School Tobacco Research Articles

Secondhand Smoke Exposure Among Nonsmoking Adolescents in West Africa.

We estimated the prevalence and determinants of secondhand smoke (SHS) exposure among nonsmoking adolescents in 9 West African countries. We conducted a pooled analysis with nationally representative 2006 to 2009 Global Youth Tobacco Survey data. We used descriptive statistics to determine the prevalence of SHS exposure and inferential statistics using a multivariable logistic regression model to determine factors associated with SHS exposure. We investigated average marginal effect results that show the probability of SHS exposure, adjusting for all other attributes. SHS exposure inside the home ranged from 13.0% to 45.0%; SHS exposure outside the home ranged from 24.7% to 80.1%. Parental or peer smoking behaviors were significantly associated with higher probability of SHS exposure in all 9 countries. Knowledge of smoking harm, support for smoking bans, exposure to antismoking media messages, and receptivity of school tobacco education were significantly associated with higher SHS exposure in most countries. West African policymakers should adopt policies consistent with Article 8 of the World Health Organization Framework Convention on Tobacco Control and its guidelines and public health education to promote smoke-free households.

Examining the impact of changes in school tobacco control policies and programs on current smoking and susceptibility to future smoking among youth in the first two years of the COMPASS study: looking back to move forward.

BackgroundSchool-based prevention activities continue to be an important tobacco control resource, however there is little guidance for school-based tobacco control programming within Ontario. The objective of this study is to identify real-world changes in school-based tobacco control programs or policies in the COMPASS study and examine of those interventions (natural experiments) had any impact on the school-level prevalence of smoking susceptibility and current smoking over time.MethodsThis paper uses longitudinal school-level smoking behaviour data from Year 1 (Y1: 2012–13) and Year 2 (Y2: 2013–14) of the COMPASS study. Changes to school-level tobacco control programs and policies were measured using the COMPASS School Programs and Policies Questionnaire and knowledge broker follow-up interviews. Quasi-experimental tests of proportion and difference-in-difference models were used to evaluate the impact of the interventions identified between Y1 and Y2 on school-level prevalence of smoking susceptibility among never smokers and current smoking.ResultsBetween Y1 and Y2, 17 schools reported a change in their tobacco control programming or policies. In four of the intervention schools, the increase in the within-school prevalence of susceptible never smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. In five of the intervention schools, the decrease in the within-school prevalence of current smokers between Y1 and Y2 was significantly greater than the natural change observed in the control schools. Only two of the new interventions evaluated (both focused on policies of progressive punishment for students caught smoking on school property), were associated with significant desirable changes in both smoking susceptibility and current smoking between Y1 and Y2.DiscussionInterventions specific to effective and enforced tobacco control were the most common and consistently had the desired impact on the school-level prevalence of smoking susceptibility and current smoking. Due to the variation in the types of interventions implemented and their effectiveness, additional evaluation evidence is necessary to determine the most successful activities and contexts among individual students. The results presented here highlight which of these real-world promising interventions should be further evaluated using the longitudinal individual-level data in COMPASS over time.

Factors Affecting High School Baseball Coaches’ Enforcement of School Tobacco Policy

In spite of policy bans and recommendations against spit tobacco (ST) use, baseball athletes have demonstrated ST prevalence rates ranging from 34% to 50% in high school, 42% in the National Collegiate Athletic Association (NCAA), and 50% in the professional ranks. To evaluate enforcement of ST bans, high school baseball coaches in North Carolina (N = 93) completed a survey about ST attitudes, behaviors, and intentions to use and enforce tobacco use policies. Findings revealed that coaches who were current ST users, considered ST pleasant, did not value health impacts, and stated the baseball environment influenced their ST use were less likely to enforce school ST policy with their players.

