Recognising the importance of chronic lung disease: a consensus statement from the Global Alliance for Chronic Diseases (Lung Diseases group).

BACKGROUND: Chronic respiratory diseases are disorders of the airways and other structures of the lung, and include chronic obstructive pulmonary disease (COPD), lung cancer, asthma, bronchiectasis, interstitial lung diseases, occupational lung diseases and pulmonary hypertension. Through this article we take a broad view of chronic lung disease while highlighting (1) the complex interactions of lung diseases with environmental factors (e.g. climate change, smoking and vaping) and multimorbidity and (2) proposed areas to strengthen for better global patient outcomes. CONCLUSION: We suggest new directions for the research agenda in high-priority populations and those experiencing health disparities. We call for lung disease to be made a research priority with greater funding allocation globally.

Awareness, attitudes and practices relating to Article 5.3 of the WHO Framework Convention on Tobacco Control among members of tobacco control committees in a southern Indian state.

BACKGROUND AND OBJECTIVES: The tobacco industry (TI) has undermined tobacco control policy for decades. The WHO Framework Convention on Tobacco Control Article 5.3 implementation guidelines provide guidance for preventing TI interference. Government officials responsible for policy implementation must understand these guidelines to manage TI tactics. This study assessed awareness, attitudes and practices of Article 5.3 guidelines among members of District Level Coordination Committees (DLCC) in Karnataka mandated with overseeing tobacco control activity. METHOD: A semistructured questionnaire survey of awareness, attitudes and adherence to Article 5.3 guidelines among 102 DLCC members carried out between January and July 2019. RESULT: Responses were received from 82 members, comprising 51 (62%) from health and 31 (38%) from non-health departments. Our study demonstrates a lack of understanding of Article 5.3 and its guidelines, even among those actively involved in tobacco control at the district level. Nearly 80% of respondents were aware that corporate social responsibility (CSR) by tobacco companies is an indirect form of promoting tobacco. However, 44% of members felt that CSR funding from the TI should be used to combat tobacco-related harm. A higher proportion (12%) of health respondents agreed that subsidies should be provided to tobacco agriculture compared with non-health (3%). CONCLUSION: Awareness of international guidance designed to prevent the TI influence on health policy among policymakers in this Indian state is low. Respondents from non-health departments were less aware of TI CSR. Those in health departments were more receptive towards taking a TI role in the future .

Universalization of Healthcare for Non-Communicable Diseases in India - Promise of Health and Wellbeing, Insurance for Universal Health Coverage.

SUMMARY: Noncommunicable diseases (NCDs) pose a significant global health and economic burden, necessitating universal health coverage (UHC). Out-of-pocket (OOPs) payments for healthcare, particularly in low- and middle-income countries lacking social protection and health insurance, contribute to impoverishment and catastrophic expenditure. This scoping review aimed to assess the state of UHC for NCDs in India, including the progress made, coverage of government health insurance schemes, challenges faced, and their potential solutions. A literature search was performed in major databases such as PubMed, Ovid, Web of Science, Embase, Cochrane Library, and Google Scholar using appropriate keywords. Findings indicated that UHC remains a distant dream in India with a disproportionately high NCD burden and a substantial portion of health-care expenses (80% outpatient, 40% inpatient) relying on OOP expenditures, causing financial hardship. Limited universal social security exacerbates health-care access challenges. The coronavirus disease-2019 pandemic has further hindered NCD services and UHC progress. The Ayushman Bharat program, featuring health and wellness centers and the Pradhan Mantri Jan Arogya Yojana, aims to address primary health-care needs and provide NCD coverage in India. Despite this, challenges persist, including inadequate availability of essential medicines and technologies in health-care facilities, as well as gaps in rural health-care access. Telemedicine services like "eSanjeevani" have been implemented to improve access in remote areas. To achieve UHC for NCDs in India, it is crucial to strengthen primary health-care, ensure medicine availability, enhance human resources, establish a referral system, address social determinants, and implement social protection.

