Training lay interventionists to support tobacco cessation among teachers in India

Abstract

Despite the rapidly increasing burden of tobacco-related morbidity and mortality in low- and middle-income countries, tobacco control initiatives – especially cessation – receive little emphasis. This is true despite low-cost methods that have potential for widespread dissemination. The purpose of this paper is to provide a case study example of how lay interventionists may be trained and supported to facilitate tobacco use cessation, based on the successful Tobacco-Free Teachers–Tobacco-Free Society program (TFT–TFS) implemented in Bihar, India. This school-based program included multiple components, with lay interventionists having a crucial role. The lay interventionists included health educators and lead teachers, both of whom were selected based on formative research, underwent extensive training and received continuing support. We emphasized encouraging and supporting teachers to quit tobacco use and engaging both tobacco users and nonusers to create a supportive environment for cessation. We also stressed that neither the health educators nor lead teachers were being trained as counselors or as cessation experts. We focused on the importance of respecting teachers as individuals and identifying locally relevant methods of cessation. Although we cannot isolate the precise contribution of the lay interventionists to the successful TFT–TFS intervention, the abstinence findings in favor of the intervention at follow-up are highly encouraging. Teachers have been neglected as lay interventionists for tobacco cessation despite the fact that they tend to be highly respected and credible. The approach used for TFT–TFS could be disseminable in multiple low- and middle-income country contexts through train-the-trainer programs targeted to teachers.

Keywords:

• tobacco
• cessation
• lay interventionists
• India

Acknowledgements

The authors wish to thank the Education Department of the Bihar State Government for its support of this study. The authors also wish to thank the numerous field investigators and staff members in India and USA who contributed to this study, including Linnea Benson-Whelan, Neha Mathur, Shree Mukesh, Pratibha Pawar, Laura Shulman, Gupteshwar Singh, Manibala Singh, and Lorraine Wallace for their contributions. In addition, this work could not have been completed without the participation of the schools, lead teachers, other teachers and other school personnel from government schools in Bihar and the Health Educators and other support staff at the School of Preventive Oncology in Patna, Bihar.