What exactly do we do ?
We are currently focussing on carrying out anti-tobacco education in the government schools of Nagpur city. The curriculum for this intervention has been developed by HRIDAY, a Delhi based NGO that is a leading light on tobacco control in India(1). The intervention has 4 components- 7 peer led classroom activities, 6 posters to be hung in the classrooms, a parental involvement component wherein 6 postcards are sent home to the parents and finally a peer leadership component, focussing on peer led health activism outside of the classroom, including competitions between classroom and schools. The entire intervention is usually carried out over a span of two months. An innovative aspect of the intervention is an activity format in which elected peer leaders facilitate small groups.
All these activities are conducted in grade 7. Middle school students are most vulnerable to the psycho-social risk factors associated with tobacco. Most adult tobacco users develop the habit before they turn 18, and early intervention to modify the risk factors is essential to obtain real benefit.
Reinforcement of the message in subsequent years is essential to help kids remain tobacco free. Therefore, we will implement appropriate strategies to ensure reinforcement when the first cohort of kids enter grade 8.
We ultimately aim to enhance the capacity of individual schools to implement a grade wise education curriculum so as to ensure sustainability of the program
So, How does it work ?
So how do we know that the money and time we are all putting in is not just a feel good exercise and is actually causing impact?
The curriculum that we are using has been tested in a group randomised trial conducted by HRIDAY. Its details can be found here The results of this trial show that in the intervention schools, the use of tobacco decreased by 15%, while in the control schools, the use of tobacco increased by 67%. Moreover, the intervention was able to significantly modify all the psychosocial risk factors associated with tobacco use.
Our program, however, differs from the HRIDAY model in a few ways.
1) Our program seeks to utilise the positive role model potential of college youth who abstain from tobacco and advocate for the same. That is why volunteers implement most of our activities, and we hypothesize that this approach will lead to even greater effectiveness of the program.
2) The HRIDAY model was a two year intervention, with seven classroom activities in each year. We plan to have classroom activities only in the first year, with reinforcement in subsequent years provided by posters, movies, talks and inter-school competitions.
Due to these differences, we are conducting our own group randomised trial with our first cohort of 1000 students. The results of this trial will only be available next year, but so far, the anecdotal reports are extremely encouraging. Some of these have been documented in a video that will be put up shortly.
Ultimately, through this format of school-based intervention we aim to modify the social acceptability of tobacco in the local community of Nagpur. Tobacco, to a large extent, is a local problem for which local solutions can be implemented successfully. In this regard, we aim to work with various stakeholders in the process, and move forward through a process of building consensus. We are therefore in talks with Nagpur Municipal Corporation, other NGOs in Nagpur (such as the Indian Medical Association (IMA)), National Medicos Organisation (NMO)and some others), colleges, eminent doctors and hospitals of the city and civil society in general.
