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Smoking among youths is a growing problem in India. According to the American cancer Society, young people anywhere who take up cigarettes are more likely than adults to become addicted and suffer from smoking-related health problems.
Surveying the situation
Tobacco use is the second major cause of death globally, according to the World Health Organization. Countless millions of people smoke, chew, and inhale it each day, despite the personal health risks. Some 250 million of India's 1 billion-plus residents consume tobacco, which causes a dramatic drain on that country — and the world — in terms of medical costs and lowered productivity.
"When you think of tobacco in the United States, you generally think of smoking cigarettes," Sorensen explains. "In India, tobacco use involves smoking cigarettes and bidis (unfiltered, leaf-rolled cigarettes), as well as chewing tobacco in many forms. Some people become addicted both orally and through smoking. There are also enormous regional variations in usage."
During her stay from November 2003 to March 2004, Sorensen worked closely with colleagues at the Tata Institute of Fundamental Research and other medical and public health organizations. Prakash Gupta, DSc, a leader in India's emerging tobacco-control movement, was a key contact.
One of Sorensen's projects examined social disparities in tobacco use among a large group of residents in Mumbai, a city of 10 million people, who had been surveyed in the 1990s. Sorensen and her partners confirmed that, as in the West, low-income, less educated populations are more likely to consume tobacco. In results to be published this spring in the American Journal of Public Health, they concluded that policy makers and others should examine occupation, education, gender, and other indicators when seeking to address this issue.
Turning to the schools, Sorensen and fellow researchers compared tobacco use patterns and prevention efforts among educators in two Indian regions. They did so by tapping data from a pair of international surveys — the Global School Personnel Survey and its related Global Youth Tobacco Survey — which are assessing the problem in many countries worldwide.
In Maharashtra, the state where Mumbai is located, about 30 percent of teachers and 13 percent of students say they use tobacco. More than one-quarter of the schools ban its use on campus.
In the more rural state of Bihar, however, nearly 80 percent of teachers and 60 percent of students reportedly consume tobacco, and there are virtually no tobacco-control policies in the schools. "Tobacco is part of the fabric of daily social interactions in Bihar; it's woven into the community," Sorensen notes. "How you address such a large public health problem in that kind of setting is a real challenge."
To delve more deeply, Sorensen conducted qualitative research through focus groups in 12 urban and rural schools in Maharashtra and Bihar. Accompanied by a co-investigator, she met with teachers and administrators to learn about their attitudes and behaviors around cigarettes, pipes, snuff, and other products — and to identify barriers to prevention within schools. "To what extent do teachers and students in this school use tobacco?" she asked these groups. "What do you know about the harmful effects? Tell me what you teach about prevention in your classrooms."
One obstacle to progress is that although educators in both states felt it was important to serve as role models by avoiding tobacco, there was little support for stopping, according to Sorensen. "So when people start, they really don't stop until they get symptoms of disease," she says. "In the U.S., someone who wants to quit smoking can find resources to help."
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