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BRIEF RESEARCH ARTICLE
Year : 2021  |  Volume : 65  |  Issue : 1  |  Page : 67-70  

Adherence to the tobacco-free educational institution guidelines at schools of Raipur Rani, Haryana


1 Senior Resident, Oral Health Sciences Centre, Unit of Public Health Dentistry, PGIMER, Chandigarh, India
2 Assistant Professor, Oral Health Sciences Centre, Unit of Public Health Dentistry, PGIMER, Chandigarh, India
3 Professor, Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
4 Professor and Head, Oral Health Sciences Centre, Unit of Pedodontics and Preventive Dentistry, PGIMER, Chandigarh, India
5 Professor, Oral Health Sciences Centre, Unit of Pedodontics and Preventive Dentistry, PGIMER, Chandigarh, India

Date of Submission21-Jan-2020
Date of Decision01-Apr-2020
Date of Acceptance24-Oct-2020
Date of Web Publication20-Mar-2021

Correspondence Address:
Arpit Gupta
Oral Health Sciences Centre, Unit of Public Health Dentistry, PGIMER, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_38_20

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   Abstract 


Tobacco-Free Educational Institution (ToFEI) guidelines are required to be followed by the schools. This cross-sectional study conducted in the year 2019 assessed the accordance with ToFEI guidelines among all the 84 schools of Raipur Rani educational block, Haryana. Investigators collected data from all the government (71) and private (13) schools during school working days. Tobacco sales within 100 yards of the school premises was covertly observed. None of the schools thoroughly complied with the tobacco-free school policy, though the compliance score for private schools (26.77 ± 19.15) was better than the government schools (13.65 ± 4.38). Only two private schools achieved the mandatory score of 50. All private schools and few government schools (42.3%) had successfully implemented the ban on tobacco sale within 100 yards of the school. None of the schools could achieve a ToFEI status in the present study. The policymakers and implementers should prioritize ToFEI agenda & support schools in achieving tobacco-free status.

Keywords: Tobacco-free schools, Cigarette and other tobacco product act, ToFEI


How to cite this article:
Kumar A, Gupta A, Goel S, Gauba K, Goyal A. Adherence to the tobacco-free educational institution guidelines at schools of Raipur Rani, Haryana. Indian J Public Health 2021;65:67-70

How to cite this URL:
Kumar A, Gupta A, Goel S, Gauba K, Goyal A. Adherence to the tobacco-free educational institution guidelines at schools of Raipur Rani, Haryana. Indian J Public Health [serial online] 2021 [cited 2021 Jul 31];65:67-70. Available from: https://www.ijph.in/text.asp?2021/65/1/67/311521



Tobacco use is the world's most significant single cause of preventable deaths and illness, which kills half of its consumers prematurely.[1] According to the Global Youth Tobacco Survey 2009, 14.6% of students use any tobacco product, 4.4% smoke cigarettes, and12.5% use some other form of tobacco.[2] The Government of India has expertly framed Cigarette and Other Tobacco Products Act 2003[3] and the National Tobacco Control Program (NTCP) in 2007–2008.[4] However, its proper implementation is still a matter of concern.

Under NTCP, the Government of India has developed Guidelines for “Tobacco-Free Educational Institutions (ToFEI),” which has to be followed by the schools across the country.[5] It is also adopted by the Central Board of Secondary Education (CBSE)[6] for implementation in each school affiliated to it. These guidelines were formed in response to the weak enforcement of laws in educational institutions (EI).[7],[8],[9],[10],[11],[12],[13] Literature search has revealed no current study that may have assessed adherence to the tobacco-free educational area policy of the schools in India using these guidelines. The present study was conducted to assess the adherence to the Tobacco-Free Educational Institution guidelines among schools at Raipur Rani educational block, Haryana, India.

This cross-sectional observational study was conducted during September–December 2019 and using census sampling included all 84 schools (71 government and 13 private) of Raipur Rani educational block, Haryana. Raipur Rani educational block is an intensive field practice area of our institution, running a school oral health program for the past 34 years. This area is growing as an educational hub with many government/ private schools and colleges mushrooming up.

The present study uses a validated standard nine criteria checklist of ToFEI guidelines by NTCP, Government of India.[5] The first three criteria (including two subcriteria) are mandatory. They are given ten weighted points each, whereas the following four & two criteria are given weighted points of 9 and 7, respectively, totaling a sum of 100. The checklist provides direct information about the display of antitobacco signage's; banning the sale of tobacco within 100 yards from the school boundary, marking 100 yards boundary around the school; address organization cultures such as inclusion of no tobacco use norm, tobacco control committee meetings, anti-tobacco activities, appointing tobacco monitors; tobacco-free environment, and evidence of tobacco use within the school campus. Schools can attain a status of tobacco-free using ToFEI guidelines if they score 90% and above; however, a score of 50 is mandatory for all.

