Master’s Project Approval Form

University of Minnesota, School of Public Health
Division of Epidemiology and Community Health

The student’s Master’s project must be pre-approved before extensive effort has been spent on implementing the chosen topic and registering for Master’s Project credits. Submit this form to your Major Coordinator upon completion.

Student’s Name: Amenah Babar Date: 1-15-08

Student e-mail: babar002@umn.edu Major: Epidemiology, MPH

Proposed Project Title:
A gender comparison of tobacco use and psychosocial risk factors among urban youth in India


Anticipated date of completion: May 5, 2008

I. Outline (detailed description of master's project)

A gender comparison of tobacco use and psychosocial risk factors among urban youth in India

Amenah A. Babar
Epidemiology MPH Candidate
Master’s Project Proposal
Dr. Michael Oakes
University of Minnesota School of Public Health

Background
The WHO has listed tobacco as the leading preventable cause of death in the world, responsible for almost 5 million deaths every year. Tobacco continues to be the second largest cause of death in the world and globalization has expanded the tobacco epidemic to the international arena. In broad terms, tobacco use is most prevalent in lower-income populations, and in males.

As the 2nd fastest growing economy in the world, India has become a promising platform for global business and has become a major target of the Tobacco Industry. In concordance, there is a notable shift of the tobacco epidemic from developed to developing nations like India. If the current trends are not curtailed, it is estimated that 10 million deaths from tobacco will occur globally by 2030, and the majority of these will occur in developing nations with India having the highest mortality rates (Gajalakshmi, Jha, Ranson, and Nguyen, 2001). Approximately 80% of current smokers live in the developing world, and in 2003, about 65% of males and 33% of females used tobacco products in India (Benegal, 2005). Where 17% of the world’s smokers reside, tobacco claims 800,000-900,000 lives a year in India (Reddy, 2005).

Of growing concern to public health officials, is the increase in tobacco use among adolescents in India. The 2000 Global Youth Tobacco Survey estimated the tobacco use in any form to be greater than 40% in youth aged 13-15 years old in nine north Indian states (Bansal, 2005), and it is estimated that nearly 5 million children under age 15 are addicted to tobacco in India (WHO, 2005). In India, it is also estimated that 5,500 Indian youth start using tobacco every day (Stigler, 2007). Age of initiation has seen a shift, as recent studies find that tobacco use was observed to be higher in 6th graders than 8th graders (Stigler et al., 2007).

Project Details
Project MYTRI (Mobilization of Youth for Tobacco Related Initiatives in India) is a group randomized, intervention trial with the goal to prevent and/or reduce tobacco use among students (n ~ 12,000) in grades 6-9 over a 2 year period in 32 Indian schools (Delhi and Chennai). 16 schools were given intervention while 16 schools were used as controls. Three surveys were conducted to determine tobacco use and psychosocial risk factors; one at baseline, one after the first year of the intervention, and one at the end of the intervention (Stigler, 2007).

Psychosocial risk factors include (bolded are ones of particular interest):
• Knowledge of health effects
• Beliefs about social consequences
• Reasons to use tobacco
• Reasons not to use tobacco
• Refusal skill self-efficacy
• Social susceptibility to chewing
• Social susceptibility to smoking
• Perceived prevalence of chewing
• Perceived prevalence of smoking
• Normative beliefs
• Normative expectations
• Advocacy skill self-efficacy
• Knowledge of tobacco control policy
• Support for tobacco control policy

These factors were targeted for intervention.

Outline for Master’s Project
I. Objective: To determine prevalence of tobacco use among boys and girls, and to determine relationship between psychosocial risk factors and gender; to compare gender specific association between SES and tobacco use, to compare gender specific differences in age association with tobacco use (6th vs 8th graders).
i. Previous studies show a clear gender difference in smoking and tobacco prevalence in western cultures, and in the adult Indian population; however, tobacco rates have increased for women, and in many cases are higher than for men (Plumridge et al., 2002; Steptoe and Wardle, 2004).
ii. There is growing evidence that peer support for smoking is greater in girls than boys; another potential motivator includes the belief that smoking has effects on weight (Potter, Pederson, Chan, Aubut, and Koval, 2004) and pressure to be thin is generally stronger for women than for men (Grogan, 2007).
iii. In addition, greater female autonomy and changes in the status of females have been associated with tobacco use in areas like the US, and can be seen in developing nations (WHO, 2003).
iv. Girls who experience depression or family violence are more likely to smoke than boys with similar backgrounds, and women and girls tend to smoke as a ‘buffer’ against negative feelings, while males smoke more from habit or to enhance positive sensations; women tend to use smoking as a ‘time out’ from the demands of caring for young children (WHO, 2003).
v. The Tobacco Industry has documented advertising strategies that target psychosocial appeals that display ideas such as vitality, slimness, emancipation, sophistication, sexual allure, autonomy, liberation, and friendship (WHO, 2003).