International Approaches to Tobacco Prevention and Cessation Programming and Policy among Adolescents in India
Purpose of the Review
India is not only one of the largest producers of tobacco in the world, but is also one of the largest consumers of tobacco products. Adolescents and young adults are the most vulnerable to tobacco addiction as early initiation is predictive of long-term use and health risks. This review seeks to provide an overview of policies and programs for tobacco prevention and cessation among adolescents. The research over the last few years is highlighted and recommendations for future programming and policy are proposed.
Tobacco control programs for adolescents in India have mostly been developed for school-based settings. The focus is largely on increasing knowledge and awareness of tobacco harm. However, evidence-based prevention and cessation programming are lacking. Policies regarding advertising and marketing to youth are regulated by national legislation and informed by WHO’s global tobacco control treaty. Stricter implementation and consistent evaluation of these policies are integral to creating an environment for reducing tobacco use and improving health outcomes.
With the tobacco industry now marketing heavily to the most vulnerable groups, especially in low and middle-income countries, it is vital to develop programs and enforce policies for adolescents that are effective for prevention as well as cessation.
KeywordsTobacco control Policy Prevention Cessation Adolescents
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Pal R, Tsering D. Tobacco use in Indian high-school students. Int J Green Pharm IJGP [Internet]. 2009 [cited 2017 31];3(4). Available from: http://www.greenpharmacy.info/index.php/ijgp/article/view/109Google Scholar
- 5.Report on Tobacco Control in India. 2004 [cited 2018 Dec 1]. Available from: http://www.who.int/fctc/reporting/Annex6_Report_on_Tobacco_Control_in_India_2004.pdf?ua=1Google Scholar
- 8.•• McKay AJ, Patel RKK, Majeed A. Strategies for tobacco control in India: a systematic review. PloS One. 2015;10(4):e0122610. This review provides a good overview of tobacco control efforts and outcomes of interventions in India. It summarizes evidence from studies, of any population resident of India consuming any form of tobacco, using the WHO treaty Framework Convention on Tobacco Control (FCTC) as the underlying framework for synthesis. https://doi.org/10.1371/journal.pone.0122610.CrossRefPubMedCentralPubMedGoogle Scholar
- 14.World Health Organization. World Health Organization. India (Ages 13–15), Global Youth Tobacco Survey (GYTS). FACT SHEET 2006. [cited 2017 Dec 5]. Available from: https://nccd.cdc.gov/GTSSDataSurveyResources/Ancillary/DownloadAttachment.aspx?ID=257Google Scholar
- 15.Chandrupatla SG, Tavares M, Natto ZS. Tobacco use and effects of professional advice on smoking cessation among youth in India. Asian Pac J Cancer Prev APJCP. 2017;27;18(7):1861–7.Google Scholar
- 16.World Health Organization. World Health Organization. India (Ages 13–15), Global Youth Tobacco Survey (GYTS). FACT SHEET 2009. 2011 [cited 2017 Oct 31]. Available from: http://www.who.int.libproxy1.usc.edu/fctc/reporting/Annexoneindia.pdf.Google Scholar
- 19.Sussman S, Black D. Advancing youth tobacco use cessation in developing countries: practical considerations. Int Public Health J. 2009;1:119–28.Google Scholar
- 21.Arora M, Stigler MH, Reddy KS. Effectiveness of health promotion in preventing tobacco use among adolescents in India: research evidence informs the National Tobacco Control Programme in India. Glob Health Promot. 2011;18(1):9–12. https://doi.org/10.1177/1757975910393163.CrossRefPubMedCentralPubMedGoogle Scholar
- 22.•• Sidhu AK, Sussman S, Tewari A, Bassi S, Arora M. Project EX-India: a classroom-based tobacco use prevention and cessation intervention program. Addict Behav. 2016;53:53–7. This study was the only school-based tobacco control intervention in India to utilize complementary alternative medicine (CAM) activities. https://doi.org/10.1016/j.addbeh.2015.09.005.CrossRefPubMedGoogle Scholar
- 26.Mistry R, Pednekar M, Pimple S, Gupta PC, McCarthy WJ, Raute LJ, et al. Banning tobacco sales and advertisements near educational institutions may reduce students’ tobacco use risk: evidence from Mumbai, India. Tob Control. 2015;24(e1):e100–7. https://doi.org/10.1136/tobaccocontrol-2012-050819.CrossRefPubMedGoogle Scholar