Training and calibration of the investigators involved in the data collection were done at the institution before commencing the study. A team of investigators visited the school during school working hours. The objective of the study was explained to the principal of the school before collecting the data. The team covertly observed tobacco sale within 100 yards of the school premises. Photographs of perceived violations were taken for records. Additional information like, whether school authorities have a copy of Cigarettes and Other Tobacco Products Act (COTPA) and school stationery having antitobacco messages were gathered.

Data were analyzed using the SPSS software version 17.0 (SPSS 17 Inc., Chicago, IL, USA). Inferential statistics such as the Fischer's exact test and Mann–Whitney U test were used to evaluate the difference between the groups. P < 0.05 was considered statistically significant.

Ethical clearance was obtained from the institute ethics committee (IEC-11/2019-1391:05.11.2019). Permission to conduct the study was sought from the Director Health Services and Director School education, Haryana. Written informed consent was obtained from the head of the schools. Confidentiality of the data was maintained.

All the schools lacked adherence with the tobacco-free school policy, i.e., none could score 90% and above. None of the schools had included the “No Tobacco Use” norm in the Educational Institution's (EI) code of conduct guidelines, organized tobacco control activity in the past 6 months, designated tobacco monitors, and marked 100 yards area from the boundary wall/fence of the schools. Around 58% of the government schools had shops selling tobacco within 100 yards, while all private schools adhered to this aspect [Table 1].
Table 1: Compliance of government and private schools with tobacco-free educational institution guidelines

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All the schools denied having a copy of COTPA or any school stationery with antitobacco messages. The overall ToFEI score for the schools ranged from 10 to 66 (mean score = 15.68 ± 9.59). The government schools attained a maximum score of 30 (mean score = 13.65 ± 4.38), whereas private schools scored a maximum of 66 (mean score = 26.77 ± 19.15). The mandatory score of 50 was achieved by two private schools only. Around 45% of the schools figured out to fulfill only a single criterion of tobacco-free school guideline. A significant difference was observed between government and private schools for the mandatory and overall scores [Table 2].
Table 2: Comparison between government and private schools for Tobacco-Free Educational Institution score

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The present study highlighted a considerable lacuna and widespread violation of ToFEI guidelines in Raipur Rani educational block of Haryana. An Educational Institute (EI) should display “Tobacco - Free Educational Institution” and “tobacco-free area” signage so that the desired message would be effectively communicated.[5] Display of signage is adhered by 3% of government schools and 23% of private schools (P < 0.001). While gathering data, it was also observed that, in many schools, signages and posters related to tobacco were lying in the school office. Thus, they were not counted in the compliance criteria for that school.

In contrast with present study findings, Goel et al.[7] reported that government schools (65%) complied more than private schools (55%). The study by Goel et al. was conducted in the tobacco smoke-free city of Chandigarh in 2007, while the present study was conducted in town and rural areas of Raipur Rani, Haryana. However, these findings are in accordance with the survey by Sayeed et al.[8] (7%), but in contrast with Chatterjee et al.[9] (31%), Priyanka et al.[10] (43%), and Goel et al.[7] (66.6%). Further, only 15% of private schools mentioned name/designation/contact number in the signage.

School management with the help of community and local administration should ensure that no tobacco products are available within 100 yards from the school campus.[5] Around 42% of government schools and all private schools adhered to these criteria. The reason for violation in government schools could be due to its location in a commercial place. The finding that overall, 51% of schools were adhering with no tobacco sale is in concordance with Priyanka et al.[10] (50%); lesser than Khargekar et al.[11] (62%) and Habbu et al.[13] (76%) and higher than that reported by Sayeed et al.[8] (35%), Chatterjee et al.[9] (31%), and Yadav et al.[12] (27%). Total compliance of private schools with no tobacco shops within 100 yards differs with Yadav et al.[12] findings where private schools had more shops than government schools. Goel et al.[7] reported public schools (35%) having more shops than private schools (30%) in Chandigarh.