Potential Risk Factors of Smokeless Tobacco Consumption Among Adolescents in South India.

INTRODUCTION: Although most of the disease burden internationally is due to tobacco smoking, smokeless tobacco (SLT) use contributed to an estimated 76 000 deaths in 2017. We have studied the potential risk factors for SLT use among adolescents in South India. METHODS: A cross-sectional questionnaire survey of all students in grades 6-8 in schools in the Udupi district of Karnataka State ascertained SLT use status and potential determinants of SLT uptake. Ever SLT use was defined as any reported consumption of any SLT products, currently or at any time in the past. Independent effects on ever SLT use status were estimated using multiple logistic regression. RESULTS: Of 46 706 students from 914 participating schools, 39 282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever SLT use was reported by 775 (2.0%) participants and in a mutually adjusted model was significantly related to age, male sex, family use, or friend's use of SLT, low socioeconomic status, high rebelliousness, and low self-esteem. After controlling for these effects, the odds of ever-SLT use were significantly higher among students who had least awareness of the harmful effects of tobacco use (odds ratio 3.7, 95% confidence interval [2.9, 4.7]) and significantly lower among those not exposed to tobacco advertising (odds ratio 0.7, 95% confidence interval [0.5, 0.8]). CONCLUSIONS: The prevalence of SLT use among children in Karnataka is relatively low when compared with other studies in India. The significant potential risk factors of SLT use include low awareness of the harmful effects of tobacco and tobacco control policies and exposure to tobacco advertising. IMPLICATIONS: The prevalence of SLT use among school going adolescents in South India is relatively low. The potential risk factors for SLT use among adolescents in southern India are similar to those for smoked tobacco. It includes age, male gender, family or friend's use of SLT, low socioeconomic status, high rebelliousness, low self-esteem, exposure to tobacco advertisement and least awareness about the harmful effects of tobacco and of tobacco control policies. The present study lays emphasis regarding creating awareness about tobacco harms and control policies for further reducing tobacco use among adolescents.

Institutional tensions, corporate social responsibility and district-level governance of tobacco industry interference: analysing challenges in local implementation of Article 5.3 measures in Karnataka, India.

INTRODUCTION: Accelerating progress on tobacco control will require Article 5.3 of the WHO Framework Convention on Tobacco Control to be systematically integrated into policies and practices of sectors beyond health at diverse government levels. However, no study has explored implementation challenges of Article 5.3 within multilevel systems such as India, where political decisions on tobacco control occur at diverse government levels, which may constrain action at local level. METHODS: Based on 33 semi-structured interviews with diverse government and civil society stakeholders across four districts in Karnataka, India (Mysore, Mangalore, Bengaluru (rural) and Udupi), this study examines challenges to implement Article 5.3 arising from competing agendas and policies of different actors at multiple levels. RESULTS: Our analysis reveals generally low levels of awareness of Article 5.3 and its guideline recommendations, even among those directly involved in tobacco control at district level. Efforts to implement Article 5.3 were also challenged by competing views on the appropriate terms of engagement with industry actors. Scope to reconcile tensions across competing health, agriculture and commercial agendas was further constrained by the policies and practices of the national Tobacco Board, thereby undermining local implementation of Article 5.3. The most challenging aspect of Article 5.3 implementation was the difficulties in restricting engagement by government officials and departments with tobacco industry corporate social responsibility initiatives given national requirements for such activities among major corporations. CONCLUSIONS: Promoting effective implementation of Article 5.3 in Karnataka will require policymakers to work across policy silos and reconcile tensions across India's national health and economic priorities.

Regulatory Compliance of Health Warnings on Tobacco Packs in Karnataka, India.

