Transitions in smoking behavior during emerging adulthood: a longitudinal analysis of the effect of home smoking bans.

OBJECTIVES: We studied the effect of home smoking bans on transitions in smoking behavior during emerging adulthood. METHODS: We used latent transition analysis to examine movement between stages of smoking from late adolescence (ages 16-18 years) to young adulthood (ages 18-20 years) and the effect of a home smoking ban on these transitions. We used data from the Minnesota Adolescent Community Cohort study collected in 2004 to 2006. RESULTS: Overall, we identified 4 stages of smoking: (1) never smokers, (2) experimental smokers, (3) light smokers, and (4) daily smokers. Transition probabilities varied by stage. Young adults with a home ban during late adolescence were less likely to be smokers and less likely to progress to higher use later. Furthermore, the protective effect of a home smoking ban on the prevalence of smoking behavior was evident even in the presence of parental smoking. However, this effect was less clear on transitions over time. CONCLUSIONS: In addition to protecting family members from exposure to secondhand smoke, home smoking bans appear to have the additional benefit of reducing initiation and escalation of smoking behavior among young adults.

Socioeconomic differences in the risk profiles of susceptibility and ever use of tobacco among Indian urban youth: a latent class approach.

PURPOSE: To empirically determine the socioeconomic differences in risk profiles of susceptibility and ever use of tobacco among adolescents in India and to investigate the association between the risk profiles and the psychosocial factors for tobacco use. METHODS: Students in 16 private (higher socioeconomic status [SES]; n = 4,489) and 16 government (lower SES; n = 7,153) schools in two large cities in India were surveyed about their tobacco use and related psychosocial factors in 2004. Latent class analysis was used to identify homogenous, mutually exclusive typologies existing within the data. RESULTS: Overall, 3 and 4 latent classes of susceptibility and ever use of tobacco best described students in higher- and lower- SES schools, respectively. Profiles with various combinations of susceptibility and ever use of tobacco were differentially related to psychosocial factors, with lower- SES students being more vulnerable to increased levels of tobacco use than higher- SES students. CONCLUSIONS: Acknowledging the multiple dimensions of tobacco use behaviors and identifying constellations of risk behaviors will enable more accurate understanding of etiological processes and will provide information for refining and targeting preventive interventions. Additionally, identifying the socioeconomic differences in susceptibility and ever use risk profiles and their psychosocial correlates will enable policy makers to address these inequities through improved allocation of resources.

Individual and neighborhood socioeconomic status effects on adolescent smoking: a multilevel cohort-sequential latent growth analysis.

OBJECTIVES: We examined the prospective effects of parental education (as a proxy for individual socioeconomic status [SES]) and neighborhood SES on adolescent smoking trajectories and whether the prospective effects of individual SES varied across neighborhood SES. METHODS: The study included 3635 randomly recruited adolescents from 5 age cohorts (12-16 years) assessed semiannually for 3 years in the Minnesota Adolescent Community Cohort study. We employed a cohort-sequential latent growth model to examine smoking from age 12 to 18 years with predictors. RESULTS: Lower individual SES predicted increased levels of smoking over time. Whereas neighborhood SES had no direct effect, the interaction between individual and neighborhood SES was significant. Among higher and lower neighborhood SES, lower individual SES predicted increased levels of smoking; however, the magnitude of association between lower individual SES and higher smoking levels was significantly greater for higher neighborhood SES. CONCLUSIONS: We found evidence for differential effects of individual SES on adolescent smoking for higher and lower neighborhood SES. The group differences underscore social conditions as fundamental causes of disease and development of interventions and policies to address inequality in the resources.

Discussions with adults and youth to inform the development of a community-based tobacco control programme.

Project Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth (ACTIVITY) is a community-based group randomized intervention trial focused on disadvantaged youth (aged 10-19 years) residing in 14 low-income communities (slums and resettlement colonies) in Delhi, India. This article discusses the findings of Focus Group Discussions (FGDs) conducted to inform the development and test the appropriateness of Project ACTIVITY's intervention model. The findings of the FGDs facilitated the understanding of factors contributing to increased tobacco uptake and cessation (both smoking and smokeless tobacco) among youth in this setting. Twenty-two FGDs were conducted with youth (10-19 years) and adults in two urban slums in Delhi. Key findings revealed: (i) youth and adults had limited knowledge about long-term health consequences of tobacco use; (ii) socio-environmental determinants and peer pressure were important variables influencing initiation of tobacco use; (iii) lack of motivation, support and sufficient skills hinder tobacco cessation and (iv) active involvement of community, family, religious leaders, local policy makers and health professionals is important in creating and reinforcing tobacco-free norms. The results of these FGDs aided in finalizing the intervention model for Project ACTIVITY and guided its intervention development.

