摘要：Objectives. We assessed the effectiveness of a 2-year multicomponent, school-based intervention designed to reduce tobacco use rates among adolescents in an urban area of India. Methods. Students from 32 schools in Delhi and Chennai, India, were recruited and randomly assigned to an intervention or control group. Baseline, intermediate, and outcome data were collected from 2 cohorts of 6th- and 8th-grade students in 2004; 14 063 students took part in the study and completed a survey in 2004, 2005, or 2006. The intervention consisted of behavioral classroom curricula, school posters, a parental involvement component, and peer-led activism. The main outcome measures were self-reported use of cigarettes, bidis (small hand-rolled, often flavored, cigarettes), and chewing tobacco and future intentions to smoke or use chewing tobacco. Results. Findings showed that students in the intervention group were significantly less likely than were students in the control group to exhibit increases in cigarette smoking or bidi smoking over the 2-year study period. They were also less likely to intend to smoke or chew tobacco in the future. Conclusions. School-based programs similar to the intervention examined here should be considered as part of a multistrategy approach to reducing tobacco use among young people in India. In the 21st century, India has become one of the countries most affected by tobacco-related mortality. It is anticipated that nearly 1 million Indians will die annually from smoking by 2010, with 70% of those deaths prematurely occurring among people between the ages of 30 and 69 years. 1 One of the challenges in global chronic disease prevention is reducing tobacco use, particularly in developing countries, such as India, with large populations (i.e., more than 1 billion residents). 2 In India, the onset of tobacco use typically occurs in adolescence, with an estimated 5500 young people initiating use of tobacco every day. 3 A recent national survey revealed that more than 25% of adolescents aged 13 to 15 years in India had used tobacco, and 17% reported current use. 4 In our own research, in which we surveyed approximately 12 000 students in 2004, we found that 6th graders were 2 to 4 times more likely than were 8th graders to have used tobacco, potentially signaling a large increase in the onset in this younger cohort. 5 Any increase in the prevalence of tobacco use will translate to even greater rates of premature disability and death in India. 1 To date, no controlled community trials, to our knowledge, have assessed a multicomponent strategy for tobacco use prevention among youth in India. In the United States, a recent Institute of Medicine report highlighted the importance of tobacco use prevention among young people as 1 of 3 major strategies (the others being cessation treatment and regulatory approaches) that can be used to “end the tobacco problem.” 6 The report recommended that middle schools and high schools implement evidence-based tobacco use prevention programs and that a national youth-oriented mass media campaign be initiated in coordination with school and community programs. 6 The evidence-based prevention programs implemented in the United States 7 may not be applicable to India (e.g., as a result of between-country cultural, structural, and language differences). 8 Thus, it seems critical to develop and evaluate a tobacco use prevention program based on interventions that have proven effective in developed countries but adapted and translated for India. 8 Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) was a group-randomized trial designed to assess a multicomponent intervention aimed at preventing tobacco use among Indian adolescents. The project was the result of a partnership between researchers at the University of Texas School of Public Health and Health Related Information and Dissemination Among Youth, a nongovernmental organization in Delhi, India. The project involved 4 phases: (1) the assessment of factors predictive of tobacco use among youth in urban India, 9 , 10 (2) the development of the intervention program and measurement methods, 8 , 10 (3) the assessment of baseline and first-year follow-up data, 5 , 11 – 13 and (4) the evaluation of final outcomes. For our study, we focused on the project's final outcomes.
