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Arora M.,Sirifort Institutional Area | Mathur M.R.,Sirifort Institutional Area | Singh N.,Health Related Information Dissemination Amongst Youth HRIDAY
Indian Journal of Pediatrics | Year: 2012

The objective of this paper is to provide a comprehensive evidence based model aimed at addressing multi-level risk factors influencing tobacco use among children and adolescents with multi-level policy and programmatic approaches in India. Evidences around effectiveness of policy and program interventions from developed and developing countries were reviewed using Pubmed, Scopus, Google Scholar and Ovid databases. This evidence was then categorized under three broad approaches: Policy level approaches (increased taxation on tobacco products, smoke-free laws in public places and work places, effective health warnings, prohibiting tobacco advertising, promotions and sponsorships, and restricting access to minors); Community level approaches (school health programs, mass media campaigns, community based interventions, promoting tobacco free norms) and Individual level approaches (promoting cessation in various settings). This review of literature around determinants and interventions was organized into developing the IMPACT framework. The paper further presents a comparative analysis of tobacco control interventions in India vis a vis the proposed approaches. Mixed results were found for prevention and control efforts targeting youth. However, this article suggests a number of intervention strategies that have shown to be effective. Implementing these interventions in a coordinated way will provide potential synergies across interventions. Pediatricians have prominent role in advocating and implementing the IMPACT framework in countries aiming to prevent and control tobacco use among adolescents and children. © 2012 Dr. K C Chaudhuri Foundation.

Arora M.,Health Related Information Dissemination Amongst Youth HRIDAY | Arora M.,Public Health Foundation of India PHFI | Mathur N.,Health Related Information Dissemination Amongst Youth HRIDAY | Gupta V.K.,Health Related Information Dissemination Amongst Youth HRIDAY | And 4 more authors.
Tobacco Control | Year: 2012

Background: Smoking in Hollywood movies is a known risk factor for teen smoking in the USA and Europe, but little is known about the association between exposure to tobacco use in Bollywood movies and teen tobacco use in India. Methods: A cross-sectional sample of 3956 adolescents (eighth and ninth grades, ages 12-16 years) from 12 randomly selected New Delhi schools was surveyed in 2009, assessing tobacco use status, receptivity to tobacco promotions (based on owning or being willing to wear tobacco-branded merchandise) and exposure to tobacco use in movies. Quartiles of exposure to tobacco use in popular Bollywood movies released from 2006 to 2008 (n=59) were determined by content coding them for tobacco use and querying the adolescents whether they had seen each one. Logistic regression was used to control for covariates including age, gender, parent education, school performance, sensation-seeking propensity, family and peer tobacco use, and authoritative parenting. Results: Altogether, the 59 movies contained 412 tobacco use occurrences. The prevalence of ever tobacco use among adolescents was 5.3%. Compared with low-exposure adolescents (quartile 1), the adjusted odds of ever tobacco use among high-exposure adolescents (quartile 4) was 2.3 (95% CI 1.3 to 3.9). Being receptive to tobacco promotions was also associated with higher adjusted odds of ever tobacco use, 2.0 (95% CI 1.4 to 3.0). Conclusion: Watching tobacco use in Bollywood movies and receptivity to tobacco promotional activities were both independently associated with ever tobacco use among adolescents in India, with ORs being similar to the studies of adolescents elsewhere.

Mahapatro M.,National Institute of Health and Family Welfare | Gupta R.N.,Indian Council of Medical Research | Gupta V.,Health Related Information Dissemination Amongst Youth HRIDAY
Indian Journal of Community Medicine | Year: 2012

Background: It is over the last decade that research in this field of domestic violence has led to greater recognition of the issue as public health problem. The paper aims to study the prevalence of physical, psychological, and sexual violence and potential risk factors of the women confronting violence within the home in India. Materials and Methods: A multicentric study with analytical cross-sectional design was applied. It covers 18 states in India with 14,507 women respondents. Multistage sampling and probability proportion to size were done. Results: The result shows that overall 39 per cent of women were abused. Women who have a lower household income, illiterate, belonging to lower caste, and have a partner who drinks/bets, etc. found to be important risk factors and place women in India at a greater risk of experiencing domestic violence. Conclusion: As India has already passed a bill against domestic violence, the present results on robustness of the problem will be useful to sensitize the concerned agencies to strictly implement the law. This may lead to more constructive and sustainable response to domestic violence in India for improvement of women health and wellbeing.

