Table 1 - uploaded by Leslie A Lytle
Content may be subject to copyright.
Source publication
This article discusses the findings of Focus Group Discussions (FGDs) that were conducted as a formative assessment for Project MYTRI (Mobilizing Youth for Tobacco Related Initiatives in India), a randomized, multicomponent, school-based trial to prevent and control tobacco use among youth in India. Forty-eight FGDs were conducted with students (N=...
Similar publications
Background and Objectives: Cigarette smoking among the youth population has increased significantly in developing countries, including Bosnia and Herzegovina. However, no extant literature assesses the prevalence of tobacco use, nor identifies factors associated with smoking. This study determined the prevalence of cigarette smoking among a specifi...
Research has shown that tobacco users have an increased risk of collisions compared to nonsmokers. Studies from 1967 through 2013 documented a crude relative risk of collision involvement of about 1.5 among smokers compared to nonsmokers. In January 2009, in response to concerns about the health risks associated with potentially high concentrations...
Citations
... The first key determinant was cultural norms. Family were generally seen to exert a stronger influence on adolescents who were from ethnic minorities [43,59], compared to those from a white ethnic group. Moreover, it was perceived to be socially unacceptable for girls to smoke in some cultures. ...
... Moreover, it was perceived to be socially unacceptable for girls to smoke in some cultures. For example, one study [43] collected data in Morocco, finding that girls were more confident to resist smoking due to the unacceptability of girls' smoking in society. In contrast, another study found that smoking was a desirable behaviour among adolescent males [45]. ...
... For example, students attending poorer government schools in Morocco perceived boys' smoking to be brave, and students were exposed to a higher prevalence of smoking among parents. Whereas students attending richer private schools with higher quality teaching, lower smoking prevalence and lower exposure, were perceived to have more confidence to resist pressure [43]. Smoking was also perceived to be determined by the lack of structured activities available for adolescents within poorer areas [61], as well as taking part in weekend cultural leisure activities with friends that are associated with smoking, such as going to discos. ...
Background
A relationship between smoking and interpersonal influences has been well established within the literature. There have been cultural shifts in denormalisation and a reduction in tobacco smoking in many countries. Hence there is a need to understand social influences on adolescents’ smoking across smoking normalisation contexts.
Methods
The search was conducted in July 2019 and updated in March 2022 within 11 databases and secondary sources. Search terms included schools, adolescents, smoking, peers, social norms and qualitative research. Screening was conducted by two researchers independently and in duplicate. Study quality was assessed using the eight-item Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-centre) tool for the appraisal of qualitative studies. Results were synthesised using a meta-narrative lens for meta-ethnography and compared across smoking normalisation contexts.
Results
Forty one studies were included and five themes were developed, mapping onto the socio ecological model. The social processes by which adolescents take up smoking differed according to a mixture of school type, peer group structure and the smoking culture within the school, as well as the wider cultural context. Data available from smoking denormalised contexts, described changes in social interactions around smoking to cope with its stigmatisation. This was manifested through i) direct peer influence, whereby subtle techniques were employed, ii) group belonging whereby smoking was less likely to be seen as a key determinant of group membership and smoking was less commonly reported to be used as a social tool, and iii) popularity and identity construction, whereby smoking was perceived more negatively in a denormalised context, compared with a normalised context.
Conclusions
This meta-ethnography is the first study to demonstrate, drawing on international data, that peer processes in adolescent smoking may undergo changes as smoking norms within society change. Future research should focus on understanding differences across socioeconomic contexts, to inform the adaptation of interventions.
... This theme focuses on the higher level determinants which set the wider context and interact with the lower level determinants discussed in the subsequent four themes to affect smoking behaviour. Nineteen studies published before the introduction of comprehensive tobacco legislation contributed to this theme (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). The main ndings within this theme centred around culture and socioeconomic status. ...
... The rst key determinant was cultural norms. It was perceived to be socially unacceptable for girls to smoke in some cultures and family were generally seen to exert a stronger in uence on adolescents among ethnic minorities (31,40). For example, Mishra et al. (31) collected data in Morocco, nding that girls were more con dent to resist smoking due to the unacceptability of girls' smoking in society. ...
... It was perceived to be socially unacceptable for girls to smoke in some cultures and family were generally seen to exert a stronger in uence on adolescents among ethnic minorities (31,40). For example, Mishra et al. (31) collected data in Morocco, nding that girls were more con dent to resist smoking due to the unacceptability of girls' smoking in society. In contrast, another study found that smokers in Saudi Arabia were perceived to be in uenced by a need to look 'Western' and 'civilised', although there were contrasting opinions on whether smoking would help to achieve that (33). ...