INTRODUCTION: In September 2014, the Government of India introduced legislation requiring all tobacco packaging to display a health warning covering 85% (60% pictorial, 25% text) of the principal display area of the pack, of at least 4 cm in height and 3.5 cm width, with legible text in a white font on a black background and in English and/or the same Indian language as the language used on the pack. We evaluated compliance with this legislation in the Udupi district of Karnataka, India. METHODS: We procured one example of every tobacco pack of cigarettes, beedis, chewing tobacco, and snuff sold by a convenience sample of retailers in one urban and two rural areas in each of the five administrative blocks of the Udupi district between June and August 2018. For each pack we measured the size of the health warning, calculated the proportion of the pack covered, and assessed the legibility. RESULTS: A total of 365 packs were collected from retailers, with 357 of these branded and eight, all packs of snuff, unbranded. Warnings on 320 (87.3%) packs did not reach the legally required proportional magnitude, warnings on 140 (38.4%) packs were not legible, and warnings on 117 packs (32.1%) did not meet the language requirement. Only 45 packs (12.3%) were fully compliant. CONCLUSIONS: Compliance with warning legislation in this district of India is low, highlighting the need for more effective enforcement. IMPLICATIONS: Warnings on tobacco packaging are an important and inexpensive means of communicating the harms associated with tobacco use. However, relatively few studies have explored regulatory compliance with warnings. We collected all unique tobacco packs from 66 retailers in a district in Karnataka in India and assessed whether each met the legislative requirements in terms of warning size and proportion of the pack covered, legibility, and the language used. Of the 365 packs collected, only one in eight was compliant with the legislative requirements. This study highlights the importance of assessing warning compliance and the need for enforcement in India.

Exposure to tobacco imagery in popular films and the risk of ever smoking among children in southern India.

BACKGROUND: Exposure to smoking in films is a recognised cause of smoking uptake among children. In India, in an attempt to protect children, films containing smoking are required to include tobacco control messaging including audiovisual disclaimers, on-screen health warnings when tobacco imagery is displayed and antitobacco 'health spots' before and during the film. We report a study of the association between ever smoking and exposure to tobacco imagery in locally popular films among children in Udupi district of Karnataka state in southern India. METHODS: A cross-sectional questionnaire survey of all students in grades 6-8 in schools in the Udupi district ascertained smoking status and potential confounders of smoking uptake, and whether children had seen any of 27 locally popular films we had coded and found to contain imagery of actual or implied tobacco use. Ever-smoking status was defined as any reported smoking of cigarettes, beedis or other tobacco products currently or at any time in the past. Independent effects on ever-smoking status were estimated using multiple logistic regression. RESULTS: Of 46 706 students enrolled in grades 6-8 in 914 participating schools, 39 282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever smoking was reported by 914 (2.3%) participants and in a mutually adjusted model was significantly related to age, male sex, living in a home where smoking is allowed, having parents or siblings who smoke, low paternal education, low levels of family wealth, low self-esteem, rebelliousness and poor school performance. After allowing for these effects, the odds of ever smoking were not increased among students who had seen any of the listed films containing tobacco imagery when included in the analysis as a binary exposure (OR 0.9, 95% CI 0.4 to 2.0), and decreased in relation to level of exposure graded into tertiles of tobacco intervals seen. CONCLUSIONS: In this cross-sectional study, children in southern India who had seen films containing tobacco imagery are no more likely to smoke than those who had not, indicating that the tobacco control messaging mandated by Indian law may be attenuating the effect of tobacco imagery in films on smoking uptake.

A cross-sectional study to identify the determinants of non-communicable diseases among fishermen in Southern India.

