An interventional study to assess the impact of health education on tobacco chewing and alcohol among school students of Bagalkot city

Introduction

Non-communicable diseases (NCDs) contribute to around 5.87 million deaths that account for 60% of all deaths in India. India shares more than two-third of the total deaths due to NCDs in the South-East Asia Region (SEAR) of WHO. Four types of NCDs – cardiovascular diseases, cancer, chronic respiratory diseases and diabetes make the largest contribution to morbidity and mortality due to NCDs. Four behavioural risk factors are responsible for significant proportions of these diseases—tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. Major metabolic risk factors are obesity, raised blood pressure, raised blood glucose and raised blood total cholesterol levels.1 The prevalence of current tobacco smoking has shown a slight decline in males but the prevalence (23.6%) is still higher than the global prevalence of current tobacco smoking (22%). Tobacco use has been identified as single largest risk factor attributable to NCDs.¹

The per capita consumption of pure alcohol (age +15) in India is estimated to be 5.2 litres per year. In 2010, the corresponding figure was 4.3 litres per year, which was significantly higher than the average consumption in the SEAR (3.2 litres per year).¹

This kind of study among the school students are not reported in India. Thus, it is a step forward taken to assess the knowledge and improve the knowledge on ill-effects of smoking, alcohol and tobacco consumption. Children are upcoming youths who if aware of the bad habits will not cultivate them in their future and build a healthy nation

OBJECTIVES

The study was undertaken to know the baseline knowledge and attitude of school children on tobacco consumption and alcohol, and to assess the impact of health education on the school students regarding the change in lifestyle such as alcohol and tobacco consumption in Bagalkot city.

METHODOLOGY

An interventional study was conducted in Bagalkot city

Source of data: All selected school students of 7th and 8th standard in Bagalkot city were undertaken for the study.

Study setting: Selected Schools of Bagalkot city

Collection of data: The present study was conducted in the selected schools in Bagalkot after obtaining the permission from the Institutional Ethics Committee.

Inclusion criteria: School students of 7th and 8th standard

Exclusion criteria: Parents of the children not given consent for the study.

Study period: for period of 2 years from June 2015 to July 2017

Sample size: Sample size was calculated based upon the study done by J M Warren² .

Sample size is calculated using Open Epi software, version 2.3.1

Two sided confidence level (1-alpha) – 95

Power (% of chance of detecting) – 80

Ratio of Controls to Cases – 1

Hypothetical proportion of Controls with Exposure – 8

Hypothetical proportion of Cases with Exposure – 4

Least extreme Odds Ratio to be detected – 0.48

Sample size – Intervention group – 556

Sample size – Control group – 556

Total Sample size – 1112

METHOD OF COLLECTION OF DATA:

The intervention programme was targeted to 3 high schools viz, Basaveshwara Pre-primary, Primary and High School, Basaveshwara International Public School, and Shishuvihaar in Urban area with CBSE syllabus; children were from affluent families (whose annual fees more than Rupees 20,000). Control groups selected similar to the intervention group selected from another 3 schools i.e., Ranganatha School, St. Anne s School and MR Ganiger Schools of Bagalkot city follow their usual health and physical education.

Initially, The Principals of the selected schools were approached to seek permission to conduct the programme with brief power point presentation by the investigators. Written approval was obtained from them. Co-operation of class teachers, science teachers and physical education teachers were sought.

Baseline data was conducted by introducing ourselves to them and using predesigned proforma. Information about socio-demographic characteristics, knowledge and practice regarding adverse effects of tobacco, alcohol was sought.

An educational Module was prepared by the programme management unit. A workshop was conducted at Medical Education Unit S. Nijalingappa Medical College. Modules were distributed to the peer educators and teachers.

1. Health education regarding ill-health effects of Tobacco and Alcohol were given by peer educators, science teachers and in-charge programme management unit

2. Family involvement.

Parents meet was arranged and health education was given regarding the same. A checklist and handout were provided to each of the students, and they were asked to provide health education to their parents, and signature to be obtained from them. This child to parent programme was well appreciated by both parents and teachers.