Background
The relationship between smoking and interpersonal influences has been well established within the literature. There has been a cultural shift in denormalisation and a reduction in tobacco smoking. Despite this, socioeconomic inequality in smoking has prevailed. This highlights the pressing need to understand health inequalities in relation to adolescents’ smoking attitudes across smoking normalisation and socioeconomic contexts.
Methods
The search was conducted in July 2019 and updated in March 2022 within 11 databases and secondary sources. Search terms included schools, adolescents, smoking, peers, social norms and qualitative research. Screening was conducted by two researchers independently and in duplicate. Study quality was assessed using the eight-item Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-centre) tool for the appraisal of qualitative studies. Results were synthesised using a meta-narrative lens for meta-ethnography and compared across smoking normalisation contexts
Results
Forty one studies were included and five themes were developed, mapping onto the socio ecological model. The social processes by which adolescents take up smoking differed according to a mixture of school type, peer group structure, socioeconomic composition and the smoking culture within the school, as well as the wider cultural context. Data available from smoking denormalised contexts, described changes in social interactions around smoking to cope with its stigmatisation. This was manifested through direct peer influence, whereby more subtle techniques were employed, group belonging whereby smoking was less likely to be seen as a key determinant of group membership and smoking was less commonly reported to be used as a social tool, and popularity and identity construction, whereby smoking was perceived more negatively in a post-legislative context.
Conclusions
This meta-ethnography is the first study to demonstrate, drawing on international data, that peer processes relating to socioeconomic inequalities in adolescent smoking may undergo changes as norms for smoking within society change. Future research should focus on understanding how differences across school-level socioeconomic contexts manifest once post-legislative norms have been established, to inform the adaptation of interventions.
... Thematic content analysiswas used for the investigation of information collected during FGDs (19). The audiotapes of FGD were transcribed in hindi language and then handwritten transcripts converted from hindi to english language into electronic format via microsoft word and later ondata was migrated to microsoft excel worksheets generating columns consisting of all comments.Thentranscripts were qualitatively assessed and analyzed by the facilitator and other researchers not involved in the study (20). Through analyzing, each response was labeled and coded which were later on categorized with themes and subthemes (21). ...
Background: Preliminary evidence showed that school-based therapeutic interventions as related services implemented by special educators under supervision of therapists proclaims effectiveness to prevent physical ailments in Cerebral Palsy children. Apparently, barriers addressed by special educators in delivering physiotherapy services hinder the progress of children in curricular & co-curricular activities. Assuming the barriers, special educators intercepted about substitutive technological therapeutic approach delineating content and module of novelty in terms of inclusive Tele-physiotherapy (i-TelePT) to combat physical ailments in educational settings. Purpose: To develop content and structure of i-TelePT module for treatment and monitoring the physical impairments in children with brain disorder i.e. C.P through focus group discussions.
Method: Two FGDs (offline & online) were conducted with special educators. Inqualitative focus group study, a total of ten same special educators were invited for both face to face and online FGDs to gather an in-depth understanding of the rehabilitation needs of the children with CP in the inclusive educational settings using a semi-structured question sheet. The entire sessions of FGD were audiotaped in face to face and recorded via zoom app in online FGD and after that transcribed, coded and analyzed employing a thematic analysis model. Results: The FGDs highlights the dynamic implications of module development of Tele-physiotherapy for CP children in educational settings and this system of technology seems to be more expressive towards fulfilling the need of children as well as special educators and even therapists who cannot regularly visit such children and deliver services. Conclusion: Undertaking evaluative work of Tele-physiotherapy reflects our pledge and enthusiasm to build a module for such Cerebral Palsy children in school settings pointing to both educational and therapeutic concerns.
... Although these interventions often emphasize both short-term and long-term consequences of tobacco use, adolescents tend view the near-term harms of tobacco as being minimal and discount the long-term harms of use (Mishra et al., 2005). Tobacco control efforts also tend to be gender-neutral even though Indian men and women differ in the types of tobacco products they prefer (Amos, Greaves, Nichter, & Bloch, 2011;Nichter & Cartwright, 1991;Placek et al., 2019). ...