BACKGROUND: India is currently facing a rising epidemic of Non-Communicable Diseases (NCDs). Identification of modifiable risk factors is of paramount importance to curb this menace. Fishermen are one of the most vulnerable occupational groups with unique characteristics that make them prone to acquire NCDs, as a significant share of their life is spent at sea. Hence, this study was planned to ascertain the burden of NCDs, determine various risk factors of NCDs, and measure the association between risk factors and NCDs among fishermen of Coastal Karnataka in South India. METHODS: A cross-sectional study was conducted among 681 fishermen aged 18 years and above as per the semi-structured interview schedule for two years (2017-2019). A convenience sampling strategy was adopted. The data was entered and analyzed using SPSS v.15.0. The results were described in terms of proportions and their 95% confidence intervals. Continuous data were summarized using the mean and standard deviation or median and interquartile range depending on the skewness of data. Chi-square test was used to study the association between NCDs and modifiable risk factors. Multiple logistic regression was used to identify risk factors of NCDs. RESULTS: The mean (SD) age of the population was 42.5 (SD 12.5) years. The mean years involved in fishing was 19.8 years (SD 10.9). More than half (59.5%) of the study participants had severe stress and most (80.3%) were ever substance users. Advancing age, not being able to contact family while at sea, poor dietary practice, ever substance use, increasing waist circumference were significant correlates of NCDs. CONCLUSIONS: The commonly prevalent risk factors of NCDs among fishermen included poor dietary practice, higher stress levels, substance use, increasing waist circumference, and inability to contact with family while at sea. Hypertension and Diabetes were the two common NCDs in the study population. There is a need for immediate attention in managing NCDs' risk factors by promoting a healthy lifestyle by primary health care providers through a sustainable community awareness program targeting fishermen at a convenient time and location, either at the sea-port or meeting places. Harmful effects of substance use, healthy dietary practices, and the importance of physical activity outside their job need emphasis. In addition, screening programs should be organized with the help of boat owners and fishing associations at-least once a year to pick up NCDs at an early stage.

Assessment of tobacco imagery and compliance with tobacco-free rules in popular Indian films.

BACKGROUND: Exposure to smoking in films causes smoking uptake among adolescents. Investigation of the extent to which tobacco imagery appears, or tobacco control laws are complied with in Indian films is limited, and especially so for films in regional languages. This study presents an analysis of tobacco content and compliance with tobacco control laws in popular films in several languages from the Karnataka state of India. METHODS: We used 5 min interval coding to measure actual tobacco use, implied tobacco use, tobacco paraphernalia and tobacco branding in the top 10 films identified from national box office ratings and regional distributor reports in Karnataka in 2015 and 2016. We also assessed compliance with tobacco-free film rules in India. FINDINGS: A total of 47 films, in English, Hindi, Malayalam, Tamil, Telugu and Tulu languages were coded. Any tobacco imagery was observed in 72% of films, and actual tobacco use in 50%. Tobacco imagery was equally prevalent in films classified as suitable for universal viewing (U category) or at age 12 or more (U/A category) films; and significantly more common in films made in regional than national language (Hindi). None of the films were fully compliant with legal requirements on health spots, audiovisual disclaimers and health warnings. CONCLUSIONS: Tobacco content was common in films classified as suitable for viewing by children, more among regional than national languages. Compliance with tobacco control laws was low. Stricter enforcement of tobacco-free film rules will protect children and adolescents from exposure to tobacco use on screen.

Community based study to assess the prevalence of diabetic foot syndrome and associated risk factors among people with diabetes mellitus.

BACKGROUND: Diabetic foot is one of the most significant and devastating complication of diabetes. The objective of this study was to assess the prevalence of diabetic foot syndrome (DFS) and the associated risk factors among people with diabetes mellitus. METHODS: A community based cross-sectional study was carried out among 620 subjects with diabetes mellitus (DM) in rural areas of Udupi district. The Michigan Neuropathy Screening Instrument was used to identify peripheral neuropathy. Ankle brachial index was used to identify peripheral arterial disease (PAD). Subjects with diabetic foot syndrome were classified according to the International Working Group on Diabetic Foot (IWGDF) classification system. RESULTS: The overall prevalence of DFS was 51.8%. Among them 31.3, 11.9 and 8.5% belonged to category 1, 2 and 3 respectively. Multivariate logistic regression analysis showed advancing age, low socio-economic status, sedentary physical activity and longer duration of DM were significant independent correlates of DFS. CONCLUSION: The overall prevalence of DFS was high among the study population; hence the screening for foot complications should start at the time of diagnosis of diabetes integrated with sustainable patient education at primary care level by training of health care providers at primary care level.