Medical school curriculum characteristics associated with intentions and frequency of tobacco dependence treatment among 3rd year U.S. medical students

ObjectivePhysicians play a critical role in addressing tobacco dependence, yet report limited training. Tobacco dependence treatment curricula for medical students could improve performance in this area. This study identified student and medical school tobacco treatment curricula characteristics associated with intentions and use of the 5As for tobacco treatment among 3rd year U.S. medical students. MethodsThird year medical students (N=1065, 49.3% male) from 10 U.S. medical schools completed a survey in 2009–2010 assessing student characteristics, including demographics, tobacco treatment knowledge, and self-efficacy. Tobacco curricula characteristics assessed included amount and type of classroom instruction, frequency of tobacco treatment observation, instruction, and perception of preceptors as role models. ResultsGreater tobacco treatment knowledge, self-efficacy, and curriculum-specific variables were associated with 5A intentions, while younger age, tobacco treatment self-efficacy, intentions, and each curriculum-specific variable were associated with greater 5A behaviors. When controlling for important student variables, greater frequency of receiving 5A instruction (OR=1.07; 95%CI 1.01–1.12) and perception of preceptors as excellent role models in tobacco treatment (OR=1.35; 95%CI 1.04–1.75) were significant curriculum predictors of 5A intentions. Greater 5A instruction (B=.06 (.03); p<.05) and observation of tobacco treatment (B=.35 (.02); p<.001) were significant curriculum predictors of greater 5A behaviors. ConclusionsGreater exposure to tobacco treatment teaching during medical school is associated with both greater intentions to use and practice tobacco 5As. Clerkship preceptors, or those physicians who provide training to medical students, may be particularly influential when they personally model and instruct students in tobacco dependence treatment.

School policies for preventing smoking among young people.

School tobacco policies (STPs) might prove to be a promising strategy to prevent smoking initiation among adolescents, as there is evidence that the school environment can influence young people to smoke. STPs are cheap, relatively easy to implement and have a wide reach, but it is not clear whether this approach is effective in preventing smoking uptake. To assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. We searched seven electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO and ERIC. We also searched the grey literature and ongoing trials resources. The most recent search was performed in May 2014. We included cluster-randomised controlled trials (c-RCTs) in which primary and secondary schools were randomised to receive different levels of smoking policy or no intervention. Non-randomised controlled trials, interrupted time series and controlled before-after studies would also have been eligible. Cross-sectional studies were not formally included but we describe their findings and use them to generate hypotheses to inform future research. We independently assessed studies for inclusion in the review, and present a narrative synthesis, as the studies are too limited in quality to undertake a formal meta-analysis. We found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow-up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face-to-face interviews with school staff members, and the outcome evaluation was performed using self-administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal STPs when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. Despite a comprehensive literature search, and rigorous evaluation of studies, we found no evidence to support STPs. The absence of reliable evidence for the effectiveness of STPs is a concern in public health. We need well-designed randomised controlled trials or quasi-experimental studies to evaluate the effectiveness of school tobacco policies.

Berlin evaluates school tobacco prevention - BEST prevention: study design and methodology.

BackgroundThe hazardous health effects of smoking are established, but there remains a need to evaluate existing smoking prevention strategies and to increase their effectiveness in adolescents. Strategies focusing on parental attitudes and rule setting have been identified as a potentially effective approach. The present manuscript describes objectives, study design and methodology of the BEST Prevention study.Methods/designBEST Prevention is a three-armed cluster randomized-controlled trial among 7th grade (11–16 years) students in Berlin, Germany. Schools were enrolled between 2010 and 2011 and allocated using a centralized randomization list into 1) a student smoking prevention intervention (visit to an established interactive circuit), 2) the same intervention plus a parent intervention, and 3) a control group (visit to an established exercise and nutrition interactive circuit). Students were assessed at baseline, 12 and 24 months via self-report, as well as via carbon monoxide and cotinine in saliva at the 24 month follow-up. Statistical analyses uses multi-level regression models with cluster effects (school and class within school) based on the intention to treat population. Here we report descriptive baseline characteristics of recruited schools, and schools classes. Two schools from the control group dropped out after allocation. Hence, 47 secondary schools from all 12 districts of the city, including 161 school classes and 3023 students are participating in the study. Of those, 2801 students completed the baseline assessment.DiscussionThe present manuscript provides details on the study design and methodology of a large school-based smoking prevention trial in a metropolitan area in Germany. Findings from this study will yield important insight into the long-term effectiveness of specific smoking prevention strategies, also in disadvantaged population groups.Trial registrationNCT01306552 (January 2011).

Symptoms of tobacco dependence among middle and high school tobacco users: results from the 2012 National Youth Tobacco Survey.

