Effect of School Policy on Tobacco Use by School Personnel in Bihar, India
Sinha, Dhirendra N., Gupta, Prakash C., Warren, Charles W., Asma, Samira, Journal of School Health
School systems often enact regulations prohibiting tobacco use on school premises. The influence of such policies on tobacco use behavior of school personnel has been examined in a few studies from the West. (1,2) This survey examined the question in Bihar State of India.
Bihar is located geographically at latitude 25.1 N and longitude 85.3 E, with a population of 82,878,796 (43,153,964 men and 39,724,832 women) and a decadal growth rate of 28.4%, a gender ratio of 921 women per 1,000 men, and a literacy rate of 47.5% (60.3% men and 33.60% women). (3)
Bihar includes two types of schools--those governed by State governments (called State schools) and those governed by the Federal government (called Federal schools). The number of State schools is much higher than the number of Federal schools, but the Federal school enrollments are about three times larger than State schools. State schools are known to have no regulation about tobacco use on school premises, either for students or school personnel. Federal schools have specific rules and regulations prohibiting use of tobacco and tobacco products on school premises by students, school personnel, parents, and visitors. (4) Federal schools have been instructed to ban the sale of tobacco products within a distance of 100 meters, but the rule generally is not enforced. (5)
Stratified samples from State and Federal schools were selected with probability proportional to enrollment in classes 8, 9, and 10. The schools that were selected were the same as those selected for the Global Youth Tobacco Survey (GYTS). (6,7) The sampling frame involved 9,905 schools, including 9,802 State schools and 103 Federal schools. The State school and Federal school samples consisted of 50 schools each (Table 1). All school personnel including teachers, administrators, literate office staff, and school health professionals were eligible to participate in the survey.
The questionnaire contained 45 close-ended questions that required a single response from a maximum of eight categories, and every question required an answer. Most questions required yes/no responses, and opinion questions were answered on a five-point scale (strongly agree to strongly disagree). A draft questionnaire was piloted in a non-sample school, followed by group discussion of ways to improve the instrument.
The survey included information on all forms of tobacco used in Bihar. In addition to cigarettes, other smoking habits included bidi (tobacco rolled in tendu leaf), hukka (water pipe or hubble bubble), and cigars. Smokeless tobacco habits included betel quid, gutka (an industrially manufactured tobacco product, containing areca nut, tobacco, and other ingredients), khaini (a tobacco and lime mixture), snuff, gul (pyrolysed tobacco with some other ingredients used as a dentifrice), tobacco toothpaste, and lal dantamanjan (red tooth powder). Some products (betel quid, gutka, khaini) are chewed, and others (gul, snuff, tobacco toothpaste, red tooth powder) are applied in the oral cavity. (8)
Survey procedures were designed to protect the privacy of school personnel by allowing anonymous and voluntary participation. The questionnaire was self-administered in the teacher's room during class breaks, and answer sheets were collected at the same time. Eleven survey administrators were trained on standard field procedures by the first author. Fieldwork was performed in State schools during November 2000 and in Federal schools during February to June 2001. A weighting factor was applied to adjust for non-response and for the varying probabilities of selection. The Epi-Info program computed prevalence rates and 95% confidence intervals for the estimates.
All selected schools participated in the study (Table 1). Response rate among eligible school personnel was 86.9% for State and 91. …