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis.

BACKGROUND: Tobacco use is associated with early, intermediate and long-term complications throughout the life course. With an influx of newer products containing nicotine, poly-tobacco use is slowly emerging as a public health concern, that is defined as existing tobacco users currently using two or more tobacco or nicotine products. While many studies have investigated single use tobacco, there is a paucity of research on regional patterns and socio-demographic factors associated with poly-tobacco use in India. OBJECTIVES: To assess prevalence of poly-tobacco use and determine the socio-demographic factors associated with poly-tobacco use in India. METHODS: Data from the Global Adult Tobacco Survey 2 (GATS, 2016-17) was analysed, which included information on tobacco use among people aged >15 years. The pattern of current tobacco status was described using descriptive statistics. Multiple logistic regression models were estimated to determine factors associated with poly-tobacco use. RESULTS: The prevalence of poly-tobacco use in India was found to be 9.8%. Among the current tobacco users, the prevalence was 33%. Significant socio-demographic factors associated with poly-tobacco use included younger age, male gender, religion and backward caste. North-eastern region reported highest prevalence of poly-tobacco use in the country, followed by the central region. CONCLUSION: The number of poly-tobacco users in India is considerably high and a matter of concern, more so in north east and central regions of the country. There is a need to create awareness about dangerous effects of all types of tobacco products and strengthen implementation of tobacco control policies with special focus on regions with high burden.

Prospective study of exposure to smoking imagery in films and changes in susceptibility to smoking in a cohort of school students in Southern India.

INTRODUCTION: India has unique tobacco-free film and TV rules designed to prevent tobacco uptake. In this study, we examined the potential influence of exposure to smoking imagery in regionally famous films, on susceptibility to smoke in teenagers enrolled in schools in a district in Southern India. METHODS: A longitudinal survey of students, in grades 6 to 8 at baseline in 2017 and grades 7 to 9 one year later in 2018, ascertained prospective incident susceptibility to smoking during the study period in relation to baseline exposure to 27 locally popular films with actual or implied smoking imagery. RESULTS: We analyzed linked data from 33676 participants, and 3973 (11.8%) of the adolescents reported incident susceptibility. There was a significant increase in susceptibility to smoking with increasing exposure at baseline to smoking imagery in films on univariable analysis, highest tertile of exposure relative to no exposure (OR=1.4; 95% CI: 1.0 -2.1, ptrend<0.001), and this trend remained significant (p=0.022) after mutual adjustment for recognized confounders, highest vs no exposure (AOR=1.3; 95% CI: 0.9-1.8). We found no statistically significant association between exposure to tobacco-free film rules and change in susceptibility. CONCLUSIONS: Prospectively, watching films featuring smoking imagery increases adolescents' vulnerability to smoking. Further research revealed no difference in susceptibility change between youth who saw partially compliant films and those who watched non-compliant films. Our findings, thus, underscore the need to incorporate comprehensive approaches to prevent the inclusion of smoking imagery in films.

Perceptions of novel warnings compared with current warning on tobacco packs, and warnings on cigarette sticks: A cross-sectional survey of college students in Southern India.

