ABSTRACT
Background:
Awareness in semi-urban school population about harmful effects of tobacco use. Hence, the objectives of the present research protocol are to evaluate the incidence of tobacco usage amongst school children and educators, to evaluate the knowledge of students and teachers regarding the harmful effects of tobacco, to educate students and teachers regarding the deleterious effects of tobacco and to evaluate the success of the intervention.
Material and Methods:
This study will be conducted at a semi-urban school located in the Wardha district. A cluster of students and teachers will be selected and will be given a pre-test to assess their knowledge regarding tobacco. The questionnaire will also help in evaluating the total number of participants consuming tobacco. Teachers will be given intervention when the data from the pre-test has been analysed. They will be educated regarding tobacco and its effects on oral health with the use of PowerPoint presentations, posters and models. Activities such as skits, role plays and discussions will be performed. Teachers will be asked to educate the students regarding the same. After the students are educated, they will be given a post-test to evaluate their understanding after the teachers have educated them. Tobacco users will be motivated to complete the cessation of tobacco. A questionnaire comprises 20 questions that are taken from National Tobacco Control Programme (NTPC) guidelines.
Expected Results:
The proposed study represents a major step towards tobacco cessation amongst semi-urban school population. Overall, the study includes evaluating the knowledge of participants, educating them regarding the harmful effects of tobacco and motivating the participants who are tobacco chewers to complete stoppage of habit. The study will develop a valid and reliable change and would contribute in the development of good oral health. This research will provide in the Indian context, evidence that will underpin better selection in semi-urban schools of the Wardha district.
Conclusion:
The proposed study represents a major step towards tobacco cessation amongst semi-urban school population. The study will develop a valid and reliable change and would contribute in the development of good oral health.
Keywords: Harmful effects, NTPC guidelines, oral health, semi-urban school, tobacco
Introduction
The leading cause of potentially malignant and malignant disorders of the oral cavity is tobacco use. Tobacco was brought to India in the late sixteenth and early seventeenth centuries by Portuguese traders.[1] Tobacco-containing products are widely available and used in India, including smoked tobacco (e.g. bidi, cigarettes, chillums, cigars, and hookahs) and tobacco that does not produce smoke (i.e. tobacco which can be chewed include as areca nut, lime, tobacco on betel leaf; gutka, which is a tobacco in chewable form consisting of areca nut; snuff can be used as a dentifrice, as in the consistency of paste, mishri or gudaku; a powder tobacco as lal-dant-manjan and gul).[2] Tobacco products have expanded in recent years to include a variety of smokeless, smoked and electronic goods.[3] Tobacco use is common in both adolescents and adults. According to the World Health Organisation (WHO) report 2020, there are approximately 1.3 billion tobacco smokers in the world today, with more than 80% of them residing in low- and middle-income countries. It is believed that around 47% aged 15 and up use tobacco.[1] India is an excellent example of a developing country’s tobacco control initiatives.[4] Preventing adolescent tobacco use is crucial in lowering morbidity and mortality since almost all tobacco product use begins during adolescence or early adulthood; about nine out of ten adult cigarette smokers begin before the age of 18 years.[5] Smoking kills over 7 million people globally each year.[6] By 2030, low- and middle-income countries will account for almost 70% of all tobacco-related fatalities.[7] According to recent estimates, 68,000–84,000 kids and youths start cigarette consumption per day in low and middle socio-economic countries, in comparison to 13,000–14,000 per day in high socio-economic countries.[8] Most of the individuals who use tobacco begin smoking in their adolescence,[9] so, the harmful effects of the use of tobacco are greatest in those who begin smoking earlier and continue for extended long periods of time.[10] With a population of around 1 billion people, tobacco use in India has a considerable impact on the worldwide problems of tobacco-related illness. According to WHO statistics, the ratio of every fatality in India related to the use of tobacco will rise from 1.4% in 1990 to 13.3% in 2020.[4] Tobacco usage patterns vary widely across India with the north-eastern parts having significantly greater incidence amongst both adults and children than the rest of the country. The varieties of tobacco utilised in each location also varied significantly.[10] In 2020, 16.2% (4.47 million) of all students reported current usage of any tobacco product, including 23.6% (3.65 million) of high school students and 6.7% (800,000) of middle school students.[11] Teachers are an essential target demographic for tobacco control activities because they serve as role models for children, deliver tobacco prevention curricula and are significant opinion leaders on school tobacco control policies.[12] Because the majority of tobacco use begins during adolescence and young adulthood, knowing the precursors to initiation is important for prevention.[13] Nicotine smoking throughout adolescence can lead to addiction, prepare the brain for other substance addictions and impair the growing brain.[13] Furthermore, longitudinal studies have discovered that teenage e-cigarette usage is linked to future cigarette smoking.[14]
Background/Rationale
The rationale of this research is to make the semi-urban school population aware of the harmful effects of tobacco use. Hence, the objectives of the present research protocol are to evaluate the incidence of tobacco usage amongst school children and educators, to evaluate the knowledge of students and teachers regarding the harmful effects of tobacco and to educate students and teachers regarding the deleterious effects of tobacco and to evaluate the success of the intervention.