Smokeless tobacco use among Indian women is increasing despite prevention efforts. Evolutionary theories suggest that reproductive-aged women should be more concerned about immediate threats to reproduction than threats to survival occurring late in life. This study therefore compared an anti-tobacco intervention that emphasized near-term reproductive harms to one involving general harms occurring later in life. Scheduled Tribal women (N = 92) from Karnataka, India participated in this study. At baseline, women reported tobacco use and knowledge of harms, provided a saliva sample to assess use, and randomly viewed either a general harms presentation (GHP) or reproductive harms presentation (RHP). At followup, women reported their use, knowledge of harms and intentions to quit, and provided another saliva sample. At baseline, participants were aware of general harms but not reproductive harms. Both interventions increased knowledge of harms. Women in the RHP condition did not list more harms than women in the GHP condition, however, and the RHP was not more effective in reducing tobacco use than the GHP. In the RHP condition fetal health was particularly salient. In the GHP condition, oral health was highly salient, aligning with the local disease ecology and research on tobacco use and attractiveness.
... Teachers are role models for the community and can play a major role in school-based health education programs [16][17][18]. An intervention study among school teachers was reported to be effective in tobacco control in the Indian state of Bihar [19]. ...
Background:
Control of blood pressure among hypertensives is a major challenge around the world. Interventions for improving hypertension control in India are very limited. This paper describes the protocol for a cluster randomized controlled trial of efficacy of behavioural intervention on control of hypertension among school teachers in Kerala.
Methods:
A total of 92 schools are randomised to intervention and control group in Kerala. A baseline survey was conducted in all schools to assess the prevalence of hypertension and its risk factors among school teachers in Thiruvananthapuram district of Kerala state, India. Teachers in both sets of schools will receive a leaflet containing details on the importance of controlling hypertension. With the objective of improving control of hypertension, the intervention schools will additionally receive self-management education and behavioural intervention programs delivered by trained intervention managers along with measurement of weight, waist circumference and blood pressure. This intervention program will be developed based on the findings of the baseline survey and selected components of successful models of hypertension control from previous research done in similar settings. The intervention will be given for 3 months after which a post-survey will be conducted among teachers of both control and intervention schools. The primary outcome is change in control of hypertension and secondary outcome is the change in behavioural risk factors of hypertension both in the control and intervention groups.
Discussion:
This is the first comprehensive study looking at the efficacy of behavioural intervention on hypertension control among school teachers in Kerala, India. This study is likely to provide an upper estimate of behavioural intervention on hypertension control since teachers are reported to have one of the highest compliance rates of behavioural intervention.
Trial registration:
This trial was prospectively registered with the Clinical Trials Registry of India [CTRI/2018/01/011402] on 18 January 2018.
... Below are several examples: The Portuguese project ECOS (Estratégias Comunitárias de Observação Social; Martinho et al. 2017) that used US-originated models as its theoretical basis but established a new multi-group intervention (i.e., individual and family support; parental training; Diversification of Cultural Experiences Programme; children's group intervention; and youngsters' group intervention) that has been directed especially for Portuguese families of complex social circumstances. Additional examples are the Swedish Örebro Prevention Programme (ÖPP; Bodin, & Strandberg, 2011), which was developed in the late 1990s in response to a governmental call for universal alcohol prevention programs that could be administered at low cost within the limitations of existing community resources (see also its adapted version to the Netherlands -PAS; Koning et al. 2009); or the Health-Related Information and Dissemination Among Youth in India (HRIDAY; Reddy et al.,2002), a part of the MYTRI Project (Mobilizing Youth for Tobacco Related Initiatives in India) that gradually (e.g., Harrell Stigler et al., 2011;Mishra et al. 2005) identified the role of parents and parental collaboration in shaping Indian youth's cigarette smoking. Both of these projects (and several others) consider generic knowledge on positive parenting but implement them only after exploration of the specific nation's circumstances, mentality and youth characteristics. ...
The purpose of the current review is to provide an updated portrayal of current knowledge concerning the role of the family in children and youth’s substance abuse prevention. A review of the literature highlights the notion that incorporating parental involvement in youth's substance abuse prevention is highly accepted. Accordingly, many programs have been developed incorporating parental involvement, some of which are internationally popular. While there is evidence that these parent-focused programs have significant utility, several topics still need further elaboration including: What is the best timing (in terms of children’s age) for parental engagement in the process of preventing children's substance abuse? What new paths can be identified for intervention? How can family’ participation be fostered? And especially, how can a balance be reached between generic principals of positive parenting and appropriate, local and sensitive, ways to implement them among non-western populations?