INTRODUCTION: In India there is insufficient knowledge of the risks associated with tobacco use. Increasing awareness of these risks is critical, with pictorial warnings on tobacco packs a cost-effective way to communicate this information. We explored perceptions of the current warning, 'Tobacco causes cancer', displayed on packs in India and four novel warnings about other potential impacts of tobacco use including social, financial, and environmental, but also complications with diabetes. As loose cigarette sales are common in India, we also explored perceptions of warnings on cigarette sticks. METHODS: A cross-sectional survey of college students aged ≥18 years in Karnataka, India, was conducted between January 2019 and February 2020. Participants were asked about salience, believability, and cognitive processing of warnings currently on packs. They were then shown an image of one current and four novel warnings and asked about their perceived effectiveness in preventing uptake and reducing and stopping tobacco use. They were then asked about warnings on cigarette sticks. RESULTS: Most participants (70.2%) recalled warnings on packs and considered them believable (55.7%), but only 12.0% read and 12.4% thought about them often. Warnings about the health impacts of tobacco use were viewed as most effective in preventing uptake, and reducing and stopping tobacco use. Nevertheless, at least a third of participants rated warnings pertaining to financial, social, and environmental impacts effective in preventing uptake, and reducing and stopping tobacco use. Approximately one-fifth (22.0%) thought that warnings on cigarette sticks would deter initiation. CONCLUSIONS: Our results suggest that health warnings are perceived as most effective in discouraging tobacco use among college students in Karnataka. While viewed as less effective than health warnings, novel non-health related messages were viewed as effective in preventing uptake, and reducing and stopping tobacco use by at least one in three participants. Warnings on cigarette sticks may help complement warnings on cigarette packs.

Programme and policy perspectives towards a tobacco-free generation in India: findings from a qualitative study.

OBJECTIVE: This study explored multistakeholder perspectives on existing adolescent-specific tobacco control policies and programmes, to advance India's transition towards a tobacco-free generation. DESIGN: Qualitative semi-structured interviews. SETTING: Interviews were conducted with officials involved in tobacco control at the national (India), state (Karnataka), district (Udupi) and village level. Interviews were audio recorded, transcribed verbatim and analysed thematically. PARTICIPANTS: Thirty-eight individuals representing national (n=9), state (n=9), district (n=14) and village (n=6) levels, participated. RESULTS: The study findings highlighted the need to strengthen and amend the existing Tobacco Control Law (2003) provisions, particularly in the vicinity of schools (Sections 6a and 6b). Increasing the minimum legal age to buy tobacco from 18 to 21 years, developing an 'application' for 'compliance and monitoring indicators' in Tobacco-Free Educational Institution guidelines were proposed. Policies to address smokeless tobacco use, stricter enforcement including regular monitoring of existing programmes, and robust evaluation of policies was underscored. Engaging adolescents to co-create interventions was advocated, along with integrating national tobacco control programmes into existing school and adolescent health programmes, using both an intersectoral and whole-societal approach to prevent tobacco use, were recommended. Finally, stakeholders mentioned that when drafting and implementing a comprehensive national tobacco control policy, there is a need to adopt a vision striving toward a tobacco-free generation. CONCLUSION: Strengthening and developing tobacco control programmes and policies are warranted which are monitored and evaluated rigorously, and where adolescents should be involved, accordingly.

A close critical look of India's National Mental Health Survey 2016.

The National Mental Health Survey 2016 (NMHS 2016) was a large epidemiological study, one of its kind, conducted by the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru to overcome the shortcomings of the previous surveys. The detailed report of the study is available in two parts- 'mental health systems' and 'prevalence, pattern and outcomes'. Though done comprehensively, there are some inevitable limitations. The private sector, a substantial health care provider in the country was not a participant in the survey. Though MINI version 6.0 is a standard and structured instrument, it does not cover many commonly encountered mental illnesses like somatoform disorders. Further, the methodology of the survey makes it difficult for an accurate calculation of the prevalence of individual major psychiatric disorders. The survey has been appraised using a standard checklist for prevalence studies. The detailed qualitative data has not been shared in the report. The contribution of the traditional indigenous systems of healthcare and accessibility of services in rural areas have not been elaborated. Thus, the need for a comprehensive and culturally sensitive assessment tool, involvement of the private sector, and enhancing funding provision to improve the infrastructure are emphasized as future directions for the subsequent phases of the survey.

