This case study has two aims. First, it describes intervention strategies from two school-based programs (HRIDAY-CATCH and Project MYTRI) designed to prevent tobacco use among adolescents in India. Second, it explains how evidence from randomized controlled trials of these intervention programs was used by HRIDAY(Health Related Information Dissemination Amongst Youth), a local non-governmental organization in Delhi, to advocate for scaling up the Government of India's(GOI) tobacco control efforts to include school health interventions as one component of India's National Tobacco Control Program (NTCP).
Few studies have explored the relationship between acculturation and health in non-immigrant populations. The purpose of this study was to investigate the relationship between "westernization" and tobacco use among adolescents living in Delhi, India. A bi-dimensional model of acculturation was adapted for use in this study to examine (a) whether young people's identification with Western culture in this setting is related to tobacco use and (b) whether their maintenance of more traditional Indian ways of living is related to tobacco use, also. Multiple types of tobacco use common in India (e.g., cigarettes, bidis, chewing tobacco) were considered. Socioeconomic status (SES), gender, and grade level were examined as potential effect modifiers of the relationship between "westernization" and tobacco use. The study was cross-sectional by design and included 3,512 students in eighth and tenth grades who were enrolled in 14 Private (higher SES) and Government (lower SES) schools in Delhi, India. A self-report survey was used to collect information on tobacco use and "westernization." The results suggest that young people's identification with Western influences may increase their risk for tobacco use (p<0.001), while their maintenance of traditional Indian ways of living confers some protection (p<0.001). Importantly, these effects were independent of one another. Boys benefitted more from protective effects than girls, and tenth graders gained more consistent benefits than eighth graders in this regard, too. Negative effects associated with identification with Western ways of living were, in contrast, consistent across gender and grade level. The positive and negative effects of acculturation on adolescent tobacco use generalized across all tobacco products considered here. Future interventions designed to curb youth tobacco use in India may benefit by paying closer attention to cultural preferences of these young consumers.
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. Methods: 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. ; Obesity Prevention Center, University of Minnesota ; PRIME program of the University of Texas, School of Public Health (Stigler, PI) ; Center for Health Promotion and Disease Prevention Research in Underserved Populations
This study investigates socioeconomic differences in patterns and trends of tobacco consumption over time among youth in India. Additionally, the distribution of tobacco use risk factors across social class was examined. The data were derived from a longitudinal study of adolescents, Project MYTRI. Students in eight private [high socioeconomic status (SES)] (n=2881) and eight government (lower SES) (n=5476) schools in two large cities in India (Delhi and Chennai) were surveyed annually about their tobacco use and related psychosocial risk factors from 2004 to 2006. Results suggest the relationship between SES and tobacco use over time was not consistent. At baseline (in 2004), lower SES was associated with higher prevalence of tobacco use but the relation between SES and tobacco use reversed two years later (2006). These findings were mirrored in the distribution of related psychosocial risk factors by SES at baseline (in 2004), and thereafter in 2006. Implications for prevention scientists and future intervention programs are considered.
