Evaluation of a Specially Designed Tobacco Control Program to Reduce Tobacco Use among School Children in Kerala

Background: Smoking and smokeless tobacco use are almost always initiated and established duringadolescence. More than 80% of adult smokers begin smoking before 18 years of age. The main objective of thepresent study is to assess the feasibility of preventing adolescent tobacco use with the help of a specially designedtobacco control program. Materials and
Methods: A cross sectional survey on tobacco use and related healtheffects was conducted using a structured questionnaire in 13 randomly selected schools in Kannur district ofKerala. These students were followed for a period of one academic year with multiple spaced interventions suchas anti-tobacco awareness classes, formation of anti-tobacco task forces, inter-school competitions, supplyingIEC (information, education and communication) materials and providing a handbook on tobacco control forschool personnel. Final evaluation was at the end of one year.
Results: There were 4,144 school children whoparticipated in the first phase of the study. The prevalence of tobacco smoking and chewing habits were 9.85%and 2.24% respectively. Ninety-one percent had parental advice against tobacco use and only 3.79% expresseddesire for future tobacco use. The final evaluation witnessed a sharp decline in the current tobacco use as 4.68%.We observed a statistically significant difference towards the future use of tobacco (p<0.001) and awarenessabout the ill effects of passive smoking (p<0.001) among boys and girls. Further a significantly increasedknowledge was observed among boys compared to girls about tobacco and oral cancer (p=0.046).
Conclusions:The comprehensive school based tobacco control project significantly reduced the tobacco use pattern in thetarget population. School tobacco projects incorporating frequent follow ups and multiple interventions appearmore effective than projects with single intervention.