Disseminating an Evidence-Based Tobacco Control Intervention for School Teachers in India: Overview and Preliminary Findings

Abstract

PURPOSE In India in 2010, tobacco use accounted for more than 1 million deaths. There is a profound need for evidence-based interventions (EBIs) that promote tobacco control on a large scale, particularly in low- and middle-income countries. Our goal was to identify creative strategies for the broad-based implementation of tobacco control EBIs that can be embedded in existing organizational infrastructures and accommodate the realities of low-resource settings. We built on an intervention for schoolteachers, called the Tobacco-Free Teachers/Tobacco-Free Society (TFT-TFS) program, which had been shown to be efficacious in increasing tobacco use cessation and tobacco policy implementation in a cluster randomized controlled trial in the Bihar School Teachers’ Study. Teachers in India are an important channel for promoting tobacco control given their roles as community leaders and role models. This study tested whether TFT-TFS can be successfully implemented by building capacity within the education department to train and support headmasters to implement TFT-TFS in their schools. METHODS Six blocks from 3 districts in Bihar, India, were randomly assigned into either the intervention or control arm. Using a cascade-training model, intervention cluster coordinators—who routinely interact with headmasters—were trained to train headmasters from their respective clusters to implement TFT-TFS over 1 academic year. This study used a noninferiority design to test if program implementation will not be inferior to the high standards demonstrated in the Bihar School Teachers’ Study and assessed program effectiveness in improving cessation and policy implementation. RESULTS Nearly all of the 46 trained intervention cluster coordinators further trained more than 90% of the 218 headmasters to implement TFT-TFS. Preliminary data also indicate that two thirds of headmasters reported implementing 3 of 4 program components. Additional findings will be available Spring 2020. CONCLUSION This research is innovative because it systematically examines the process of scaling up one of the first EBIs to promote tobacco use cessation among teachers in India.