... There are only a few studies in India regarding relation between family's socio-economic status and tobacco use in children. A study by HRIDAY conducted in urban areas of Delhi and Chennai showed higher prevalence of tobacco use among the lower SES government students than students belonging Upper SES families (Mishra et al. 2005). ...
Tobacco use among school children is becoming a serious problem. The early age of initiation underscores the urgent need to intervene and protect this vulnerable group from falling prey to this addiction. The present study was undertaken to assess (i) the prevalence and pattern of tobacco use among school children in India (ii) relation of tobacco use prevalence and pattern with socio-economic status (SES) of student’s family. This is a cross sectional 16 months study done in school going Indian students aged ≥ 6 years with sample size of 1460. The prevalence of tobacco use in children from lower SES families was 9.4% compared to 5.7% in children from middle SES families (p = 0.017). Among children who used tobacco, mean age of onset was younger among children from lower SES (9.97 year vs 11.85 year, p = < 0.01) and they were more likely to use smokeless tobacco only (79.1% vs 61.3%, p = .0.006). However there was no significant difference between two groups in factors which motivated them towards first experience of tobacco. Also there was no significant difference between family histories of two groups in terms of tobacco use. The high prevalence of tobacco consumption, especially smokeless tobacco among children highlights the need for early intervention like regular screening at school level. Also tobacco use cases need to be followed up with intensive treatment.
... A majority of the studies, 21, were conducted in North and Central America and 15 in Europe [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. A small minority of the studies were thus undertaken in the other continents, Asia [61][62][63], Africa [64] and Australia [65]. The participants in the included articles varied in age between 3 and 25. ...
... Furthermore, the included articles in this scoping review varied according to research settings. We categorised three broad settings, 13 were conducted in community settings [26, 29-32, 35, 37, 38, 41, 43, 44, 61, 65], a further 11 in healthcare settings [25,28,42,46,49,52,53,55,[57][58][59], and 17 in school settings [27,33,34,36,39,40,45,47,48,50,51,54,56,60,[62][63][64]. ...
... However, both of these foci were supporting interventions concerning health and well-being. The main areas in 30 articles were supportive lifestyle interventions and concerned: a healthy diet and obesity [27,36,39,41,47,54,56,60], physical activity [26,36,38,39,41,45,48,54], substance abuse such as, alcohol, tobacco and drug use [29,34,40,43,44,51,61,62,65], sexual and reproductive health [29,31,42,43,50,64], violence [29,37], stress [33], social skills [63], health beliefs [30] and mental health promotion [35]. In addition to lifestyle issues, eleven of the articles considered issues that supported children and young people with their illness or disease. ...
Background:
Greater interest is being shown in participatory approaches, especially in research on interventions that concern children and young people's health and well-being. Although participatory approaches have user involvement in common, they differ in terms of the explicit guidance on how to actually involve and engage children and young people in health research. The aim of this scoping review was to systematically map recent research involving children and young people in the development of interventions targeting issues of health and well-being.
Methods:
An interpretative scoping literature review based on: a scientific literature search in (health and social science) databases, reference lists, a manual search in key journals and contact with existing networks was conducted. A total of 4458 references were identified through the literature search, of which 41 studies published between 2000 and 2017 were included in the review. The target population was children and young people under 25 years old. Level of participation was categorized according to Shier's Pathways to Participation Model.
Results:
The review showed that participatory approaches were most often used in the development of interventions in school settings and in community and healthcare settings and on issues concerning support in lifestyle or in managing illness or disease. The level of participation varied from children and young people taking part just as active informants, through stages of greater participation both in quantitative and qualitative terms, to children and young people becoming an active agent involved as a co-researcher where the research process was shaped by views of a higher level of mutuality. Most of the studies were categorised at a medium level and only three studies were judged to involve the children and young people at the highest level.
Conclusions:
This scoping review showed that work remains in enabling children and young people to influence the development of interventions targeting health and well-being. In relation to level of sustainability in the interventions, it is relevant that goals, strategies and processes are formulated by those who can gain from the interventions. Participatory approaches aiming for a higher level of participation where children and young people work together with the researchers in partnerships are thus warranted.
