variation among Tibetans at different altitudes.

BACKGROUND: Age-related increase in blood pressure (BP) throughout adulthood have been commonly observed in industrialized and developing populations which is generally not observed in traditional populations. Based on studies in the Andes, Tien Shan, Pamir and US highlands, BP values are generally lower in high- than low-altitude populations. At present, Tibetans are residing at different altitudes in India and little is known about BP variation for this population. AIMS: This study reports BP variation among Tibetans in India in view of the hypothesis of age-related increase and of lower BP at high altitude. SUBJECTS AND METHODS: BP, height, weight, triceps skinfold thickness (SFT), mid-upper arm circumference (MUAC), and haemoglobin and haematocrit level were obtained from 1091 individuals (508 males, 583 females) at four different settlements, one being at high altitude (Choglamsar, Leh; altitude: 3521 m) and three at low altitudes (Bylakuppe, Chandragiri and Delhi; altitude: less than 1000 m), which were pooled. Comparison between altitudes was carried out separately for the two sexes and for the two age groups: children and adolescents 10-19 years of age; and adults 20 years and above. Those independent variables that could significantly explain the variance in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in stepwise regression were controlled for while comparing high and low altitudes using analysis of covariance (ANCOVA). RESULTS: The three low-altitude samples showed similar values for adult BP after controlling for age and other BP correlates. Age was highly correlated to adult BP for both males and females after adjusting for anthropometric and haematological variables. A similar analysis for children and adolescents showed lower BP values at high altitude. CONCLUSION: Lower BP values among Tibetan children and adolescents at high altitude suggest that altitude affects BP as previously hypothesized, but only in youth. Similar BP in adults at low and high altitudes may reflect the effects of other variables on BP. Measures of adiposity (SFT, BMI and MUAC) have a significant effect on BP. Increase in BP with adult age is observed in Tibetans, which is similar to the pattern observed among populations undergoing modernization.

ABO and Rh D polymorphism among Tibetans in India.

A study of ABO and Rh D polymorphisms was conducted on 923 Tibetans living in exile in four different places (both high and low altitudes) in India. The frequencies of alleles p, q, and r for the ABO blood group system were found to be 0.1295, 0.2544, and 0.6152, respectively, and for alleles D and d of the Rh blood group system the allele frequencies were 0.9428 and 0.0572, respectively, for the total data. No significant difference was found for the allele frequencies among the four places for the two blood group systems. The allele frequencies were in Hardy-Weinberg equilibrium for the ABO blood group system and show East Asian affinity for the Tibetans.

Birth weight among Tibetans at different altitudes in India: are Tibetans better protected from IUGR?

We report the variation in birth weight among the Tibetans at different altitudes in India to test the hypothesis of greater protection from intrauterine growth retardation (IUGR) among Tibetan compared with other high-altitude native populations. We found that the birth weight of Tibetans at Leh (3521 m, high altitude) is quite similar to what has been reported previously for Tibetans at similar altitudes and is significantly higher than the low-altitude native populations living at similar altitudes. Tibetan birth weights are greater than those of other ethnic groups, both at high and low altitudes. Compared with Tibetans at high altitude (Leh, India; 3521 m), Tibetans at low altitudes (Bylakuppe, India; 800 m and Chandragiri, India; 970 m) have heavier birth weights. This finding is similar to what has been observed previously for other high-altitude native populations. Greater protection from IUGR is not observed for Tibetans compared with other high-altitude native populations as was reported previously. Genetic potential for birth weight is seemingly manifested only at low altitude.