3. Various fun programmes, activities and community-based programmes/events were arranged with the peer educators and other interested students to bring the public awareness about the topic.

Poster competition on ill effects of tobacco and alcohol was arranged in all the schools, and awarded prizes for the best posters.

Role play was done by the school students on the school day with the theme of adverse effects of tobacco and alcohol on health, family and society.

Rally was conducted in Vidyagiri area of Bagalkot to create awareness about the hazards of tobacco consumption and alcohol by using placards and slogans.

Post interventional data was collected using predesigned proforma. Information about sociodemographic characteristics, change in knowledge and practice regarding adverse effects of tobacco and alcohol consumption was taken.

Statistical analysis

Data collected were entered in the Microsoft excel sheet and later analysed using SPSS software. Chisquare test for proportions and student t-test for quantitative data was applied. Likert score was considered and scoring was done accordingly. P<0.05 was considered as statistically significant.

RESULTS

In the study, Intervention group had 598 children and control group has 575 children (Table.1).

Knowledge about Ill-health effect of Alcohol in post-test group was more than pre-test and it is statistically significant. Knowledge about Ill-health effect of alcohol is more in post-test intervention group than in post-test control group and is statistically significant. (Table.2).

Knowledge about ill effects of smoking, chewing tobacco and alcohol was found to increase significantly in post-test intervention group (Table.3)..

Knowledge about ill effects of smoking, tobacco chewing and alcohol in post-test group was found to be more in intervention group as compared to control group and this was statistically significant.

Knowledge about ill-effects of smoking was almost same in both pre-test and post-test control.

Knowledge about ill-effects of tobacco chewing was found to be more in post-test control as compared to pre-test control but it was not statistically significant.

Knowledge about ill-effects of alcohol was found to be more in pre-test control group as compared to post-test control group and it was statistically significant (P value= .006)

In pre-test and post-test intervention group, majority of participants (55.9% and 84.2% respectively) believed that passive smoking is definitely harmful of health (Table.4).

In pre-test and post-test control group, majority of participants (56.8% and 73.5% respectively) believed that passive smoking is probably not harmful.

Overall, 42.6% participants believe that passive smoking is definitely harmful.

In pre-test and post-test intervention groups, majority of participants (76.1% and 94.2% respectively), said they will definitely not smoke if offered by best friend (Table.5)..

While in pre-test and post-test control groups, 44.7% in pre-test and 59.2% in post-test group, said they would definitely smoke if offered by best friend.

DISCUSSION

An experimental study was done on school children of Bagalkot city to assess the impact of health education on tobacco consumption and alcohol and its effects. All four groups had almost equal number of study participants i.e. pre-test intervention group (598), post-test intervention group (570), pre-test control group (575) and posttest control group (558). The total numbers of participants were 2301. 48.1% were male & 51.9% were female.

Knowledge about ill effects of smoking (Mean score increased from 1.12 to 1.54), chewing tobacco (Mean score increased from 0.81 to 1.08) was found to increase significantly in post-test intervention group when compared to pre-test and is statistically significant whereas Knowledge about smoking was almost same in both pre-test and post-test control.

Similarly increase in the knowledge regarding ill effects alcohol (Mean score from 0.62 to 1.33) among post intervention groups and it was statistically significant.

Knowledge about ill-effects of tobacco chewing was found to be little more in post-test control as compared to pre-test control but it was not statistically significant.

Jayakrishnan and colleagues 3 in their study among adolescent students in Thiruvananthapuram district of Kerala found that the overall prevalence of self-reported ever users of tobacco in the current academic year was 7.4%, while that of ever alcohol users was 5.6%. Similar observations were made in aspects of Knowledge assessment as our study wherein scores revealed a significant increase in the mean knowledge scores after post training evaluation (mean score = 10.34) when compared to pre-training evaluation (mean score = 9.26).