Method
Sample size selection
Sample size is determined using the formula given below
√n = zα/2 2 × σ/E
In which,
σ = previous expected values = 20
E = desired margin of error = 5
z α/2, confidence interval of 90%, z = 1.65
n = sample size, that is 350
The sample consists of teachers and students of semi-urban schools in the area nearby the Wardha which is in Maharashtra. A convenient sampling method is applied as per the respondent from an online questionnaire survey.
Inclusion criteria: Teachers, Students of age 12–17 years of school.
Exclusion criteria: Students under the age of 12 years.
Measurement
It is a cross-sectional survey conducted in semi-urban school in the nearby region of the Wardha. The participants of this study include teachers, students especially the age of 12–17 years adolescents’ age group. This study is to assess and educate them about the effect of tobacco use. A special form has been created to collect all of the necessary important details. There were two primary elements of the questionnaire: basic demographic information and knowledge evaluation questions regarding the effect of tobacco use death trolls and Multiple choice questions (MCQs) on constituents of tobacco which will help them to understand how harmful it is to be used. A questionnaire will be used to gather data and evaluate the results. Close panel questions are structured [Assessment Questionnaire].
The ethical clearance is obtained from the institutional ethics committee of Datta Meghe Institute of Medical Sciences (Deemed to be a University). The Ethical clearance number is DMIMS/IEC/2022/980 in the Material and Method Section.
A questionnaire will be used to evaluate the research participant’s knowledge, attitude and behaviour. This questionnaire’s items will be divided into the following three different sources: theory, study and observation. The questionnaire included a total of 20 items that evaluated knowledge and attitude. On a three-point rating scale, attitude will be assessed: yes or no. Questions related to attitude included: what the student or teacher thinks about tobacco use and death trolls.
Bias: All possible sources of bias have been eliminated.
Quantitative variables: With the use of a record in an excel sheet, all of the questions pertaining to the questionnaire will be collected.
Statistics: For frequency distribution and descriptive statistics, Statistical Package for Social Sciences software version 22 will be applied. Data will be gathered (Micro-Soft Excel, Micro-Soft Office), and correlation analysis of Pearson and the Chi-square test will be used to analyse connections between age, gender, qualification, attitude and knowledge and practise of participants of the study in semi-urban school. For recording responses to the questionnaire, descriptive statistics and frequency distribution will be used. Chi-square analysis and correlation of Pearson are done to evaluate the knowledge, attitude and behaviour of teachers and students of the semi-urban school nearby the Wardha region.
Expected outcomes/results: The proposed study represents a major step towards tobacco cessation amongst semi-urban school population. Overall, the study includes evaluating the knowledge of participants, educating them regarding the harmful effects of tobacco and motivating the participants who are tobacco chewers to complete stoppage of habit. The study will develop a valid and reliable change and would contribute in the development of good oral health. This research will provide in the Indian context, evidence that will underpin better selection in semi-urban schools of the Wardha district.
Discussion
Caroline, Michaela and Page et al. conducted a study at the University of Oklahoma and Arkansas, in 2020. The study was school-based tobacco education programmes for the adolescent population. They assessed the student’s knowledge before educating and after educating. There were 41 participants which were educators, 37 participants were between the ages of 30 and 65 years and 4 were <30 years of age. Participant’s overall knowledge was improved from the pre- to the post-test (P <.05).[15]
Glorian Sorensen et al.[12] conducted a study for teachers of Maharashtra and Bihar to make them aware of the harmful effects of tobacco use in 2005. The number of participants from Maharashtra was 954 and from Bihar was 524. So, the study revealed that in Bihar, 78% of teachers and in Maharashtra, 31% of teachers were currently tobacco users. The result of the study was that when compared to Maharashtra, the prevalence of tobacco usage was considerably greater amongst Bihar teachers.