A growing body of evidence suggests that tobacco dependence symptoms can occur soon after smoking onset and with low levels of use. However, limited data are available nationally and among non-cigarette tobacco users. To examine the prevalence and determinants of tobacco dependence symptoms among adolescent tobacco users in the 2012 National Youth Tobacco Survey, a nationally representative, school-based survey of U.S. middle and high school students. Multivariate logistic regression was used to identify independent predictors of dependence symptoms among current users (i.e., past 30-day use) of cigarettes, cigars, or smokeless tobacco. Analyses were conducted in 2013 using SAS-callable SUDAAN, version 11 to account for the complex survey design. Prevalence of tobacco dependence symptoms ranged from 20.8% (95% CI=18.6, 23.1) of current tobacco users reporting wanting to use tobacco within 30 minutes of waking to 41.9% (95% CI=39.3, 44.5) reporting recent strong cravings. Reporting of dependence symptoms was most consistently associated with polytobacco use, higher frequency of use, earlier initiation age, and female gender. A 2-4-fold increase in the odds of symptom reporting was found in adolescents using tobacco products on as few as 3-5 days compared to those who only used it for 1-2 of the past 30 days. A substantial proportion of U.S. adolescent tobacco users, including those with low levels of use, report symptoms of tobacco dependence. These findings demonstrate the need for full implementation of evidence-based strategies to prevent both experimentation and progression to regular tobacco use among youth.

The Long Arm of Adolescence: School Health Behavioral Environments, Tobacco and Alcohol Co-Use, and the 5HTTLPR Gene

Although sociologists, demographers, and others have thoroughly studied contextual and life course influences on tobacco and alcohol use in adolescence and young adulthood, far less attention has been paid to the determinants of tobacco and alcohol co-use. This is important to remedy because co-use has a nonadditive effect on long-term health. In this article, we use nationally representative, longitudinal data from adolescents and young adults to examine patterns of joint tobacco and alcohol use behaviors across the life course. Importantly, we describe how these trajectories are linked to respondents’ high school’s joint profile of tobacco and alcohol use, measured two ways: as the proportion of tobacco and alcohol co-users, and as the “excess proportion” above that expected based on the marginal probabilities of smoking and drinking in that school. Joint tobacco and alcohol use is associated with both measures, emphasizing the “long arm” of adolescent contexts. Furthermore, we extend previous research to assess whether there is a gene-environment interaction between this school-level measure, 5HTTLPR, and tobacco and alcohol co-use, as suggested by recent work analyzing drinking and smoking separately. We find evidence of such a pattern but conclude that it is likely to be due to population stratification or other forms of confounding.

Addictive Internet Use among Korean Adolescents: A National Survey

BackgroundA psychological disorder called ‘Internet addiction’ has newly emerged along with a dramatic increase of worldwide Internet use. However, few studies have used population-level samples nor taken into account contextual factors on Internet addiction.Methods and FindingsWe identified 57,857 middle and high school students (13–18 year olds) from a Korean nationally representative survey, which was surveyed in 2009. To identify associated factors with addictive Internet use, two-level multilevel regression models were fitted with individual-level responses (1st level) nested within schools (2nd level) to estimate associations of individual and school characteristics simultaneously. Gender differences of addictive Internet use were estimated with the regression model stratified by gender. Significant associations were found between addictive Internet use and school grade, parental education, alcohol use, tobacco use, and substance use. Female students in girls' schools were more likely to use Internet addictively than those in coeducational schools. Our results also revealed significant gender differences of addictive Internet use in its associated individual- and school-level factors.ConclusionsOur results suggest that multilevel risk factors along with gender differences should be considered to protect adolescents from addictive Internet use.

The association between senior student tobacco use rate at school and alternative tobacco product use among junior students in Canadian secondary schools.

