Preventing smoking uptake among adolescents - A primary prevention initiative for chronic lung disease in India

Lead Research Organisation: University of Nottingham
Department Name: School of Medicine

Abstract

Smoking tobacco is the largest avoidable cause of lung cancer, chronic obstructive pulmonary disease and a range of other pulmonary disorders, and preventing the uptake and perpetuation of tobacco use is therefore crucial to reducing the global burden of chronic lung disease. Tobacco consumption is increasing in India, and as a large potential future market for tobacco products the country is vulnerable to aggressive marketing and promotion by the tobacco industry. This proposed project aims to identify and understand environmental factors that increase the risk of adolescents starting to smoke tobacco, with the aim of informing interventions that can reduce the number of new tobacco smokers and ultimately prevent chronic lung disease in the future. We will also investigate current attitudes to tobacco control policy implementation from stakeholders at local and national levels, to identify obstacles to more extensive implementation of anti-smoking policies. To ensure that our findings can be used to maximum effect they will be shared with all relevant stakeholders promoting public health in India; our findings are also likely to be directly relevant to smoking prevention in other low and middle-income countries.

Technical Summary

Smoking is the largest avoidable cause of chronic lung diseases. In India, tobacco consumption is increasing, particularly among the rapidly growing young adult population. Preventing the uptake and perpetuation of smoking is therefore crucial to reducing the future burden of chronic lung disease.

This project aims to identify the main determinants of smoking uptake among adolescents in India. We will survey a population of 45,000 students in school grades 6-8 in Udupi region, ascertaining current and susceptibility to future tobacco use; and exposure to determinants including tobacco affordability and ease of access, tobacco imagery in films and music videos and in retail displays, health warnings, anti-tobacco media campaigns, smoke-free homes and schools, and potential confounders (including age, gender, family and peer smoking, self-esteem, rebelliousness, academic grades). One year later we will re-survey the cohort, now in grades 7-9, to estimate prospectively the independent effects and attributable risks of these exposures on smoking susceptibility and uptake. We will then carry out qualitative studies of perceived appropriate policy responses to our findings among national and regional policymakers, and local groups including police, community leaders, tobacco vendors, teachers, parents and adolescents.

Survey data will be analysed using descriptive statistics and logistic regression of independent effects of putative risk factors with adjustment for confounders; and the prospective data using a random effects model to allow for clustering effects at the block and school level. Qualitative data will be analysed using a framework approach. We will use our study findings, which are likely to be generalisable to other LMICs, to formulate and prioritise population and individual strategies to prevent smoking uptake in India, and to work with others to engage with policymakers and others to promote implementation.

Planned Impact

Who will benefit from this research?

The main beneficiaries will be children and young people for whom the lifetime direct and indirect health effects, financial and opportunity costs of smoking, and the harms caused by their smoking to others in their families, peer groups and wider society, will be avoided. Intermediate beneficiaries will include national and local government officers, politicians, other policymakers and advocacy groups in India and in other LMICs, the WHO Framework Convention Alliance, and others who will use and apply our findings to reduce the uptake and prevalence of smoking among young people.

How will they benefit from this research?

Half of all regular smokers die from smoking, and every year of smoking after the age of 35 reduces life expectancy by three months; smoking also exacerbates poverty. Young people who avoid taking up smoking, or quit smoking, will therefore avoid these substantial harms, thus enjoying massive benefits in quality and quantity of life, wealth and productivity; this will also benefit their families, friends and wider society who also benefit from reduced passive smoke exposure. Wider society will benefit from avoiding the opportunity costs of tobacco use; the litter and fire risks generated by smoking; the demand on health services and loss of productivity that smoking causes, and environmental damage arising from tobacco farming. Since many of the impacts of tobacco use are rapidly reversible, benefits will accrue almost immediately after successful behaviour change.

Academic benefits arise from improved understanding of the relative importance of determinants of tobacco use in India, and insights into the design and implementation of improved population strategies and other policies to prevent smoking uptake. It is likely that these benefits will also apply in other countries at a similar stage of economic development to India.
 