Sookyung Kim et al. conducted the study in Korea in march 2021. They implemented a nationwide School-based Smoking Prevention Programme to decrease tobacco smoking. They focused on five groups with 29 teachers who were leading in charge of the School-based Smoking Prevention Programme. The School-based Smoking Prevention Programme had instructors and counsellors to support smoking cessation programmes that consider in school contexts. The instructors were advocated for tobacco prevention programmes at the local, state and national levels. This study sheds light on a national strategy for launching a school-based smoking prevention programme to create a tobacco-free generation. According to the findings of this study, the School-based Smoking Prevention Programme has a significantly favourable influence on smoking rates. To improve the School-based Smoking Prevention Programme, this study recommends developing supportive environments through a positive impact on the attitudes of school principals, improving the standard textbook in institutionalised curriculum content, providing additional support to teachers and clearly defining the roles of public institutions to prevent overlap.[16,17,18,19]
Key result: Tobacco cessation, Motivating the participants, Education and knowledge of participants, complete stoppage of habit.
Generalizability: External and internal validity are both acceptable in this study.
Conclusion
The proposed study represents a major step towards tobacco cessation amongst semi-urban school population. The study will develop a valid and reliable change and would contribute in the development of good oral health.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
ASSESSMENT QUESTIONNAIRE: THE NATIONAL TOBACCO CONTROL PROGRAMME (NTCP) GUIDELINES-BASED EDUCATION MODEL IN SEMI-URBAN SCHOOL POPULATION
NAME
AGE/SEX
CLASS
FATHER'S NAME
EDUCATION/OCCUPATION
MOTHER'S NAME
EDUCATION/OCCUPATION
DO YOU KNOW TOBACCO? YES NO
DO YOU KNOW THE VARIOUS FORMS OF TOBACCO? YES NO
HAVE YOU EVER EATEN TOBACCO? YES NO
DO YOUR PARENTS KNOW ABOUT YOUR HABITS? YES NO
WHICH FORM OF TOBACCO DO YOU USE.
SMOKE SMOKELESS
Quiz of the Death toll and use of tobacco in yes or no form:
1. Tobacco can be chewed or smoked. Yes no.
2. Gutkha is completely safe to eat. Yes no.
3. Eating Tobacco is healthy for gums and teeth Yes no.
4. Cigarettes with a low tar level are risk-free. Yes no.
5. More persons die from HIV/AIDS than from cigarette usage. Yes no.
6. Tobacco causes more deaths than accidents, HIV/AIDS, fires, and suicides. Yes no.
Multiple-choice questions on constituents of tobacco:
1. Which product, other than tobacco, contains nicotine?
(a) Insecticides (b) Car batteries (c) Car exhaust
2. Solution used for cleaning floor contains:
(a) Ammonia (b) Naphthalene (c) Arsenic
3. Tobacco and automobile exhaust both produce a by-product called
(a) Arecoline (b) Carbon monoxide (c) Nitrogen
4. This is used to keep dead bodies alive in biology labs and is found in large quantities in cigarette products
(a) Arsenic (b) formaldehyde (c) Menthol
5. Exposure to a highly dangerous gas, such as that present in cigarette exhaust fumes, can result in death.
(a) Hydrogen cyanide (b) Carbon monoxide (c) Nitrogen
6. White ant poison contains this compound.
(a) Ammonia (b) Nicotine (c) Arsenic
7. Tar is a constituent of tobacco smoke.
(a) Mortar (b) Paint (c) Coal tar
8. Ammonia, which is also used as a fertiliser, is included in cigarettes.
(a) Floor cleaner (b) Paint (c) Insecticide
9. The substance, which is present in cigarettes and tobacco products, is employed in the construction of buildings and sidewalls.