Impact of tobacco advertisements on tobacco use among urban adolescents in India: results from a longitudinal study.

OBJECTIVES: To examine the longitudinal relationship between exposure and receptivity to tobacco advertisements and progression towards tobacco use among adolescents in India. DESIGN AND SETTING: A 2-year longitudinal group-randomised trial, Mobilizing Youth for Tobacco Related Initiatives (MYTRI), was undertaken from 2004 to 2006 in 32 schools in Delhi and Chennai. Among the control schools (n=16), mixed-effects regression models were used to assess the objectives. Subjects Students who were non-susceptible, never users of tobacco (n=2782) at baseline (2004) in the control schools of Project MYTRI, who progressed academically and were followed up at endline (2006). MAIN OUTCOME MEASURES: Progression towards tobacco use (on tobacco uptake continuum). RESULTS: Bivariate results suggest that exposure to tobacco advertisements at baseline was associated in a dose-dependent manner with progression at endline. Students exposed at more than four places were 1.5 times (95% CI 1.12 to 1.94; p<0.05) more likely to progress towards tobacco use at endline versus those not exposed. Among boys, those exposed at more than four places were 1.7 times more likely to progress (95% CI 1.14 to 2.62; p<0.05). These significant results disappeared in multivariate analysis, when other psychosocial risk factors for tobacco use were controlled. In both bivariate and multivariate analyses, the risk of progression at endline was more than two times higher (95% CI 1.28 to 4.32; p<0.05) among boys who were highly receptive versus non-receptive boys. The same relationship did not hold among girls. CONCLUSION: High receptivity to tobacco advertising predicts future progression to tobacco use among boys in India. Suggestive evidence exists of a causal relationship between tobacco marketing and adolescent tobacco use.

Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: results of a cross-sectional study.

BACKGROUND: In developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors. DESIGN: Cross-sectional study. SETTING: Eight schools (Private and Government) of Delhi in the year 2006. PARTICIPANTS: 1814 students from 8th and 10th grades; response rate was 87.2%; 55% were 8th graders, 60% were boys and 52% attended Private schools. MAIN OUTCOME MEASURES: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors. DATA ANALYSIS: Mixed effects regression models were employed, adjusting for age, gender, grade level and school type (SES). RESULTS: Significantly more Government school (lower SES) students consumed breakfast daily as compared to Private school (higher SES) students (73.8% vs. 66.3%; p<0.01). More 8th graders consumed breakfast daily vs.10th graders (72.3% vs. 67.0%; p<0.05). A dose-response relationship was observed such that overall prevalence of overweight and obesity among adolescents who consumed breakfast daily (14.6%) was significantly lower vs. those who only sometimes (15.2%) or never (22.9%) consumed breakfast (p<0.05 for trend). This relationship was statistically significant for boys (15.4 % vs. 16.5% vs. 26.0; p<0.05 for trend) but not for girls. Intake of dairy products, fruits and vegetables was 5.5 (95% CI 2.4-12.5), 1.7 (95% CI 1.1-2.5) and 2.2 (95% CI 1.3-3.5) times higher among those who consumed breakfast daily vs. those who never consumed breakfast. Breakfast consumption was associated with greater physical activity vs. those who never consumed breakfast. Positive values and beliefs about healthy eating; body image satisfaction; and positive peer and parental influence were positively associated with daily breakfast consumption, while depression was negatively associated. CONCLUSION: Daily breakfast consumption is associated with less overweight and obesity and with healthier dietary- and physical activity-related behaviors among urban Indian students. Although prospective studies should confirm the present results, intervention programs to prevent or treat childhood obesity in India should consider emphasizing regular breakfast consumption.

Experimenting with cigarettes and physical activity among Mexican origin youth: a cross sectional analysis of the interdependent associations among sensation seeking, acculturation, and gender.