The Educational institutions, along with health authorities, should undertake tobacco control activities in the school premises from time to time.[5] None of the schools organized an antitobacco activity in the last 6 months. They had not included “No Tobacco Use” norm in the EI's code of conduct guidelines. In contrast, Priyanka et al.[10] reported that tobacco control activities were integrated with school health programs in 86.7% of schools. It is recommended that the schools should designate Tobacco Monitors (s), who can be some office staff, teacher, or a student (from class IX onward). Health & Wellness Ambassadors can also be designated as tobacco monitors.[5] Surprisingly, none of the schools took the initiative to appoint tobacco monitors in both groups. Posters highlighting effect of tobacco were observed in one government school and three private schools, while Priyanka et al.[10] reported a higher prevalence (40%) in Mangaluru schools. A crucial point noted was that none of the schools had any evidence of tobacco use in the campus which is in accordance with a study by Goel et al.[7] (97.2%) but higher than Chatterjee et al.[9] (59%). Priyanka et al.[10] reported that 23.3% of schools had stationaries with antitobacco messages and 10% with a copy of COTPA available in the office. In contrast, the present study reported none for both the criteria.

More commitment from private schools for making their schools as “Tobacco-Free Area” can be related to better infrastructure facilities available to them and strict accreditation policy of CBSE, which is revised periodically. Tobacco-free school status should be considered as mandatory during the school accreditation process, and schools should be issued certificates by the Local Health and Education Departments.

The present study focuses on this crucial but neglected issue of Tobacco free educational institutions status, however with a few limitations. The surveillance for tobacco sale was done for a limited period (15–30 min) per school, which may not record temporary vendors visiting the area within 100 yards of the schools. The study used Google maps and Global Policy and Strategy (GPS) to create 100 yards boundary around EIs, which could be a crude approximation because of GPS errors of up to 10 m. Other sections of COTPA like tobacco sale by minors and loose cigarette sales etc. were not included. The study area is limited to one jurisdiction (though universal sampling attempted); hence, generalizability should be done with caution.

The private schools performed better and scored more than government schools for ToFEI score. None of the schools could achieve a ToFEI status in the present study. The policymakers and implementers should take ToFEI agenda as a part of their routine school-based program and support schools in achieving tobacco-free status.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Research for International Tobacco Control. WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER Package. Geneva: World Health Organization; 2008.  Back to cited text no. 1
    
2.
World No Tobacco Day 2019: Tobacco and Lung Health; 2019. Available from: http://www.searo.who.int/tobacco/en. [Last accessed on 2019 Dec 04].  Back to cited text no. 2
    
3.
Government of India. The Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, No 34; 2003. Available from: http://legislative.gov.in/actsofparliamentfromtheyear/cigarettes-and-other-tobacco-products-prohibition-advertisement. [Last accessed on 2019 Dec 04].  Back to cited text no. 3
    
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5.
Guidelines for Tobacco Free Educational Institution. Available from: https://www.ntcp.nhp.gov.in/assets/document/TEFI-Guidelines.pdf. [Last accessed on 2019 Dec 04].  Back to cited text no. 5
    
6.
Tobacco Free Educational Institutions (CBSE). Available from: http://www.cbseacademic.nic.in/web_material/Circulars/2015/03_Circular_Tobacco.pdf. [Last accessed on 2019 Dec 04].  Back to cited text no. 6
    
7.
Goel S, Sardana M, Jain N, Bakshi D. Descriptive evaluation of cigarettes and other tobacco products act in a North Indian city. Indian J Public Health 2016;60:273-9.  Back to cited text no. 7
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8.
Sayeed S, Labani S, Asthana S. Compliance of a government act on cigarettes and other tobacco products around educational institutions of Noida. Peertechz J Bioinform Biostat 2017;1:1-3.  Back to cited text no. 8
    
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Chatterjee N, Kadam R, Patil D, Todankar P. Adherence to the tobacco-free school policy in rural India. Asian Pac J Cancer Prev 2017;18:2367-73.  Back to cited text no. 9
    
10.
Priyanka R, Rao A, Rajesh G, Ramya S, Mithun PB. Compliance with statutory tobacco guidelines in and around schools in Mangaluru, India: An observational study. World J Dent 2017;8:10-3.  Back to cited text no. 10
    
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Khargekar NC, Debnath A, Khargekar NR, Shetty P, Khargekar V. Compliance of cigarettes and other tobacco products act among tobacco vendors, educational institutions, and public places in Bengaluru City. Indian J Med Paediatr Oncol 2018;39:463-6.  Back to cited text no. 11
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Yadav R, Swasticharan L, Garg R. Compliance of specific provisions of tobacco control law around educational institutions in Delhi, India. Int J Prev Med 2017;8:62.  Back to cited text no. 12
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Habbu SG, Krishnappa P. Assessment of implementation of COTPA-2003 in Bengaluru city, India: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:444-8.  Back to cited text no. 13
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