(a) Lime (b) Lead (c) Arsenic
10. Which tobacco constituent is used in the construction of roads
(a) Tar (b) Lead (c) Arsenic
11. A substance used in biology labs to preserve dead bodies is also contained in smokeless tobacco products like gutka.
(a) Cadmium (b) Formaldehyde (c) Oxygen
12. A tobacco product is also found in car batteries.
(a) Cadmium (b) Formaldehyde (c) Oxygen
13. Gas released by smoking tobacco is
(a) Carbon monoxide (b) Formaldehyde (c) Oxygen
14. Chewing tobacco products/paints include a substance that can cause brain damage.
(a) Lead (c) Oxygen (b) Nitrogen
References
- 1.Soben Peter. 7th ed. Arya Publishing House; 2021. Essential of Public Health Dentistry (Community Dentistry), Epidemiology, etiology and prevention of oral Cancer; p. 385. [Google Scholar]
- 2.Gupta PC. Geneva, Switzerland: World Health Organization; 2001. Regional Summary for South-East Asia, in Tobacco Control Country profiles: 2001. [Google Scholar]
- 3.Wang TW, Gentzke AS, Creamer MR, Cullen KA, Holder-Hayes E, Sawdey MD, et al. Tobacco product use and associated factors among middle and high school students-United States, 2019. MMWR Surveill Summ. 2019;68:1–22. doi: 10.15585/mmwr.ss6812a1. doi:10.15585/mmwr.ss6812a1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.World Health Organization. Tobacco or Health: A Global Status Report: Country Profiles by Region. Geneva, Switzerland: World Health Organization; 1997. [Google Scholar]
- 5.US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available from: https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf . [Google Scholar]
- 6.GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the global burden of disease study 2015. Lancet. 2016;388:1659–724. doi: 10.1016/S0140-6736(16)31679-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Jha P, Chaloupka FJ. Washington (DC): The World Bank; 1999. Curbing the Epidemic: Governments and the Economics of Tobacco Control. [Google Scholar]
- 8.Gajalakshmi CK, Jha P, Ranson K, Nguyen S. Global patterns of smoking and smoking-attributable mortality. In: Jha P, Chaloupka FJ, editors. Tobacco Control in Developing Countries. Cary (NC): Oxford Univ. Press; 2000. [Google Scholar]
- 9.Patel DR. Smoking and children. Ind J Pediatr. 1999;66:817–24. doi: 10.1007/BF02723844. [DOI] [PubMed] [Google Scholar]
- 10.Peto R, Zaridze D. Lyon, France: International Agency for Research on Cancer; 1986. Tobacco: A Major International Health Hazard. [Google Scholar]
- 11.Gentzke AS, Wang TW, Jamal A, Park-Lee E, Ren C, Cullen KA, et al. Tobacco product use among middle and high school students-United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1881–8. doi: 10.15585/mmwr.mm6950a1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Sorensen G, Gupta PC, Sinha DN, Shastri S, Kamat M, Pednekar MS, et al. Teacher tobacco use and tobacco use prevention in two regions in India:Results of the Global School Personnel Survey. Prev Med. 2005;41:417–23. doi: 10.1016/j.ypmed.2004.09.048. [DOI] [PubMed] [Google Scholar]
- 13.U. S. Surgeon General. E cigarette use among youth and young adults Retrieved from Rockville, MD. 2016:1–286. [Google Scholar]
- 14.Chaffee BW, Watkins SL, Glantz SA. Electronic cigarette use and progression from experimentation to established smoking. Pediatrics. 2018;141:e20173594. doi: 10.1542/peds.2017-3594. doi:10.1542/peds.2017-3594. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Baer CM, Khoussine MA, Dobbs PD. Tobacco prevention education for middle school and high school educators. Health Educ J. 2021;80:16–27. [Google Scholar]
- 16.Kim S, Yoo S, Cho SI, Jung H, Yang Y. Experiences of the first year implementation of a nationwide school-based smoking prevention program in Korea. Int J Environ Res Public Health. 2021;18:3291. doi: 10.3390/ijerph18063291. doi:10.3390/ijerph 18063291. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.National Tobacco Control Programme, A Guide for teacher 2011. ISBN 978-81-920192-2-2 [Google Scholar]
- 18.Madhu PP, Reche A, Chhabra KG, Chapade A. Artificial intelligence in diagnosis of oral potentially malignant lesions-need of the hour. J Pharm Res Int. 2021;33:83–90. [Google Scholar]
- 19.Rao S, Raut P, Agrawal R, Chhabra KG, Madhu PP, Reche A. Evaluation of effectiveness of chronic care model on smokeless tobacco cessation by measuring urinary cotinine level among the patient attended in the selected dental college &hospital, India -An experimental study. J Pharm Res Int. 2021;33:438–43. [Google Scholar]