Tobacco and areca nut cessation programme for adolescent school students in Mumbai, India

Background The prevalence of tobacco use among children aged 13-15 years is 14.6% and 15.5% of non-users intended to start smoking in the next year. School going children also consume areca nut (“supari”), which is an easily available carcinogenic, psychoactive substance, acting as a gateway product to tobacco use. This current and intended use will exacerbate the burden of tobacco related morbidity and mortality. LifeFirst program was implemented in 15 schools catering to lower socioeconomic population in slum areas of Mumbai in the academic year 2016-17 for helping students quit their tobacco and supari use. Methods Orientation sessions about harmful effects of tobacco and areca nut were conducted using audio-visual aids for 2379 students of the 7th, 8th and 9th grades. Students were informed about the availability of a cessation service within the school and encouraged to register voluntarily. The registered students were divided into groups of 10-15 students each and six group-sessions involving videos, games, role plays and activities were conducted over six months. The sessions were theme based; covering topics like rapport building, ill-effects of tobacco, coping mechanisms, refusal skills etc. The self-reported status of tobacco use was recorded individually during each session. Extended 4-month post-program follow-up was conducted. Results Of the 492 students (84% boys) registered for the program, 88% were only supari users, 10% used supari and tobacco, 2% only smokeless and less than 1% only smoked. 67% were daily users. The mean age of initiation was 11.7 years and 79% were introduced to the product by their peers. 71% reported as not using tobacco and supari at the end of the programme with 12% relapse recorded during extended follow up. Conclusions Providing structured cessation services with positive peer influence facilitated by trained counselors encourages and aides tobacco and areca nut users to stop their habit