Arora M.,Health Related Information Dissemination Amongst Youth HRIDAY | Arora M.,Sirifort Institutional Area August Kranti Marg | Stigler M.H.,University of Houston | Reddy K.S.,Health Related Information Dissemination Amongst Youth HRIDAY | Reddy K.S.,Sirifort Institutional Area August Kranti Marg
Global Health Promotion | Year: 2011

This case study has two aims. First, it describes intervention strategies from two school-based programs designed to prevent tobacco use among adolescents in India. Second, it explains how evidence from randomized controlled trials of these intervention programs was used by a local non-governmental organization in Delhi to advocate for scaling up the Government of India's tobacco control efforts to include school health interventions as one of the components of India's National Tobacco Control Program. This case study illustrates the need for developing countries to conduct rigorous evaluation in order to provide context-relevant evidence prior to scaling up interventions. © The Author(s) 2011.

Arora M.,Health Related Information Dissemination Amongst Youth HRIDAY | Arora M.,Public Health Foundation of India PHFI | Gupta V.K.,Health Related Information Dissemination Amongst Youth HRIDAY | Nazar G.P.,Health Related Information Dissemination Amongst Youth HRIDAY | And 3 more authors.
Tobacco Control | Year: 2012

Objectives To examine the longitudinal relationship between exposure and receptivity to tobacco advertisements and progression towards tobacco use among adolescents in India. Design and setting A 2-year longitudinal grouprandomised trial, Mobilizing Youth for Tobacco Related Initiatives (MYTRI), was undertaken from 2004 to 2006 in 32 schools in Delhi and Chennai. Among the control schools (n=16), mixed-effects regression models were used to assess the objectives. Subjects Students who were non-susceptible, never users of tobacco (n=2782) at baseline (2004) in the control schools of Project MYTRI, who progressed academically and were followed up at endline (2006). Main outcome measures Progression towards tobacco use (on tobacco uptake continuum). Results Bivariate results suggest that exposure to tobacco advertisements at baseline was associated in a dose-dependent manner with progression at endline. Students exposed at more than four places were 1.5 times (95% CI 1.12 to 1.94; p<0.05) more likely to progress towards tobacco use at endline versus those not exposed. Among boys, those exposed at more than four places were 1.7 times more likely to progress (95% CI 1.14 to 2.62; p<0.05). These significant results disappeared in multivariate analysis, when other psychosocial risk factors for tobacco use were controlled. In both bivariate and multivariate analyses, the risk of progression at endline was more than two times higher (95% CI 1.28 to 4.32; p<0.05) among boys who were highly receptive versus non-receptive boys. The same relationship did not hold among girls. Conclusion High receptivity to tobacco advertising predicts future progression to tobacco use among boys in India. Suggestive evidence exists of a causal relationship between tobacco marketing and adolescent tobacco use.

Arora M.,Health Related Information Dissemination Amongst Youth HRIDAY | Arora M.,4 2 Sirifort Institutional Area | Nazar G.P.,Health Related Information Dissemination Amongst Youth HRIDAY | Gupta V.K.,4 2 Sirifort Institutional Area | And 4 more authors.
BMC Public Health | Year: 2012

Background: In developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors. Methods. Design: Cross-sectional study. Setting: Eight schools (Private and Government) of Delhi in the year 2006. Participants: 1814 students from 8§ssup§th§ esup§ and 10§ssup§th§esup§ grades; response rate was 87.2%; 55% were 8§ssup§th§esup§ graders, 60% were boys and 52% attended Private schools. Main outcome measures: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors. Data analysis: Mixed effects regression models were employed, adjusting for age, gender, grade level and school type (SES). Results: Significantly more Government school (lower SES) students consumed breakfast daily as compared to Private school (higher SES) students (73.8% vs. 66.3%; p<0.01). More 8§ssup§th§esup§ graders consumed breakfast daily vs.10§ssup§th§esup§ graders (72.3% vs. 67.0%; p<0.05). A dose-response relationship was observed such that overall prevalence of overweight and obesity among adolescents who consumed breakfast daily (14.6%) was significantly lower vs. those who only sometimes (15.2%) or never (22.9%) consumed breakfast (p<0.05 for trend). This relationship was statistically significant for boys (15.4 % vs. 16.5% vs. 26.0; p<0.05 for trend) but not for girls. Intake of dairy products, fruits and vegetables was 5.5 (95% CI 2.4-12.5), 1.7 (95% CI 1.1-2.5) and 2.2 (95% CI 1.3-3.5) times higher among those who consumed breakfast daily vs. those who never consumed breakfast. Breakfast consumption was associated with greater physical activity vs. those who never consumed breakfast. Positive values and beliefs about healthy eating; body image satisfaction; and positive peer and parental influence were positively associated with daily breakfast consumption, while depression was negatively associated. Conclusion: Daily breakfast consumption is associated with less overweight and obesity and with healthier dietary- and physical activity-related behaviors among urban Indian students. Although prospective studies should confirm the present results, intervention programs to prevent or treat childhood obesity in India should consider emphasizing regular breakfast consumption. © 2012 Arora et al.; licensee BioMed Central Ltd.