BackgroundThe use of alternative tobacco products (ATPs) has grown in popularity among Canadian youth. This study examined the association between a school-level characteristic (the senior student tobacco use rate) and the current use of manufactured cigarettes, little cigars or cigarillos, cigars, roll-your-own cigarettes, smokeless tobacco (SLT), and a hookah among junior students.MethodsThis study used nationally representative Canadian data from 29,495 students in grades 9 to 12 as part of the 2010/2011 Youth Smoking Survey. For each ATP, we described rates of senior and junior tobacco use, calculated the variance attributed to school-level factors, and examined the association between the senior student (grades 11 and 12) tobacco use rate and the current use of each ATP among junior students (grades 9 and 10) while accounting for relevant student-level characteristics. SAS 9.3 was used for all analyses.ResultsOver half of schools sampled had senior students that reported using each ATP. School-level differences accounted for between 14.1% and 29.7% of the variability in ATP current use among junior students. Each one percent increase in the number of senior students at a school that currently use manufactured cigarettes, SLT, or a hookah was significantly independently associated with an increased likelihood that a junior student at that school currently used manufactured cigarettes (OR 1.04, 95% CI 1.01 to 1.06), SLT (OR 1.14, 95% CI 1.06 to 1.24), or a hookah (OR 1.09, 95% CI 1.03 to 1.14).ConclusionsCharacteristics of the school environment a junior student attends appear to play an important role in ATP use, and tobacco control programs and policies should be designed to ensure that they include strategies to curb the use of all tobacco products. Additional evidence is needed for the impact of comprehensive school-based tobacco control approaches.

Comparative study on the knowledge-attitude-belief and practice to tobacco control between Chinese and foreign medical students in Soochow University

Objective : Based on the survey of the knowledge-attitude-belief and practice to tobacco control between Chinese and foreign medical students in Soochow University, the authors intended to explore the current situation, differences and influencing factors of Chinese and foreign medical students, in order to provide a reference for tobacco control policies and measures set by the Medical College of Soochow University. Methods : By stratified sampling, we selected 200 Chinese medical students and 200 foreign medical students of Medical College in different grades and different majors, and adopted anonymous questionnaires to investigate. Results : The smoking rates of Chinese and foreign male medical students were 7.4%, 15.5% respectively , while female medical students' smoking rates were 0.0, 8.1% respectively. Foreign medical students’ daily smoking was mostly 4~10, which was significantly greater than the Chinese medical students （ P &lt;0.05）; besides, the identification degree to the responsibilities and duties for smoking control of the professional medical staff were both higher. The influence of the different smoking rates between Chinese and foreign medical students was mainly ethnic background, and the influences of the different smoking behavior mainly depended on their knowledge and attitude towards tobacco control. Conclusion : There is a need for schools to adopt health education measure to promote the school tobacco control based on the differences of the knowledge-attitude-belief and practice to tobacco control between Chinese and Foreign Medical students. Help medical students to translate knowledge of tobacco control they have already mastered into belief, and further affect their behavior.

Multilevel Analysis of the Impact of School‐Level Tobacco Policies on Adolescent Smoking: The Case of Michigan

In efforts to curb and prevent youth smoking, school tobacco policies have become an important and effective strategy. This study explores the degrees and types of tobacco-free school policy (TFSP) enforcement that are associated with adolescent smoking. A multilevel analysis was performed using 983 students who are nested in 14 schools. The individual-level data are drawn from the 2009 Michigan Youth Risk Behavior Survey. The school-level data are drawn from the 2008 School Health Profiles survey. Two factors are associated with lower adolescent smoking: greater punishment for TFSP violation and more tobacco control communication efforts. By contrast, the factors associated with higher adolescent smoking are designation of a tobacco-free school zone and school-level smoking. This study theoretically and methodologically guides researchers to test TFSP effectiveness in other states. Three strategic implications emerge: (1) schools should provide a consistent antismoking message in smoke-free environments; (2) schools should integrate TFSP into a comprehensive tobacco control initiative, including community-wide tobacco control programs and messages; and (3) the way a specific TFSP is promoted and communicated could determine how effective it is.

An Evaluation of Public School District Tobacco Policies in St. Louis County, Missouri

One way to address tobacco use by youth is for primary and secondary schools to adopt and implement comprehensive tobacco policies. The purpose of this study was to evaluate the comprehensiveness of tobacco policies in St. Louis County, Missouri public school districts. We evaluated the strength of tobacco policies from all 23 public school districts located in the county using the Center for Tobacco Policy Research's School Tobacco Policy Index, a standardized tool for rating school tobacco policies. The districts averaged a score of 24.4 of 40 possible points on the Index. Policies scored highest on the Tobacco-Free Environment domain and lowest on the Enforcement domain. Policies averaged about half of the total possible points for the Prevention and Treatment Services and Policy Organization domains. Despite more than a decade of efforts by the Centers for Disease Control and Prevention to improve school tobacco policies, this study shows that policies in St. Louis County districts have yet to meet the standard of comprehensiveness. It is recommended that schools adopt policies that are comprehensive and that address all domains of the School Tobacco Policy Index.