Development and Validation of a New Tool to Measure Performance Knowledge and Communication Skill of Multidisciplinary Health Science Learners on Radiation Emergency Preparedness and Response Management.

OBJECTIVE: The purpose of the study was to design, develop, and validate a newer tool on radiation emergency preparedness responses (RadEM-PREM IPE tool) to measure communication, knowledge, performance skills in multidisciplinary health science learners. METHODS: The study design is a prospective, single centric, pilot study. Five subject experts designed, analyzed, and selected items of the instrument for relevant content and domain. Psychometrics that the tool assessed were content validity, internal consistency, test-retest reliability, and intraclass correlation coefficient. Twenty-eight participants completed test-retest reliability for validation of 21 sorted out items calculated percentage of agreement >70% I-CVI/UA (item content validity index with universal acceptability) and S-CVI/UA (scale content validity index with universal agreement method). RESULTS: Items with percentage agreement >70% and I-CVI over 0.80 were kept, ranged from 0.70 to 0.78 were revised, and below 0.70 were rejected. Items with kappa values ranging from 0.04 to 0.59 were revised and ≥0.74 were retained. Internal consistency assessed using Cronbach's alpha was 0.449. Positive correlation between attitude and communication (r = 0.448), between performance and communication (r = 0.443) were statistically significant at 0.01 level. Overall, intraclass correlation coefficient for all the measures is 0.646, which is statistically significant at 0.05 level (P < 0.05). CONCLUSIONS: Study concludes that the RadEM-PREM IPE tool would be a new measuring tool to assess knowledge, performance, and communication skills of interprofessional radiation emergency response team learner's evaluation.

Outcome of structured health education intervention for obesity-risk reduction among junior high school students: Stratified cluster randomized controlled trial (RCT) in South India.

BACKGROUND: Obesity has been identified as a serious global health concern whose prevalence doubles almost every 10 years. Health education regarding physical activity and healthy diet imparted to adolescents could prove to be fruitful in reducing obesity-risk. Objectives of this study were to evaluate the effect of health education intervention on knowledge, attitude, and practices (KAP) regarding obesity-risk reduction and to estimate the postinterventional change in body mass index (BMI) and total body fat (%) among adolescent school children in South India. MATERIALS AND METHODS: Stratified cluster randomized controlled trial was carried out among 398 students recruited at baseline including 206 and 192 participants in intervention and control group respectively selected through simple random sampling from eligible government aided and private schools to assess KAP regarding physical activity and diet using pretested and validated questionnaire by making three school visits 6 months apart. Anthropometric measurements were recorded in first and third visit only, while health education intervention was given in first visit to intervention and third visit to control group after taking their responses on the questionnaire. Data were entered and analyzed using SPSS version 15. RESULTS: Overall dropout rate was 13.5% with dropout in intervention and control group being 12.6% and 14.5% respectively, making 180 participants in intervention and 164 in control group available for analysis. Mean physical activity KAP score improved significantly from 16.19 ± 4.61 to 19.46 ± 10.07 in intervention group. Mean dietary KAP score also improved significantly from 21.38 ± 4.07 to 23.43 ± 4.53 in intervention group (p < 0.001). Mean BMI decreased significantly within intervention group (p < 0.001) as compared to control group (p = 0.908). Based on cut-off level for total body fat (%) to categorize obesity-risk among participants, statistically significant decline in proportions from 26.1% to 13.3% was observed in intervention group (p < 0.001). CONCLUSION: Results depicted better KAP in intervention group than control group in all the three visits while it improved significantly within both groups. Hence, the health education was found to be effective in improving the overall KAP regarding modifiable risk factors of obesity among the study participants. Further studies to screen the adolescents for obesity-risk and successive health education sessions must be carried within schools in order to bring about change in knowledge, attitude, and practices regarding obesity-risk.

