|Year : 2019 | Volume
| Issue : 1 | Page : 28-33
Effect of information, education, and communication activity on health literacy of smoking and alcohol among school-going adolescents in Delhi
Srishti Yadav, Anita Khokhar
Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
|Date of Web Publication||4-Jul-2019|
F-130/A, 4th Floor, Gautam Nagar, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Background: Noncommunicable diseases (NCDs)/lifestyle diseases account for a major cause of deaths every year. Risk factors such as smoking and alcohol consumption contributing to the development of lifestyle diseases were more prevalent in the developed countries decades back, but millions of productive years of life are lost due to NCDs in India too.
Objective: This study was conducted to assess the health literacy of school-going adolescents regarding harmful effects of smoking and alcohol consumption and assess the improvement in their knowledge after different information, education, and communication (IEC) activities.
Methods: It was a school-based interventional study conducted among students of class 6, 7, and 8. Assessment of health literacy of risk factors – smoking and alcohol use in lifestyle diseases was done by self-administered questionnaire among school-going adolescents. Intervention in the form of IEC was done three times, and the postintervention data were collected 2 weeks after the first and 3 months after the last intervention. Responses were scored and categorized as satisfactory and unsatisfactory.
Results: There were a higher proportion of students with satisfactory level of knowledge of smoking and alcohol use effects in both the schools after 3 months of educational intervention, although the result was statistically significant for School 2 only where intervention was given by didactic lectures (P < 0.05).
Conclusions: There was an improvement in scores of students in both the schools after 2 weeks and 3 months of educational intervention, though the results were statistically significant for 3 months only (P < 0.05).
Keywords: Adolescents, alcohol, health literacy, information education communication, smoking
|How to cite this article:|
Yadav S, Khokhar A. Effect of information, education, and communication activity on health literacy of smoking and alcohol among school-going adolescents in Delhi. Indian J Community Fam Med 2019;5:28-33
|How to cite this URL:|
Yadav S, Khokhar A. Effect of information, education, and communication activity on health literacy of smoking and alcohol among school-going adolescents in Delhi. Indian J Community Fam Med [serial online] 2019 [cited 2019 Nov 13];5:28-33. Available from: http://www.ijcfm.org/text.asp?2019/5/1/28/262119
| Introduction|| |
Globally, noncommunicable diseases (NCDs) account for approximately 17 million deaths a year, which is nearly one-third of the total number of deaths occurring globally in a year. Risk factors such as smoking and alcohol consumption contributing to the development of lifestyle diseases were more prevalent in the developed countries earlier, but millions of productive years of life were lost due to the NCDs in India too.
Risk-taking behaviors that can have lifelong implications are often begun in adolescence. Two common health–risk behaviors that are frequently initiated are cigarette smoking and alcohol consumption. Thus, intervention should start at an early age as it takes time for healthy practices to blend into behavior. To address the vast magnitude of this problem, health literacy may play an important role in prevention.
A school is a key location for educating children about health, hygiene, and nutrition and for putting in place the interventions to promote the health of children.
Health literacy is defined as the ability to obtain, read, understand, and use health-care information to make appropriate health decisions for one's own health and family and community health and follow instructions for treatment. An adequately health literate individual can communicate with health professionals, understand and use health materials (in a variety of formats) that they need to stay healthy, apply health-related knowledge to health care, and decision-making so that they are able to make healthy choices and have more control over the things that make them healthy.
This study was done with the objective of assessing the health literacy of risk factors of NCDs such as smoking and alcohol among school-going adolescents; conducting intervention by information, education, and communication (IEC) activity among school-going adolescents; and assessing the effect of the different IEC activities among them.
| Methods|| |
It was a school-based interventional study conducted in Najafgarh in the year 2016. Prior permission was obtained from the Deputy Directorate of Education and Institutional Ethical Committee to conduct the study. From 13 schools in Najafgarh, two schools were selected by simple random method of sampling and the Principals of these schools were explained about the objectives and methodology of the study and consent was obtained from them. A total of 120 students were selected from each school using a list of all students enrolled in class 6th, 7th, and 8th obtained from both the schools. One section of each standard was selected by simple random method from both the schools and assent was obtained from the students. Students who were absent during the baseline evaluation were excluded from the study.
Since this study is a part of the bigger study in which all risk factors of NCDs are studied, thus sample size calculation is not based on these two risk factors. For the main study, sample size was calculated based on the study conducted by George et al. in 2014 in two government and one private school in Central Delhi in which they found that among the various risk factors of lifestyle diseases listed in the study; 34.6% (P 1) students (the least) had the knowledge that by exercising for at least 1 h a day cardiovascular diseases can be prevented. In the main study, the knowledge was expected to increase to up to 60% (P 2) among the students after the intervention. Taking an alpha error (α) and beta error (β) of 5% and 20%, the sample size calculation was as follows:
Considering design effect = 2, n × 2 = 51 × 2 = 102
Loss to follow-up or nonresponse of up to 10%
Sample size came out to be 120.
Thus, a total of 120 students from class 6th, 7th, and 8th in each school were taken.
A pretested, semi-structured, self-administered questionnaire based on the materials to be used for intervention was used for baseline and postintervention data. The questions were based on the IEC material taken from the World Health Organization (WHO) and Central Health Education Bureau (CHEB) which were to be used for the intervention. The response options were Yes/No/Don't know. Each right answer was awarded score 1 and wrong answer as 0. No response was considered as incorrect response and scored 0. The responses were scored and categorized as unsatisfactory (<50% score) and satisfactory (>50% score) knowledge. The maximum scores for questions on smoking and alcohol were 12 and 7 respectively and the minimum score was 0. Intervention was given in the form of IEC activity on harmful effects of smoking and alcohol use with the help of posters and pamphlets taken from the WHO office and CHEB, New Delhi, for School 1 and lecture from the same reference material was prepared in PowerPoint Presentation for School 2.