Evaluation of a Specially Designed Tobacco Control Program to Reduce Tobacco Use among School Children in Kerala

Smoking and smokeless tobacco use are almost always initiated and established during adolescence. More than 80% of adult smokers begin smoking before 18 years of age. The main objective of the present study is to assess the feasibility of preventing adolescent tobacco use with the help of a specially designed tobacco control program. A cross sectional survey on tobacco use and related health effects was conducted using a structured questionnaire in 13 randomly selected schools in Kannur district of Kerala. These students were followed for a period of one academic year with multiple spaced interventions such as anti-tobacco awareness classes, formation of anti-tobacco task forces, inter-school competitions, supplying IEC (information, education and communication) materials and providing a handbook on tobacco control for school personnel. Final evaluation was at the end of one year. There were 4,144 school children who participated in the first phase of the study. The prevalence of tobacco smoking and chewing habits were 9.85% and 2.24% respectively. Ninety-one percent had parental advice against tobacco use and only 3.79% expressed desire for future tobacco use. The final evaluation witnessed a sharp decline in the current tobacco use as 4.68%. We observed a statistically significant difference towards the future use of tobacco (p<0.001) and awareness about the ill effects of passive smoking (p<0.001) among boys and girls. Further a significantly increased knowledge was observed among boys compared to girls about tobacco and oral cancer (p=0.046). The comprehensive school based tobacco control project significantly reduced the tobacco use pattern in the target population. School tobacco projects incorporating frequent follow ups and multiple interventions appear more effective than projects with single intervention.

Violence at School and Alcohol and Tobacco Consumption in Students of Secondary Education

Adolescence is a transitional process between childhood and adulthood (Antona, Madrid and Alaez, 2003), which involves physical, cognitive and social changes (Johnson, Roberts and Worrell, 1999). During this stage, risky behaviours are often developed, including alcohol and tobacco consumption. Alcohol is the most psychoactive substance consumed among adolescents, aged 14-18, followed by tobacco in Spain (DGPNSD, 2009). The teenagers who use alcohol and tobacco have a higher probability of having problems of aggresiveness and violence and it is also related to health problems (Bellis et al., 2005; Gil and Gil-Lacroix Lacroix, 2006; Room, Babor and Rehm, 2005). Several studies (Bond, Carlin, Thomas, Rubin and Patton, 2001; Cangas, Gázquez, Perez-Fuentes, Moldes and Rubio, 2007; Piñero-Ruiz, López-Espín, Cherry and Torres-Cantero, 2012) have linked the presence of violence at school disturbing the environment and having negative consequences for the health and behaviour to a higher frequency in the consumption of alcohol and tobacco. In this study, 2552 questionnaires were collected with ages among 12-16 years from the Murcia Region. The results showed that students with aggressive behaviours at school have a higher frequency of alcohol and tobacco consumption.

Violence at School and Alcohol and Tobacco Consumption in Students of Secondary Education

Adolescence is a transitional process between childhood and adulthood (Antona, Madrid and Alaez, 2003), which involves physical, cognitive and social changes (Johnson, Roberts and Worrell, 1999). During this stage, risky behaviours are often developed, including alcohol and tobacco consumption. Alcohol is the most psychoactive substance consumed among adolescents, aged 14-18, followed by tobacco in Spain (DGPNSD, 2009). The teenagers who use alcohol and tobacco have a higher probability of having problems of aggresiveness and violence and it is also related to health problems (Bellis et al., 2005; Gil and Gil-Lacroix Lacroix, 2006; Room, Babor and Rehm, 2005). Several studies (Bond, Carlin, Thomas, Rubin and Patton, 2001; Cangas, Gázquez, Perez-Fuentes, Moldes and Rubio, 2007; Piñero-Ruiz, López-Espín, Cherry and Torres-Cantero, 2012) have linked the presence of violence at school disturbing the environment and having negative consequences for the health and behaviour to a higher frequency in the consumption of alcohol and tobacco. In this study, 2552 questionnaires were collected with ages among 12-16 years from the Murcia Region. The results showed that students with aggressive behaviours at school have a higher frequency of alcohol and tobacco consumption.

