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Tobacco use often starts in adolescent years when school personnel form important role models, potentially influencing tobacco use. To plan effective interventions, it is essential to have information on the extent and the type of tobacco use among school personnel, their attitudes towards tobacco control, and the existence of school health polices about tobacco.1
Tobacco use among 13–15 year old students is being studied worldwide through the Global Youth Tobacco Survey (GYTS)2 which incorporates the Global School Personnel Survey (GSPS). The objectives of GSPS are: (1) obtain baseline information on tobacco use; (2) evaluate the existence, implementation, and enforcement of tobacco control policies in schools; (3) understand the knowledge and attitudes towards tobacco control policies; (4) assess training and material requirements for implementing tobacco prevention and control interventions; and (5) verify some information obtained from the GYTS. The GSPS was piloted in the state of Bihar, India and this report presents the results from the first pilot of GSPS.
GSPS is a cross sectional survey that employs a cluster sample design to produce a representative sample of school personnel drawn from the same schools that were selected for GYTS. For GYTS, schools were sampled with probability of selection proportional to the school enrolment size in grades 8–10 (corresponding to ages 13–15 years). A total of 50 schools out of 9905 listed for Bihar state were sampled. All school personnel (including all non-teaching staff) in the selected schools were eligible to participate. In India, education is a state responsibility and almost all schools were part of Bihar state educational system.
Bihar GSPS was conducted in the months of September and October 2000 using the same survey personnel who had conducted GYTS. The questionnaire contained 46 multiple choice questions. Survey procedures allowed for anonymous and voluntary participation. School personnel completed the self administered questionnaire during the break hours, recording their responses directly on a sheet which could subsequently be optically read by machine. The data file obtained was analysed using Epi Info. This software took the sampling weights into account for producing unbiased estimates of proportions and confidence intervals.
All selected schools participated in the survey (response rate 100%). Selected schools reported having a total of 697 eligible personnel, out of which 637 returned the completed questionnaire. The main reason for non-response was absence from school on the day of the survey. The school personnel response rate was 91.4%.
Out of 637 participating school personnel, 73% were men. Some 22.5% were less than 40 years old and 38.6% were 50 years or older. Very few were more than 60 as mandatory retirement age is 60 years. Women were somewhat younger than men. The majority of school personnel (83.5%) were teachers and there were only two health personnel.
Table 1 shows tobacco use prevalence among school personnel. Some 77.4% reported using tobacco in one form or the other. The prevalence was almost identical among men (77.6%) and women (77.0%). There was little difference in smokeless tobacco use among men (58.7%) and women (53.4%). Although smoking among women in India is generally proscribed, prevalence of smoking among women in this sample was quite high (31%). Most of it was cigarette smoking (26.9%). Among men, overall smoking prevalence was 47.4%, and cigarette smoking 40.5%. It should be noted that prevalence of cigarette smoking and other smoking habits do not add up to the prevalence of smoking, and prevalence of smoking and smokeless tobacco use do not add up to prevalence of tobacco use. This is because many individuals reported using tobacco in multiple forms.
Almost all school personnel (91%) agreed that tobacco was addictive, and 85% admitted that it had serious health consequences. While 92% of never users of tobacco believed that environmental tobacco smoke (ETS) was harmful to people who were repeatedly exposed to it, 83% of current tobacco users agreed with that statement. While 83% of never tobacco users complained that ETS was a nuisance, only slightly fewer (77%) current tobacco users did so.
Except for two people, everyone replied that there was no policy on tobacco use either for students or personnel. Even though tobacco use among school personnel was high, a vast majority was concerned about youth tobacco use (84.7%). A large proportion (90.4%) wanted a policy prohibiting tobacco use by students and, surprisingly, even more wanted a policy prohibiting tobacco use among school personnel (93.9%).
Another striking finding was that 80% thought that tobacco companies deliberately encourage youth to use tobacco. Some 88.3% wanted tobacco companies not to sponsor sports events and 95% wanted a complete ban on tobacco advertisements. Surprisingly, even though a majority were tobacco users, 78.4% agreed with the need to increase prices of tobacco products, with no difference between users and non-users.
The GSPS study findings reveal an alarming picture of very high tobacco use among school personnel, and a total absence of any tobacco control policy in schools administered by the state government in Bihar. The results dispel the myth of smoking as taboo among middle class women in India in so far as self administered, anonymous questionnaires revealed 31% of female school personnel reported current smoking and 26.9% reported smoking cigarettes. This social change is likely to be due to several factors such as female emancipation and role modelling from western media. The role of marketing strategies by cigarette companies however, cannot be underestimated. Almost all cigarette advertising imagery includes women, and a cigarette brand specially targeted at women with the name “Ms” is available on the market. This kind of cigarette smoking is still practised away from public view—unlike hukka (hubble bubble) and cheroot smoking by rural women—but clearly it may not remain so for long.
The findings, however, do present an encouraging picture of widespread and near total support towards the formulation and implementation of effective tobacco control policy measures.
The Department of Non-communicable Diseases and Health Promotion, World Health Organisation, funded this study. Authors wish to acknowledge the contribution and help from Samira Asma, Lawerence Green, Laura Kann and Leanne Riley.
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