Adherence to the Tobacco-Free School Policy in Rural India

Abstract

<br /> <strong><span style="font-size: small;">Background: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">In India, 267 million adults use tobacco with prevalence of 35% in rural areas and 13% among </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">those between 15 and 24 years. With 40% of India's population below 19 years, tobacco-free schools (TFS) can be a </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">critical strategy for preventing tobacco-use among youth. This study examined the extent of and factors associated with complete adherence to national TFS guidelines among rural schools in the state of Maharashtra. </span></span><strong><span style="font-size: small;">Methods: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">Trained observers visited 507 rural schools to check adherence to eleven TFS criteria and conducted a cross-sectional survey of school-level indicators. These data were coupled with school-based information from the District Information System for Education (DISE) to analyze factors associated with TFS-adherence. </span></span><strong><span style="font-size: small;">Results: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">Only 11% of schools adhered to all eleven TFS criteria. Majority (72%) prohibited sale of tobacco inside and within 100 yards of the school; 63% displayed </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">no-smoking posters; and 59% banned tobacco use inside premises. However, only 18% consulted with state tobacco </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">advisor and only 28% of schools had tobacco prevention messages on school stationery. Bivariate analysis revealed that complete TFS-adherence was associated with participation of school in sports (p<0.001) and extra-curricular competitions (p<0.001); internet connectivity (p<0.005) and e-learning facilities (p<0.05); and teachers' attendance </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">at capacity-building workshops (p<0.05). A logistic model identified competitive sports participation (OR=3.27, </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">p<0.005) as a key predictor of adherence to the TFS policy. </span></span><strong><span style="font-size: small;">Conclusion: </span></strong><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">This is the first study in India that measures and examines compliance among rural schools with national TFS guidelines; thus filling an existing gap in the tobacco </span></span><span style="font-family: Times New Roman,Times New Roman; font-size: small;"><span style="font-family: Times New Roman,Times New Roman; font-size: small;">control literature. Schools that provide students and staff with opportunities for overall development seem more likely to implement tobacco-free guidelines. By understanding the hard-to-meet criteria, policy-makers and practitioners can support schools in becoming tobacco-free. Integrating tobacco control programs with overall development goals of the school is one way forward. </span></span>