Description Quarterly meeting in District Tobacco Control Cell
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a advisory committee
Impact Our team member from Manipal is a part of District Tobacco Control Cell, the DTCC meets once in every three months to discuss the present situation on tobacco control. Our team member will be consulted for the suggestions in stricter implementation of the tobacco control policies. Our research findings were also presented in the meetings to get a greater clarity on the burden of tobacco among the district.
 
Description Yearly Meet in State Tobacco Control Cell, Government of Karnataka
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Membership of a guideline committee
Impact Our team member from Manipal is being invited to the meeting held anually where in decission pertaining to newer policies and ammendments to the existing policies are being planned.
 
Description MOU with State Tobacco Control Cell, Government of Karnataka 
Organisation Government of Karnataka
Country India 
Sector Public 
PI Contribution I have been in regular contact with the research team at Manipal and constantly guided them in carrying out implementation research. This has enabled my research partnerrs to provide appropriate suggestions for strict implementation of tobacco control policies. My research partners have been regularly engaging with the officials, policy makers and key stakeholders in the area of Tobacco control.
Collaborator Contribution Our partners are quite enthusiastic about contributing towards tobacco control and the suggestions given by the Manipal team is valued and given due consideration by the members of state anti-tobacco cell.
Impact This collaboration has enabled the team to provide appropriate suggestions for better implementation of tobacco control policies. The research team have been regularly engaging with the officials, policy makers and key stakeholders in the area of Tobacco control.
Start Year 2018
 
Description NIHMHANS 
Organisation National Institute of Mental Health and Neurosciences
Country India 
Sector Hospitals 
PI Contribution Initial discussion about future research projects.
Collaborator Contribution The collaboration is in its infancy and needs to be further explored.
Impact We could apply for the NIHR funding proposal, which was not successfull.
Start Year 2017
 
Description Awareness programs on Social media 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The intended purpose was to reach multiple audiences across the globe to create awarness on tobacco control in a simple manner for ease of understanding.
Year(s) Of Engagement Activity 2020,2021
URL https://www.youtube.com/channel/UC-J0bQDdbRG-CWrlDvV4mIw
 
Description Awareness skits on occasion of WNTD 2019 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact The skits were organised in open spaces for large audience visibility and trigger inquisitiveness about tobacco awareness and control. This was specifically done in local language to facilitate greater outreach.
Year(s) Of Engagement Activity 2019
URL https://www.youtube.com/watch?v=6kV1b8J07co&t=225s
 
Description Collaborative International webinar on occasion of WNTD 2021 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Undergraduate students
Results and Impact The intended purpose of the webinar was to render a message to the WNTD Theme "Commit to Quit", which was succesful in instilling interest on tobacco control among the young participants. There was also presentation on country best practices by researchers from Bangladesh, Ethiopia, Ghana, India and Uganda.
Year(s) Of Engagement Activity 2021
 
Description GACD Annual Meeting - Shalini Bassi 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact 2018 GACD Annual Scientific Meeting in São Paulo, Brazil on the 12-16th November 2018
Year(s) Of Engagement Activity 2018
 
Description International Seminar on Alcohol and Tobacco abuse 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The delegates spoke about harm to others from alcohol use in regional and national level along with the public health paradigm of it, followed by the panel discussion with the stakeholders.
Internal Policies for Tobacco control and also Tobacco burden and strategies for tobacco control in India were discussed.
Year(s) Of Engagement Activity 2017
 
Description Stakeholder consultation on tobacco free generation 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact The Government of Karnataka had convened a meeting of various stakeholders including our research team member in planning to unveil a policy on Tobacco free generation. Majority of the members supported the views of State Anti-Tobacco cell and assured support for the same.
Year(s) Of Engagement Activity 2020
 
Description The Cancer Collective 2021 - CME 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The results of the present grant were shared across the wider professional group and stakeholders for their views and opinions.
Year(s) Of Engagement Activity 2021