Adolescents’ Perceived Control in the Sociopolitical Domain

Sociopolitical control (SPC) has been identified as a critical component of empowerment, resilience and civic development among young people. Sociopolitical control has been assessed according to a two dimensional model: (1) leadership competence and (2) policy control. Very little is known, however, about heterogeneity of perceptions of SPC, how this heterogeneity is distributed across subpopulations, and how it may affect relationships between SPC and other variables. This study used a person-centered approach, latent class cluster analysis, to test items on a SPC scale for youth. Participants were high school students ( n = 334) in the Northeastern United States. Four distinct groups of participants emerged: those with (1) exceptional SPC, (2) elevated SPC, (3) limited SPC, and (4) diminished policy control. Group differences were observed on a set of relevant variables including perceived school importance, tobacco use, bullying behaviors, and sense of community. Implications are discussed for policy, practice and future research.

Associations Between School Perceptions and Tobacco Use in a Sample of Southern Middle School Students

Cigarettes are responsible for nearly 443,000 deaths per year in the United States. Eighty percent of adult smokers began smoking before the age of 18. In 2009, 17.2% of high school and 5.2% of middle school youths reported being a smoker. Research on school perceptions suggests that “engaged” students get more from school on all levels, including reduced health risk behaviors. The purpose of this study was to identify which school perceptions are protective against tobacco use in a sample of middle school youths. Results conclude that high levels of educational attachment are significantly associated with low levels of tobacco use.

Social, Psychological, and Environmental-Structural Factors Associated with Tobacco Experimentation among Adolescents in Shanghai, China

Objective: To estimate the prevalence and social, psychological and environmental-structural determinants of tobacco experimentation among adolescents in Shanghai, China. Methods: We conducted a cross-sectional study based on a two-stage cluster sample design by using the Chinese version of the Global Youth Tobacco Survey (GYTS) to investigate smoking behavior among 19,117 students from 41 junior and senior high schools in Shanghai, China. The association between potential factors and tobacco experimentation were assessed using complex samples procedure logistic regression. Results: Of the 19,117 respondents, 10.5% (15.3% boys and 6.2% girls) reported the tobacco experimentation. The main social, psychological, and environmental-structural factors associated with tobacco experimentation were having close friends who smoke (AOR = 8.21; 95% CI: 6.49–10.39); one or both parents smoking (AOR 1.57; CI: 1.39–1.77); a poor school tobacco control environment (AOR 1.53; CI: 1.37–1.83); a high acceptance level of tobacco use (AOR 1.44; CI: 1.28–1.82); and a high level of media tobacco exposure (AOR 1.23; CI: 1.10–1.37). Peer smoking might contribute to smoking experimentation among girls (AOR 8.93; CI: 5.84–13.66) more so than among boys (AOR 7.79; CI: 5.97–9.94) and media tobacco exposure had no association with tobacco experimentation among female students. Conclusions: Social, psychological, and environmental factors are closely associated with tobacco experimentation among adolescents. Prevention programs aimed at reducing teen tobacco experimentation should be conducted at home and school with support by parents, peers and teachers. Our findings should prove useful for future development of intervention strategies among adolescents in Shanghai, China.

Designing in the social context: using the social contextual model of health behavior change to develop a tobacco control intervention for teachers in India

This article provides a theory-based, step-by-step approach to intervention development and illustrates its application in India to design an intervention to promote tobacco-use cessation among school personnel in Bihar. We employed a five-step approach to develop the intervention using the Social Contextual Model of Health Behavior Change (SCM) in Bihar, which involved conducting formative research, classifying factors in the social environment as mediating mechanisms and modifying conditions, developing a creative brief, designing an intervention and refining the intervention based on pilot test results. The intervention engages users and non-users of tobacco, involves teachers in implementing and monitoring school tobacco control policies and maximizes teachers' role as change agents in schools and communities. Intervention components include health educator visits, discussions led by lead teachers, cessation assistance, posters and other educational materials and is implemented over the entire academic year. The intervention is being tested in Bihar government schools as part of a randomized-controlled trial. SCM was a useful framework for developing a tobacco control intervention that responded to teachers' lives in Bihar.