Determination of the prevalence and attitudes toward tobacco use was assessed among 13-15 years school students in Bihar (India). Settings and design: Schools having grade 8-10 in Bihar. A two stage cluster sample design was used. SUDAAN; and the C-sample procedure in Epi- Info was used for statistical analysis. Of the 2636 respondents, 71.8% (76.5% boys, 57.2% girls) were ever tobacco users; of them 48.9% had used tobacco before 10 years of age. Current use was reported by 58.9% (Boys 61.4%, Girls 51.2%); smokeless tobacco by 55.6% (Boys 57.6%, Girls 49.2%); and smoking by 19.4% (23.0 % boys, 7.8% girls). Nearly one third (29%) students were exposed to ETS inside their homes and nearly half (48%) outside their homes. Almost all students reported watching cigarette and gutka advertisements in almost all kinds of media and events. Tobacco use by parents and friends, knowledge on harmful effects of chewing tobacco, smoking and environmental smoke, and attitudes on tobacco use by others were strongly associated with student tobacco use. Current tobacco use was reported significantly more by students who received pocket money/or were earning than by students who did not receive any pocket money/ or did not earn (p value for trend <0.0001). Over half of current users (56%) bought their tobacco products from stores; of these, over 3/4th (77.2%) of them despite their age, had no difficulty in procuring these products. Teaching in schools regarding harmful effects of tobacco use was non-existent (3%). This urgently requires a comprehensive prevention program in schools and the community especially targeted towards girls.

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Information about prevalence of tobacco use was assessed among school children in Goa, India. Among 50 sampled schools, the school response rate was 98% and, over 94% students participated in the survey (56% were boys, 44% girls). Ever tobacco use was reported by 13.5% of which over 40% reported initiation at 10 years of age or earlier. The current tobacco use (any product) was reported by 4.5%, without much difference in smokeless tobacco use (2.8%) and smoking (3.0%). Smokeless tobacco was use mainly in the form of applying mishri, tobacco containing toothpaste or toothpowder. Smoking among boys was 3.5% and girls 2.2%. Nonusers reported knowledge about the harmful effect of tobacco two to three times more than tobacco users. Over about 50% of students reported having been taught in school about the dangers of tobacco use. Tobacco users (60.5%) as well as non-users (63%) favoured ban smoking in public places equally. Tobacco use by parents and close friends was positively associated with students' current tobacco use.

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A study was conducted in selected districts of Bihar to evaluate the effectiveness of Intensive vs. Minimal, Community centered vs. Clinic/Camp centered and Mass/Group vs. Individual targeted intervention programs for cessation of tobacco use. Relevant Qualitative and Quantitative data was collected and analyzed using the SPSS statistical package. Results revealed high (>50%) pre- intervention prevalence of tobacco use and oral diseases related to tobacco usage and no community initiative towards control of tobacco use. Post intervention data revealed 4% quitting, 3% dose reduction and 2% reduction in usage of multiple types of tobacco. The study demonstrated that community centered mass approaches with minimal sustained intervention was more effective than clinic centered, intensive, individual approach.

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The association between school tobacco policies and tobacco use prevalence among students were examined. A two stage cluster sample design with probability proportional to the enrolment in grades VIII-X was used. Comparison was made between schools with a tobacco policy (Federal schools) and schools without a policy (State schools). Stratified probability samples of 50 schools each were selected. SUDAAN; and the C-sample procedure in Epi-Info was used for statistical analysis. Students from State schools (without tobacco policy) reported significantly higher ever and current any tobacco use, current smokeless tobacco use and current smoking compared to Federal schools (with tobacco policy) both in rural and urban areas. Classroom teaching on the harmful effects of tobacco was significantly higher (17-24 times) in Federal schools than State schools both in rural and urban areas. Parental tobacco use was similar for students in Federal and State schools. Students attending state schools were more likely than students attending Federal schools to have friends who smoke or chew tobacco. These findings suggest that the wider introduction of comprehensive school policies may help to reduce adolescent tobacco use.