... social susceptibility, advocacy skills, self-efficacy) and socio-environmental factors (e.g. perceived prevalence, exposure to tobacco advertising, enforcement of tobacco control policies) are associated with youth tobacco use [10,12,14]. Project Advancing Cessation of Tobacco In Vulnerable Indian Tobacco consuming Youth (ACTIVITY) was a community-based, cluster randomized trial to test the efficacy of a multicomponent tobacco reduction intervention for youth (10-19 years) in low SES communities in Delhi (2009)(2010)(2011). ...
... ACTIVITY adapts research evidence from developed countries that reveals that program and policy-based interventions can be successful in reducing the prevalence of tobacco use among youth [13]. The intervention model ( Fig. 1) was based on social cognitive theory [18], the researchers' prior experience with comprehensive tobacco control interventions in India [12,14,19,20], existing literature on tobacco control among youth globally, and qualitative research conducted at the beginning of the study that identified important cultural and contextual factors relevant to the program design and implementation [9]. Intervention strategies were employed to influence intra-personal (e.g. ...
... year intervention embraced comprehensive community-based, low-cost, multiple strategies to promote awareness and skills around prevention and cessation of tobacco use among youth [8]. ACTIVITY adapts research evidence from developed countries that reveals that program and policy-based interventions can be successful in reducing the prevalence of tobacco use among youth [14].The intervention model was based on social cognitive theory [17], the researchers' prior experience with comprehensive tobacco control interventions in India [11,15,18,21], existing literature on tobacco control among youth globally, and qualitative research conducted at the beginning of the study that identified important cultural and contextual factors relevant to the program design and implementation [10]. Intervention strategies were employed to influence intrapersonal and socio-environmental risk factors that were identified in our formative research as critical to reducing the prevalence of tobacco use. ...
To test the efficacy of an intervention to reduce tobacco use among youth (10–19 years old) in slum communities in Delhi, India. This community-based cluster-randomized trial included 14 slums composed of purposely built resettlement colonies and adjacent inhabitant-built Jhuggi Jhopris. Youth in the intervention received a 2 year multiple-component intervention: (a) youth and adult leader training; (b) peer-led interactive activities and outreach; (c) tobacco cessation camps; and (d) enforcement of India’s Tobacco Control Law (smoke-free environments and youth access). Overall, no differences between the intervention and control conditions were observed over time; self-reported tobacco use declined in both groups. However, when stratified by type of residence, a significant decrease was observed among youth in the resettlement colonies in the intervention group for overall tobacco use (slope = −0.69) and cigarette and bidi smoking (slope = −0.66), compared to an increase in the control group (slope = 0.24 and 0.12, respectively) (P < 0.001). No differences in smokeless tobacco (SLT) use were observed for either group. Comprehensive community-based interventions that engage youth can be effective in reducing smoking among disadvantaged youth in India. More intensive interventions, like tax increases or large-scale media campaigns, appear warranted for the most marginalized in this context and for SLT products.
... As the study aimed to describe the adolescents' general knowledge and opinions about smoking, a representative sample was recruited. It consisted of adolescents aged 13-16 years and from grades 8-10, because these are known to be vulnerable to initiation of smoking and using other tobacco products (6,20). Moreover, an equal number of girls and boys from private as well as public schools and from different castes were recruited. ...
The use of tobacco products among adolescents in Southeast Asia represents a major public health burden. Two out of ten adolescents attending school are tobacco users and several factors influence them to initiate tobacco use. Most studies related to tobacco use are quantitative, whereas qualitative studies exploring adolescents’ smoking behavior and their views, knowledge and experiences are scarce.
To gain a deep understanding of Nepalese adolescents’ knowledge and opinions about smoking and reasons for smoking initiation.
Adolescents from four secondary schools in the Bhaktapur district, Nepal.
Eight focus-group discussions were conducted with 71 adolescents aged 13–16 years and from grades 8–10. Data were analyzed using manifest qualitative content analysis.
The participants knew that smoking represents health risks as well as socio-economic risks, but few described the addictive nature of tobacco and health risks related to passive smoking. Most participants related smoking initiation to the smoking behavior of peers and family members, but easy accessibility to cigarettes, ineffective rules and regulations, and exposure to passive smoking also created environments for smoking. Some expressed confidence to resist peer pressure and refuse to start smoking, but also expressed the need for prevention strategies in schools and for governmental initiatives, such as more strict implementation of tobacco control and regulations to prevent and reduce smoking.
Curbing the tobacco epidemic in Nepal requires healthy public policies and multifaceted interventions to address the knowledge gap on health consequences associated with smoking among adolescents, teachers and parents/adults.