BACKGROUND: Sensation seeking tendencies tend to manifest during adolescence and are associated with both health-compromising behaviors and health-enhancing behaviors. The purpose of this study is to evaluate the relationship between sensation seeking and physical activity, a health-enhancing behavior, and between sensation seeking and experimenting with cigarettes, a health compromising-behavior, among a cohort of Mexican origin adolescents residing in the United States with different levels of acculturation. METHODS: In 2009, 1,154 Mexican origin youth (50.5% girls, mean age 14.3 years (SD = 1.04)) provided data on smoking behavior, physical activity, linguistic acculturation, and sensation seeking. We conducted Pearson's χ2 tests to examine the associations between categorical demographic characteristics (i.e. gender, age, country of birth and parental educational attainment) and both cigarette experimentation and physical activity and Student's t-tests to examine mean differences on the continuous variables (i.e. sensation seeking subscale) by the behaviors. We examined mean differences in the demographic characteristics, acculturation, and both behaviors for each of the sensation seeking subscales using analysis of variance (ANOVA). To examine relationships between the sensation seeking subscales, gender, and both behaviors, at different levels of acculturation we completed unconditional logistic regression analyses stratified by level of acculturation. RESULTS: Overall, 23.3% had experimented with cigarettes and 29.0% reported being physically active for at least 60 minutes/day on at least 5 days/week. Experimenting with cigarettes and being physically active were more prevalent among boys than girls. Among girls, higher levels of sensation seeking tendencies were associated with higher levels of acculturation and experimentation with cigarettes, but not with physical activity. Among boys, higher levels of sensation seeking tendencies were associated with higher levels of acculturation, experimenting with cigarettes and being physically active. CONCLUSIONS: Our results suggest that interventions designed to prevent smoking among Mexican origin youth may need to address social aspects associated with acculturation, paying close attention to gendered manifestations of sensation seeking.

Weight-related concerns and weight-control behaviors among overweight adolescents in Delhi, India: a cross-sectional study.

BACKGROUND: Obesity is emerging as a public health problem among adolescents in India. The aim of this study was to describe specific weight-related concerns among school-going youth in Delhi, India and to assess the prevalence of weight control behaviors, including healthy and unhealthy ones. Differences by weight status, gender, grade level, and school-type (a proxy for SES in this setting) are considered. METHODS: This study is cross-sectional by design. A sample of eighth and tenth graders (n=1818) enrolled in Private (middle-high SES) and Government (low SES) schools (n=8) in Delhi, India participated. All students' height and weight were measured. Students participated in a survey of weight-related concerns and weight-control behaviors, as well. Mixed-effects regression models were used to test for differences in weight-related concerns and weight-control behaviors across key factors of interest (i.e., weight status, gender, grade level, and SES). RESULTS: The combined prevalence of obesity and overweight was 16.6%, overall. Controlling one's weight was important to overweight and non-overweight youth, alike (94.2% v. 84.8%, p<0.001). Significantly more overweight or obese youth reported trying to control their weight last year, compared to those who were not overweight (68.1% v. 18.0%, p<0.001). Healthy weight control behaviors were more common than unhealthy or extreme practices, although the latter were still prevalent. Half of the overweight or obese students misclassified their weight status, while about 1 in 10 non-overweight youth did the same. Body dissatisfaction was highest among overweight youth and girls. CONCLUSIONS: Interventions to promote healthy weight control should be pertinent to and well-received by school-going youth in India. Healthy weight control practices need to be explicitly encouraged and unhealthy practices reduced. Future interventions should address issues specific to body image, too, as body dissatisfaction was not uncommon among youth.

Direct and indirect associations between internalized homonegativity and high-risk sex.

Recent meta-analytic work has endorsed a lack of any meaningful, direct relationship between internalized homonegativity (IH) and high-risk sex. It may not be possible to observe a direct association, however, if heterogeneity in response to IH is considered. This investigation used data from 1,669 men who have sex with men who completed an online survey of sexual behavior in 2005 to consider two potential intermediate variables (compulsive sexual behavior [CSB] and the frequency of sexual partnering) that could increase (CSB) and decrease (frequency of sexual partnering) the probability of having unprotected anal sexual intercourse. We used Mplus (Version 5.1) to estimate confirmatory factor analysis and structural models. Statistical mediation models identified indirect associations through both CSB (positive association) and the number of male sexual partners (negative association). The different directions of association, when combined, cancelled out one another. This contributed to the observed lack of association between IH and high-risk sexual behavior. Future work on risk behavior that incorporates IH will need to consider heterogeneity in how individuals respond to the construct and how these different processes are associated with risk behavior.

Cognitive and home environmental predictors of change in sugar-sweetened beverage consumption among adolescents.