Tobacco prevention and control interventions in humanitarian settings: a scoping review protocol.

INTRODUCTION: Tobacco has been a complex global problem that has adversely affected almost all the sectors of society. However, the ill-effects are often most reflected in humanitarian settings, which inadvertently are surmounted by fragile systems. We aim to map tobacco prevention and control intervention in humanitarian settings. METHODS AND ANALYSIS: This scoping review will follow the guidelines of the Joanna Briggs Institute. A comprehensive search strategy was designed using Medical Subject Heading terms, subject experts and pertinent reviews. The search was conducted on Medline (through PubMed and Ovid), EMBASE (through OVID), ProQuest Health and Medical Complete, EBSCO (through CINAHL Complete), Scopus and Web of Science databases. Two reviewers will independently screen the identified studies on removing duplicates, which shall be followed by data extraction using a pretested data extraction form. A narrative synthesis approach will be employed to collate the findings from the studies and tabular formats would be used to aid the representation. ETHICS AND DISSEMINATION: This review will identify, map and synthesise the interventions for tobacco prevention and control in the humanitarian settings. An ethics committee approval was not sought for this body of work as it does not include human subjects. Results from the study will be disseminated through conference presentations and peer-reviewed publications.

Strengthening tobacco control policies during the COVID-19 pandemic in India.

Problem considered: The aim of this paper was to support policy makers to make informed decisions regarding public health response in general, and tobacco control interventions particularly, in the context of COVID-19. Methods: An online cross-sectional survey using a semi-structured questionnaire was conducted in the year 2020 with stakeholders in tobacco control and public health experts from private and government organizations. Information pertaining to background characteristics of study participants and impact of pandemic on tobacco use and means to leverage tobacco control policy was collected. Data was analysed using Microsoft excel 2010 and results are presented as frequencies and percentages along with key responses from open ended questions. Results: A total of 72 stakeholders were approached out of which, 46 (56.1%) responded and were included. About 32 (74.4%) of the participants thought that public health authorities had given advice on stopping tobacco use during COVID-19 pandemic. About 19 (43.2%) participants did not notice any change in level of interest in tobacco cessation during the pandemic while a majority 34(73.8%) agreed that COVID-19 pandemic had an impact on health seeking behaviour of patients with non-communicable diseases. Nearly half of participants, 21(48.8%) opined that tobacco industry was engaged in corporate social responsibilities during COVID-19. Conclusion: The stakeholders expressed that there is a good opportunity to further strengthen tobacco control activities during COVID-19 pandemic and also emphasized need to closely monitor tobacco industry interference during this time.

Implementation of Article 5.3 of the World Health Organization Framework Convention on Tobacco Control: A Subnational Assessment.

Background: Article 5.3 of the World Health Organization's Framework Convention on Tobacco Control necessitates the governments to take measures to protect health policy from the commercial and other vested interests of the tobacco industry (TI). Considering the vast geographical area and diversity between states within India, it is necessary to evaluate the level of implementation of Article 5.3 at the sub-national level. Hence, this study was conducted to assess the implementation of Article 5.3 in the Karnataka state of southern India. Materials and Method: Southeast Asia Tobacco Control Alliance Tobacco Industry Interference index was adopted and used for the study. A desk review was conducted for 2018. Publicly available evidence of tobacco industry interference was scored based on its frequency, severity, and the government's response to it. Lower the score, effective the level of governance against the TI interference, which predicts well for the state. Results: The study demonstrates a score of 46 out of 95 in the implementation of Article 5.3 in Karnataka, which is lower when compared to the national score of 69 out of 100 for 2018. Corporate social responsibility, conflict of interest, and unnecessary interactions with TI are the major areas that need focus to comply with the provisions of Article 5.3. Conclusion: Overall, Karnataka needs to strengthen the implementation of Article 5.3 and develop a strategy in line with the global best practices. This assessment can help in identifying areas requiring enhanced vigilance to avoid industry interference.