Promoting Tobacco Control Among Teachers in India

描述（由申请人提供）：国家癌症研究所在其2006年绕开预算报告中将发展中国家的烟草控制研究列为其烟草研究的首要重点之一，反映了对可归因于烟草的全球疾病负担日益增加的关切。印度提供了一个发展中国家内烟草控制工作的重要案例，它是世界上第二大国家，人口超过10亿，估计有2.5亿10岁及以上的烟草使用者。本研究建议对印度比哈尔邦的教师进行综合控烟干预试验，比哈尔邦是印度烟草使用最高的地区之一。教师作为社区规范和学生榜样方面的关键意见领袖，是控烟工作的重要先锋人群。根据全球学校人员调查，2000年比哈尔邦78%的教师使用某种形式的烟草。本研究的具体目的是：(1)评估综合控烟干预对比哈尔邦学校教师戒烟人数增加的影响程度；(2)评估综合控烟干预对学校控烟政策变化的影响程度；(3)评估综合控烟干预对教师调节机制改变的影响程度；(4)评估被分配干预条件的学校实施干预的关键指标，包括干预的实施程度、干预的覆盖范围和对干预协议的忠实度。本随机对照试验以学校为干预和随机化单位。印度比哈尔邦的公立学校（N=100），包括8-10年级（即13-15岁），将被随机选择，招募参与研究，并在阶层（农村，城市）中随机分配到两种条件之一（干预与延迟干预对照）。数据将通过三个时间点的教师调查收集；政策评估；还有一个过程评估。我们在比哈尔邦的初步工作为这项工作提供了一个关键的起点，并证明了拟议研究的可行性。该干预措施旨在平衡对教师烟草使用模式的潜在干预影响与在当地资源限制下的可行性，从而最大限度地提高传播潜力。

DESCRIPTION (provided by applicant): The National Cancer Institute places tobacco control research in developing countries among its top tobacco research priorities in its 2006 Bypass Budget Report, reflecting concerns about the growing global disease burden attributable to tobacco. India provides an important case example of tobacco control efforts within a developing country, as the second largest country in the world with a population of over one billion people, and with an estimated 250 million tobacco users age 10 and above. This study proposes to test a comprehensive tobacco control intervention for teachers in the Indian state of Bihar, representing one of the highest tobacco-using regions in India. Teachers are an important vanguard population for tobacco control efforts in their roles as key opinion leaders in relation to community norms and role models for students. According to the Global School Personnel Survey, 78% of teachers in Bihar used some form of tobacco in the year 2000. The specific aims of this study are to: (1) assess the extent to which a comprehensive tobacco control intervention results in increased cessation of tobacco use among teachers in Bihar schools; (2) assess the extent to which a comprehensive tobacco control intervention results in changes in school tobacco control policies; (3) assess the extent to which a comprehensive tobacco control intervention results in changes in defined mediating mechanisms among teachers; and (4) assess key indicators of intervention implementation among schools assigned to the intervention condition, including the extent of the implementation of the intervention, the reach of the intervention, and the fidelity to the intervention protocol. This randomized controlled trial uses the school as the unit of intervention and randomization. Government schools (N=100) including grades 8-10 (i.e., ages 13-15) in the state of Bihar, India, will be randomly selected, recruited to participate in the study, and randomly assigned within strata (rural, urban) to one of two conditions (intervention versus delayed intervention control). Data will be collected by a teacher survey at three time points; a policy assessment; and a process evaluation. Our preliminary work in Bihar provides a critical starting point for this work, and demonstrates the feasibility of the proposed study. The intervention has been designed to balance potential intervention impact on teachers' tobacco use patterns with feasibility within the constraints of local resources, thereby maximizing the potential for dissemination.