Sugar-sweetened beverage (SSB) consumption may increase risk for unnecessary weight gain. To develop interventions discouraging consumption, more insight is needed about cognitive and environmental predictors related to the decrease in SSB consumption. The present paper aims (1) to describe the relationship between potential cognitive determinants of change (attitudes, subjective norms, perceived behavioural control and intentions) and perceived environmental factors (family food rule and home availability of SSB) with changes in SSB consumption between baseline and 4-month follow-up and (2) to study whether the relationships between the environmental factors and SSB consumption are mediated by the cognitive determinants. Information on possible predictors and SSB intake at baseline and 4-month follow-up was provided by 348 Dutch adolescents (aged 12-13 years) through online questionnaires that were completed at school. Multilevel logistic regression and mediation analyses were used to determine direct and indirect associations between predictors and behaviour. The present results show that a high perceived behavioural control to decrease intake at baseline was associated with a decrease in consumption of SSB between baseline and follow-up (OR = 0.53). Low availability and a stricter family food rule were associated with a decrease in SSB consumption between baseline and follow-up (OR = 2.39, 0.54). The association between availability and decrease in SSB consumption was for 68 % mediated by perceived behavioural control to drink less. In conclusion, interventions to decrease SSB intake should focus on improving attitudes and perceived behavioural control to reduce intake, and on limiting home availability and stimulating stricter family food rules regarding SSB consumption.

Tobacco-use psychosocial risk profiles of girls and boys in urban India: implications for gender-specific tobacco intervention development.

INTRODUCTION: This study examined the distribution of psychosocial risk factors and prevalence of tobacco use among youth in urban India by gender. METHODS: Data were obtained from a cross-sectional baseline survey of a group-randomized tobacco intervention trial involving 6th and 8th graders from 32 schools in Delhi and Chennai (N = 11,642). Mixed-effects regression models were used to examine differences in the prevalence of tobacco use by gender, to determine how the relationship between current tobacco use and related psychosocial risk factors varied by gender, to compare the distribution of risk factors by gender, and to determine if any of these relationships varied by grade level or school type. RESULTS: 14.7% of girls and 21.1% of boys reported ever-use of tobacco. The psychosocial risk profile for tobacco use was remarkably similar for boys and girls, though some differences were apparent. For example, exposure to advertising and beliefs about social effects of use were significant risk factors for girls but not for boys. Across the board, girls showed lower risk for all psychosocial risk factors, except for perceived prevalence of chewing and smoking, for which girls had higher risk compared with boys. DISCUSSION: While the psychosocial risk profile for boys suggests a more vulnerable population for tobacco use, the closing gap in tobacco use between boys and girls indicates a need to examine possible differences in psychosocial risk factors. This study reports that there are subtle, but important, differences in risk factors between genders, having implications for gender-specific intervention development.

Process evaluation of a tobacco prevention program in Indian schools--methods, results and lessons learnt.

In India, 57% of men between 15 and 54 years and 10.8% of women between 15 and 49 years use tobacco. A wide variety of tobacco gets used and the poor and the underprivileged are the dominant victims of tobacco and its adverse consequences. Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) was a tobacco prevention intervention program, a cluster-randomized trial in 32 Indian schools which aimed to decrease susceptibility to tobacco use among sixth- to ninth-grade students in urban settings in India. This culture-specific intervention, which addressed both smokeless and smoked forms of tobacco, was Indian in content and communication. We qualitatively developed indicators which would help accurately measure the dose of the intervention given, received and reached. A multi-staged process evaluation was done through both subjective and objective measures. Training the teachers critically contributed toward a rigorous implementation and also correlated with the outcomes, as did a higher proportion of students participating in the classroom discussions and better peer-leader-student communication. A sizeable proportion of subjective responses were 'socially desirable', making objective assessment a preferred methodology even for 'dose received'. The peer-led health activism was successful. Teachers' manuals need to be concise.

Parents' and children's self report of parenting factors: How much do they agree and which is more strongly associated with early adolescent alcohol use?

OBJECTIVE: The purpose of this study was to determine if parents' and children's reports of parenting practices were correlated, if the reports were differentially associated with alcohol use, and which report had the strongest association with alcohol use. DESIGN: Cross-sectional and longitudinal. SETTING: Public schools, Chicago, Illinois. METHOD: Participants included 1373 ethnically-diverse students and parents involved in an alcohol use prevention intervention. Surveys were conducted in sixth grade and eighth grade. Mixed-effects regression analyses were used to model relationships cross-sectionally and longitudinally. RESULTS: Parents' and children's perceptions of parenting practices, while significantly correlated, were not strongly associated. Analyses within each parenting domain found parents' report of parental monitoring and children's reports of alcohol-specific communication, general communication, and relationship satisfaction were associated with alcohol use behaviors and intentions. After adjusting for all other parenting practices, parents' report of parental monitoring and children's report of alcohol-specific communication were most strongly related to alcohol use behaviors and intentions both cross-sectionally and longitudinally. CONCLUSIONS: When comparing results across studies, it is important to identify whose report was used, parent or child, as the results may differ based on reporter. Studies with limited resources may consider using parents' reports about parental monitoring and using children's reports for alcohol-specific communication, general communication, and relationship satisfaction.