Srinath Reddy K.,Public Health Foundation of India PHFI | Yadav A.,Public Health Foundation of India PHFI | Arora M.,Public Health Foundation of India PHFI | Nazar G.P.,Health Related Information Dissemination Amongst Youth HRIDAY
Tobacco Control | Year: 2012

Tobacco use is one of the major risk factors for non-communicable diseases, with a profound impact on resource-poor low-income and middle-income countries such as India, where tobacco use is high and where socioeconomic as well as health inequalities are rampant. Effective implementation of the Framework Convention on Tobacco Control requires multisectoral efforts that can fructify through integration of tobacco control into broader health and development agendas such as food and water security, environment, the right to education and human rights. The global tobacco control community will need to explore innovative partnerships beyond its traditional confines and build a global coalition that supports tobacco control by partnering with others having convergent concerns on common determinants. A firm political commitment and intersectoral coordination between government and non-government agencies is paramount in order to implement effective tobacco control programmes. Integration of tobacco control into other health and development agendas as described in this paper has the potential to contribute to the achievement of all the eight United Nations Millennium Development Goals. This paper explores why the whole of government should accord a high priority to tobacco control, and how this integration could be achieved.

PubMed | Health Related Information Dissemination Amongst Youth HRIDAY, Public Health Foundation of India PHFI and Imperial College London
Type: Journal Article | Journal: Heart Asia | Year: 2016

To estimate exposure to tobacco imagery in youth-rated Bollywood films, and examine the results in light of recent developments in Indias film rating system.Content coding of 44 top grossing Bollywood films (including 38 youth-rated films) released during 2006-2008 was undertaken to estimate tobacco occurrences and impressions.Out of the 38 youth-rated (U and U/A) films coded, 50% contained tobacco imagery. Mean tobacco occurrences were 1.9, 2.9 and 13.7 per U, U/A and adult (A) rated films, respectively. Top grossing youth-rated films delivered 1.91 billion tobacco impressions to Indian cinema audiences.Half the youth-rated Bollywood films contain tobacco imagery resulting in large population level exposure in India, relative to other countries. Measures to reduce youth exposure to tobacco imagery through films, such as restricting access through the rating system, will complement other tobacco control measures.

PubMed | Health Related Information Dissemination Amongst Youth HRIDAY, Public Health Foundation of India PHFI and University of Texas at Austin
Type: Journal Article | Journal: Global heart | Year: 2015

Prevention of tobacco use is critical for primordial prevention of cardiovascular diseases. Low- and middle-income countries such as India face a burgeoning burden of tobacco-related cardiovascular diseases. A focus on adolescents and young people is consistent with a primordial approach to cardiovascular disease prevention and appropriate given the natural history of tobacco use, in regards to its onset and progression. The primordial prevention approach is feasible, because it attempts to bring about behavior change (sustained abstinence for nonusers) at the population level. This paper reviews effective strategies for population-based tobacco control among adolescents including settings-based interventions at school, at home, and in the community, as well as policy and media interventions. It goes on to briefly touch on the pivotal role that medical professionals, particularly cardiologists, play in fortifying such interventions and summarizes some key recommendations based on review of evidence on the effectiveness of these interventions.

PubMed | Health Related Information Dissemination Amongst Youth HRIDAY
Type: Journal Article | Journal: Health education research | Year: 2013

Project Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth (ACTIVITY) is a community-based group randomized intervention trial focused on disadvantaged youth (aged 10-19 years) residing in 14 low-income communities (slums and resettlement colonies) in Delhi, India. This article discusses the findings of Focus Group Discussions (FGDs) conducted to inform the development and test the appropriateness of Project ACTIVITYs intervention model. The findings of the FGDs facilitated the understanding of factors contributing to increased tobacco uptake and cessation (both smoking and smokeless tobacco) among youth in this setting. Twenty-two FGDs were conducted with youth (10-19 years) and adults in two urban slums in Delhi. Key findings revealed: (i) youth and adults had limited knowledge about long-term health consequences of tobacco use; (ii) socio-environmental determinants and peer pressure were important variables influencing initiation of tobacco use; (iii) lack of motivation, support and sufficient skills hinder tobacco cessation and (iv) active involvement of community, family, religious leaders, local policy makers and health professionals is important in creating and reinforcing tobacco-free norms. The results of these FGDs aided in finalizing the intervention model for Project ACTIVITY and guided its intervention development.

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