- 27.Mead EL, Rimal RN, Cohen JE, Turner MM, Lumby EC, Feighery EC, et al. A two-wave observational study of compliance with youth access and tobacco advertising provisions of the Cigarettes and Other Tobacco Products Act in India. Nicotine Tob Res Off J Soc Res Nicotine Tob. 2016;18(5):1363–70. https://doi.org/10.1093/ntr/ntv263.CrossRefGoogle Scholar
- 32.Saraf DS, Gupta SK, Pandav CS, Nongkinrih B, Kapoor SK, Pradhan SK, et al. Effectiveness of a school based intervention for prevention of non-communicable diseases in middle school children of rural North India: a randomized controlled trial. Indian J Pediatr. 2015;82(4):354–62. https://doi.org/10.1007/s12098-014-1562-9.CrossRefPubMedGoogle Scholar
- 33.Mall ASK, Bhagyalaxmi A. An informal school–based, peer-led intervention for prevention of tobacco consumption in adolescence: a cluster randomized trial in rural Gandhinagar. Indian J Community Med Off Publ Indian Assoc Prev Soc Med. 2017;42(3):143–6.Google Scholar
- 34.Harrell MB, Arora M, Bassi S, Gupta VK, Perry CL, Srinath Reddy K. Reducing tobacco use among low socio-economic status youth in Delhi, India: outcomes from project ACTIVITY, a cluster randomized trial. Health Educ Res. 2016;31(5):624–38. https://doi.org/10.1093/her/cyw039.CrossRefPubMedCentralPubMedGoogle Scholar
- 35.• Arora M, Mathur MR, Singh N. A framework to prevent and control tobacco among adolescents and children: introducing the IMPACT model. Indian J Pediatr. 2013;80(1):55–62. This article presents a comprehensive theoretically informed model that can be useful in designing, implementing and evaluating multi-level tobacco control interventions. https://doi.org/10.1007/s12098-012-0768-y.CrossRefGoogle Scholar
- 36.Stigler MH, Perry CL, Arora M, Shrivastav R, Mathur C, Reddy KS. Intermediate outcomes from Project MYTRI: mobilizing youth for tobacco-related initiatives in India. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2007;16(6):1050–6. https://doi.org/10.1158/1055-9965.EPI-06-0929.CrossRefGoogle Scholar
- 37.Reddy UK, RKN S, Ul Haque MA, Basavaraja H, BLG A, Divakar DD. Effectiveness of health education and behavioral intervention for tobacco de-addiction among degree students: a clinical trial. J Int Soc Prev Community Dent. 2015;5(Suppl 2):S93–100. https://doi.org/10.4103/2231-0762.172949.PubMedCentralPubMedGoogle Scholar
- 39.McDermott L, Stead M, Gordon R, Angus K, Hastings G. A review of the effectiveness of social marketing nutrition interventions. Report prepared for the National Social Marketing Strategy for Health. Stirling: Institute for Social Marketing. 2006. p. 14.Google Scholar
- 40.Sorensen G, Pednekar MS, Sinha DN, Stoddard AM, Nagler E, Aghi MB, et al. Effects of a tobacco control intervention for teachers in India: results of the Bihar school teachers study. Am J Public Health. 2013;103(11):2035–40. https://doi.org/10.2105/AJPH.2013.301303.CrossRefPubMedCentralPubMedGoogle Scholar
- 42.Sabnis R, Sahu K, Thakur D, Surana S, Mazhar H, Pandey S. Urban and rural disparity in tobacco use and knowledge about oral cancer among adolescents: an epidemiological survey on 12 and 15-year school going students. J Int Soc Prev Community Dent. 2016;6(Suppl 3):S226–31. https://doi.org/10.4103/2231-0762.197200.PubMedCentralPubMedGoogle Scholar
- 43.Harrell MB, Arora M, Bassi S, Gupta VK, Perry CL, Srinath Reddy K. Reducing tobacco use among low socio-economic status youth in Delhi, India: outcomes from project ACTIVITY, a cluster randomized trial. Health Educ Res. 2016;31(5):624–38. https://doi.org/10.1093/her/cyw039.CrossRefPubMedCentralPubMedGoogle Scholar
- 45.Telecom Regulatory Authority of India. New Delhi. Press release on telecom subscription data as on 31st October, 2017 [Internet]. 2017 Dec [cited 2018 Jan 6]. Available from: http://www.trai.gov.in/sites/default/files/PR_No_104_Eng_12122017_0.pdfGoogle Scholar
- 46.Telecom Regulatory Authority of India. New Delhi. Press Release on Indian Telecom Services Performance Indicator Report for the Quarter ending September, 2017 [Internet]. 2017 Dec [cited 2018 Jan 6]. Available from: http://www.trai.gov.in/sites/default/files/Press_Release_No109_Eng_28122017.pdfGoogle Scholar
- 48.• Ghorai K, Akter S, Khatun F, Ray P. mHealth for smoking cessation programs: a systematic review. J Pers Med. 2014;4(3):412–23. This review provides a good introduction and synthesis of mHealth services for smoking cessation. It provides guidelines for theory-based smart phone interventions for smoking cessation in the future. https://doi.org/10.3390/jpm4030412.CrossRefPubMedCentralPubMedGoogle Scholar