Preventing tobacco use among young people in India: Project MYTRI.

OBJECTIVES: We assessed the effectiveness of a 2-year multicomponent, school-based intervention designed to reduce tobacco use rates among adolescents in an urban area of India. METHODS: Students from 32 schools in Delhi and Chennai, India, were recruited and randomly assigned to an intervention or control group. Baseline, intermediate, and outcome data were collected from 2 cohorts of 6th- and 8th-grade students in 2004; 14,063 students took part in the study and completed a survey in 2004, 2005, or 2006. The intervention consisted of behavioral classroom curricula, school posters, a parental involvement component, and peer-led activism. The main outcome measures were self-reported use of cigarettes, bidis (small hand-rolled, often flavored, cigarettes), and chewing tobacco and future intentions to smoke or use chewing tobacco. RESULTS: Findings showed that students in the intervention group were significantly less likely than were students in the control group to exhibit increases in cigarette smoking or bidi smoking over the 2-year study period. They were also less likely to intend to smoke or chew tobacco in the future. CONCLUSIONS: School-based programs similar to the intervention examined here should be considered as part of a multistrategy approach to reducing tobacco use among young people in India.

Psychosocial mediators of a school-based tobacco prevention program in India: results from the first year of project MYTRI.

Each day in India, an estimated 5,500 youth initiate tobacco use, contributing to predictions that by 2020, tobacco will account for 13% of all deaths in India. Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) is a multi-component school-based intervention designed to prevent and reduce tobacco use among adolescents in Delhi and Chennai, India. The intervention was implemented over the 2004-2006 school years and involved 6th and 8th grade students in 32 classrooms. Students participated in peer-led classroom activities involving games, competitions, and other activities intended to target a number of psychosocial risk factors believed to prevent tobacco use among urban Indian youth. To more fully understand how Project MYTRI influenced students' intentions to smoke or chew tobacco, the current study used mediation analysis to investigate whether Project MYTRI altered the psychosocial risk factors as intended, and whether the changes in psychosocial risk factors were, in turn, responsible for altering students' tobacco-use intentions. Multi-level mediation models were estimated using student data from baseline and 1-year follow-up surveys. Results indicated that the psychosocial risk factors Knowledge of Health Effects, Normative Beliefs, Reasons to Use Tobacco, and Perceived Prevalence were significant mediators between the intervention activities and students' tobacco use intentions. Evidence of inconsistent mediation was observed for the Perceived Prevalence factor. These findings, combined with those from qualitative research and the second-year student data, will help to illuminate the impact of Project MYTRI on participating youth.

Outcomes from a randomized controlled trial of a multi-component alcohol use preventive intervention for urban youth: project northland Chicago.

AIMS: The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings. DESIGN AND SETTING: Sixty-one public schools in Chicago were recruited to participate, were grouped into neighborhood study units and assigned randomly to intervention or 'delayed program' control condition. PARTICIPANTS: The study sample (n = 5812 students) was primarily African American, Hispanic and low-income. INTERVENTION: Students, beginning in sixth grade (age 12 years), received 3 years of intervention strategies (curricula, family interventions, youth-led community service projects, community organizing). MEASUREMENTS: Students participated in yearly classroom-based surveys to measure their alcohol use and related risk and protective factors. Additional evaluation components included a parent survey, a community leader survey and alcohol purchase attempts. FINDINGS: Overall, the intervention, compared with a control condition receiving 'prevention as usual', was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e. related risk and protective factors). There was a non-significant trend (P = 0.066) that suggested the ability to purchase alcohol by young-appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance. Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana and tobacco use combined (P = 0.01), with alcohol use alone approaching statistical significance (P = 0.06). CONCLUSIONS: Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.

Associations between tobacco marketing and use among urban youth in India.