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Tobacco use prevalence, knowledge and attitude was assessed among school personnel in Orissa. A single cluster sample design with probability proportional to the enrolment in grades VIII-X was used. Statistical analysis was done using SUDAAN; and the C-sample procedure in Epi-Info. The school response rate was 100%. Over 72% of school personals participated in the survey, the proportion of men being 84%. Current cigarette smoking, bidi smoking and smokeless tobacco use was reported by 26.8%, 30.1% and 38.8% school personnel respectively. Current daily cigarette smoking, bidi smoking and smokeless tobacco use reported by 18.3%, 16.6% and 24.2% school personnel respectively. Men reported significantly more all kinds of daily tobacco use as compared to women. School tobacco control policy on three scales was reported poor (25-39%). However most of the school personnel felt need for such policies (88-98%).Teaching and training on tobacco was reported low (22.7%-35.9%).Most of the school personnel (87-95%) were supportive on different measures on tobacco control issues. Introduction of comprehensive school policies and enforcement on tobacco use may help to reduce adolescent and school personnel tobacco use.

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Information about tobacco use prevalence, knowledge and attitude was assessed among school personnel in schools of West Bengal. Statistical analysis was done using SUDAAN; and the C-sample procedure in Epi-Info. The school response rate was 100%. Current any smoking and smokeless tobacco use was reported by 30.9% and 13.1% school personnel respectively. Current daily smoking, and smokeless tobacco use reported by 20.4%, and 5.8% school personnel respectively. Men reported significantly more for all kinds of daily tobacco use as compared to women. School tobacco control policy on three scales was reported poor (17.7- 30%). However most of the school personnel felt need for such policies (82.7-93.6%).Teaching and training on tobacco was reported low (29.9%-50.4%). However most of the school personnel (79.1-93.6%) were supportive on different measures of tobacco control. Training of school personnel may provide students with essential tools to help them adopt and maintain a smoke free lifestyle.

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Information about tobacco use prevalence, knowledge and attitude was assessed among school personnel in Uttar Pradesh. A single cluster sample design with probability proportional to the enrolment in grades 8-10 was used. Statistical analysis was done using SUDAAN; and the C-sample procedure in Epi-Info. The school response rate was 100%. School personnel response rate ranged from 72-80%, the proportion of men being 84-92%. Current cigarette smoking and smokeless tobacco use reported by all teachers was 21.9% and 75.6% respectively. The prevalence of daily cigarette smoking was ranged by 12.6-15.1%; bidi and other smoking 4.8-13.4%; smokeless tobacco use 16.3-19.8%. Existing school policy on four measures were reported poor however over 72% school personnel felt need for policy prohibiting tobacco use among students and school personnel. Tobacco prevention instruction by teachers did not fare much better on six different measures (4.9-30.9%). However over 2/3rd school personnel were very supportive on tobacco control issues. There was no training among school personnel on tobacco use prevention skills (3.7%). However most of the school personnel (67.1%) were curious about getting such trainings. A positive environment for tobacco use prevention needs to be created by adopting comprehensive tobacco control policies for schools. First step towards this may be training of school personnel on tobacco use prevention skill and supply of teaching materials.

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Aim : To know about the tobacco control practices by medical doctors in Bihar, India. Settings & design : All medical doctors in Bihar, India. Two stage sampling with probability propotional to the number of doctors in the districts was used. Method : Anonymous survey was conducted on structured questionnaire. Statistical analysis : SUDAAN; and Epi-Info. Results : Most of the doctors were government doctors. Most doctors (>75%) reported either for no policy or partial policy in health settings however over 2/3rd of medical doctors felt need for their training on tobacco cessation. Most of the doctors did not take tobacco history (60-80%). Conclusion : Medical doctors in Bihar need to be trained for tobacco cessation. Smoking needs to be enforced vigorously in health sector to protect patients and doctors.

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