Knowledge about ill effects of smoking (post-test intervention mean score 1.54 when compared to pre-test control mean score 1.04), tobacco chewing (post-test intervention mean score 1.08 when compared to pre-test control mean score 0.98) and alcohol (post-test intervention mean score 1.33 when compared to pre-test control mean score 0.13) in post-test group was found to be more in intervention group as compared to control group and this was statistically significant.

In pre-test and post-test intervention group, majority of participants (55.9% and 84.2% respectively) believed that passive smoking is definitely harmful for health. Increase in the knowledge here in this group can be attributed to educational intervention. In pre-test and post-test control group, majority of participants (56.8% and 73.5% respectively) believed that passive smoking is probably not harmful. Increase in the knowledge was not found in the control group.

Our study findings were similar to Bharadwaj4 et al., study wherein there was a gross lack of knowledge, regarding second hand smoking among the school children. With a short interactive session of one hour, majority of students gained sufficient knowledge regarding active as well as passive smoking, to the extent that more than 50% of them felt confident enough to give advice and request active smokers in order to discourage this habit if situation arose.

In pre-test and post-test intervention groups, majority of participants (76.1% and 94.2% respectively), said they will definitely not smoke if offered by best friend. After intervention, there was improvement in the attitude of the students.

While in pre-test and post-test control groups, 44.7% in pre-test and 59.2% in post-test group said they would definitely smoke if offered by best friend.

In 2 groups, majority of participants answered one ill effect regarding knowledge about illeffects of chewing tobacco. There was increase in the knowledge in post-test intervention as well as in post-test control group. But the increase in the knowledge was found to be more in post intervention than the post control group.

According to the study by Abidh Ibrahim5 et al., 78.23% said that they were aware of effects of smoking on health. 39.83% and 14.78% thought it would lead to lung disease and heart disease respectively. 7.8% of the smokers were aware that smoking leads to cancer.

Overall, from the 4 groups, majority of participants gave just one correct answer about ill-effects of smoking.

In our study, Knowledge about ill effects of alcohol increased from pre-test to post-test in the intervention group. (One ill effect: from 38.7%- 53.1%, two ill effects: 9.8%-27.8% and three ill effects from1.4-8.2%).

The present study findings were almost similar to the study of Jani and colleagues reported that, in pre-test adolescents were having on average 43.43% knowledge regarding ill effects of alcohol consumption and in post-test, average 65.33% knowledge regarding ill effect of alcohol consumption and conclude that there is significant difference between pre-test and post-test knowledge score of adolescents.⁷

The topics such as ill effects of smoking, chewing tobacco, and consumption of alcohol should be included in the school syllabus as this study showed improvement in the knowledge about the same in the intervention. The above activities can be carried out in the form of health education (by the teachers, peer educators and health professionals), role play, by conducting Jathas, competition such as quiz, poster competition, essay competition and sports competition. The School authorities, parents and school children should adhere to the strict implementation of legislation related to substance abuse.

CONCLUSION

An Intervention model was carried out to assess the impact of health education on tobacco chewing, smoking and alcohol among school students of Bagalkot city. The intervention group knowledge improved with regards to ill effects of smoking, chewing tobacco and alcohol as compared to control group After the intervention, the knowledge about passive smoking was more than the pre-test; the attitude towards not smoking was improved; and also there was improvement in the knowledge about ill effects of chewing tobacco.

As per one more study by Ram Vinod Tiwari6 et al., 63% boys and 83.2% girls said that consuming chewable tobacco cause Oral Cancer. 92% boys & 96% girls told that Smoking is harmful to health. Knowledge about number of ill effects of smoking among study subjects.

Financial support: Funded by RGUHS

Conflicts of interest: Nil

ACKNOWLEDGEMENTS

We are thankful for advanced research wing RGUHS who have funded this research.