OBJECTIVES: To study if receptivity and exposure to tobacco marketing are correlated with tobacco use and psychosocial risk factors for tobacco use among a sample of urban Indian youth. METHODS: Analysis of cross-sectional survey data from Project MYTRI, a group randomized intervention trial, in Delhi and Chennai, India, collected from sixth and eighth graders (n=11,642), in 32 schools in 2004. RESULTS: Exposure to tobacco advertisements and receptivity to tobacco marketing were significantly related to increased tobacco use among students. CONCLUSION: This association suggests the need to strengthen policy and program-based interventions in India to reduce the influence of such exposures.

Prevention in translation: tobacco use prevention in India.

Mobilising Youth for Tobacco-Related Initiatives in India (Project MYTRI) is a randomized community trial to prevent tobacco use among students in Grades 6 through 9 in 32 private and government schools in Delhi and Chennai, India (N=12,484). The project is a partnership between researchers and practitioners in the United States and India. This article describes the steps that were carried out to ensure that prior effective programs are appropriate and applicable to India. These steps involve (a) developing a conceptual behavioral intervention model, (b) ensuring the appropriateness of the model for urban India, (c) developing intervention strategies that modify factors in the model, (d) implementing the MYTRI program with more than 5,000 students, and (e) evaluating the process and outcomes of the intervention. Data to date suggest that this process has been successful, including high participation rates, teacher perceptions of appropriateness, and agreements for further implementation.

Intermediate outcomes from Project MYTRI: mobilizing youth for tobacco-related initiatives in India.

The purpose of this article is to present the intermediate results for Project MYTRI, a school-based, multiple component intervention designed to prevent and reduce many forms of tobacco use (chewing tobacco, cigarettes, and bidis) among youth in India. The intervention is based on effective models in the United States "translated" for use in this context. The intervention targets two cohorts of students who were in the 6th and 8th grade when the study started. Thirty-two schools in Delhi (north India) and Chennai (south India) were randomized to receive the intervention (n = 16) or serve as a delayed intervention control (n = 16). Students in these schools were surveyed before the intervention began and at an intermediate point, 1 year into this 2-year intervention (n = 8,369). A test of the changes in risk factors for tobacco use between the baseline and intermediate surveys revealed that, compared with the control, students in the intervention condition (a) had better knowledge about the health effects of tobacco (P < 0.01); (b) believed that there were more negative social consequences to using tobacco (P = 0.04); (c) had fewer reasons to use tobacco (P < 0.01); (d) had more reasons not to use tobacco (P = 0.03); (e) were less socially susceptible to chewing (P = 0.04) and smoking (P = 0.03) tobacco; (f) perceived fewer peers and adults around them smoked (P < 0.01) or chewed (P < 0.01) tobacco; (g) felt that tobacco use was not acceptable, especially among their peers (P < 0.01); (h) were more confident in their ability to advocate for tobacco control (P = 0.03); (i) were more knowledgeable about tobacco control policies (P < 0.01); and (j) supported these policies, too (P = 0.04). Fewer students in the intervention condition reported having intentions to smoke tobacco in the next year (P = 0.02) or chew tobacco when they reached college (P < 0.01). No changes in actual tobacco use were observed at this stage of the study.

Differences in tobacco use among young people in urban India by sex, socioeconomic status, age, and school grade: assessment of baseline survey data.

BACKGROUND: The epidemic of tobacco use is shifting from developed to developing countries, including India, where increased use is expected to result in a large disease burden in the future. Changes in prevalence of tobacco use in adolescents are important to monitor, since increased use by young people might be a precursor to increased rates in the population. METHODS: 11 642 students in the sixth and eighth grades in 32 schools in Delhi and Chennai, India, were surveyed about their tobacco use and psychosocial factors related to onset of tobacco use. Schools were representative of the range of types of school in these cities. RESULTS: Students who were in government schools, male, older, and in sixth grade were more likely to use tobacco than students who were in private schools, female, younger, and in eighth grade. Students in sixth grade were, overall, two to four times more likely to use tobacco than those in eighth grade. 24.8% (1529 of 6165) of sixth-grade students and 9.3% (509 of 5477) of eighth-grade students had ever used tobacco; 6.7% (413 of 6165) and 2.9% (159 of 5477), respectively, were current users. Psychosocial risk factors were greater in sixth-grade than in eighth-grade students. The increase in tobacco use by age within each grade was larger in sixth grade than in eighth grade in government schools, with older sixth-grade students at especially high risk. DISCUSSION: The finding that sixth-grade students use significantly more tobacco than eighth-grade students is unusual, and might indicate a new wave of increased tobacco use in urban India that warrants confirmation and early intervention.