After the baseline evaluation in June in both the schools, the intervention was done on the next visit inJuly by giving the pamphlets to the students and displaying posters in their classes and common areas. The postintervention data were obtained after 2 weeks from both the schools by administering the same questionnaire. After that respective interventions were repeated two more times monthly among the students of both the schools in August and September for reinforcing knowledge. Thus, interventions were given a total of three times in the span of 3 months, and postintervention data were also obtained at 3 months from the last intervention, i.e., in January. Thus, postintervention data were obtained two times – first at 2 weeks after the first intervention and the other after 3 months from the last intervention.
There was a loss to follow-up in both the schools during interventions. At 2 weeks, there was attrition rate of 7.5% in School 1 and 4% in School 2 and at 3 months follow-up, there was attrition of 21% in both the schools.
Data analysis was done using Statistical Package for the Social Sciences software SPSS for windows version 17.0. Released 2008 (SPSS Inc., Chicago, IL, USA). All the values were analyzed using descriptive statistics to calculate frequencies, mean, range, and standard deviation. Chi-square test was applied to compare the proportion of scores (satisfactory and unsatisfactory) at baseline, 2 weeks, and 3 months and P < 0.05 was considered to be statistically significant.
| Results|| |
There were a total of 120 students each in both the schools. The mean age of students of both the schools was 12.2 years. Majority of students of both the schools belonged to nuclear family and socioeconomic Class IV according to the Modified BG Prasad scale, 2017. Majority of the students' parents were educated till primary as shown in [Table 1].
|Table 1: Distribution of the study participants according to sociodemographic characteristics (n=120)|
Click here to view
Cancer and premature death were the maximally known harm of smoking among the students and the least known harm was “atherosclerosis” and “osteoporosis” as shown in [Table 2].
|Table 2: Distribution of the study participants according to awareness of harmful effects of smoking before the intervention (n=120)|
Click here to view
“Liver damage” was the maximally known harm of alcohol consumption and the least known harm was “diabetes” as shown in [Table 3].
|Table 3: Distribution of the study participants according to awareness of harmful effects of alcohol before the intervention (n=120)|
Click here to view
There were a higher proportion of students with satisfactory level of knowledge about smoking after 2 weeks of intervention in School 1, while there was a lower proportion of students with satisfactory level of knowledge about smoking after 2 weeks of intervention in school 2 compared to baseline though these differences were not statistically significant (P > 0.05). There were a higher proportion of students with satisfactory level of knowledge about alcohol after 2 weeks of intervention in both the schools compared to baseline, but this difference was not statistically significant (P > 0.05) as shown in [Table 4].
|Table 4: Comparison between level of knowledge of smoking and baseline at baseline and 2 weeks after intervention in School 1 and 2|
Click here to view
There were a higher proportion of students with satisfactory level of knowledge about smoking after 3 months of intervention in both the schools compared to baseline, and this difference was statistically significant (P < 0.05). There were a higher proportion of students with satisfactory level of knowledge about alcohol after 3 months of intervention in both the schools compared to baseline, though this difference was statistically significant (P > 0.05) for School 2 as shown in [Table 5].
|Table 5: Comparison between level of knowledge of smoking and alcohol at baseline and 3 months after intervention in School 1 and 2|
Click here to view
| Discussion|| |
In the present study, cancer as the harm caused by smoking was known to the maximum students of School 1 and premature death as the harm caused by smoking was known to the maximum students of School 2. The least known harm caused by smoking in School 1 was atherosclerosis, while in School 2 osteoporosis was the least known harm of smoking. In a study conducted by Sogarwal et al. in 2011 among students of both private and government school of Nainital, Wardha, Thrissur, Ratlam, and Nellore, cancer was the most commonly known harm of smoking and the least known was diabetes. In another study conducted by Matapathi et al. in 2014 in Bengaluru, majority of the students knew bad odor and staining of teeth followed by oral cancer and lung cancer as harmful effects of smoking. In another study conducted by Sreedhar et al. in 2013 among high school students in Hyderabad, most commonly known of harmful effects of smoking were lung cancer followed by oral cancer and oral diseases. In another study conducted by Singh and Gupta in 2006 among students of class 9–12 in Jaipur, >90% students were aware of its importance (smoking) in causing respiratory diseases followed by cause general debility, heart disease, cancer, impotence, ulcer of stomach, and death.
In another study conducted by George et al. in 2012 in Delhi in both government and private schools, majority of the students in government school knew smoking causes heart diseases. In another study conducted by Chaudhari et al. in 2016 among high school children of Patan city, Gujarat, knowledge regarding hazards of smoking was maximum for lung cancer followed by for oral cancer. In another study conducted by Jayakrishnan et al. in 2016 among students of rural government school of Kerala, 41.5% students were aware of the relationship between oral cancer and tobacco and 4.5% students mentioned CVD as tobacco related.
In the present study, there were a statistically significant higher proportion of students with satisfactory level of knowledge about smoking after 3 months of educational intervention (through posters and pamphlets) compared to baseline in School 1. In another study conducted by Chaudhari et al. in 2015 in Gujarat, baseline knowledge of the students regarding the hazards of smoking was increased after the intervention and the difference was significant similar to the present study. In an interventional study conducted by Matapathi et al. in 2014 among students of class 9th and 10th in Bengaluru, mean score of knowledge of harmful effects of smoking increased from baseline to posthealth education irrespective of the method used (lectures with PPT in one school and only lecture in other school), and the difference was statistically significant. In another study conducted by Kumar B et al. in 2013 in Dehradun among students of class 11th and 12th. There was a significant improvement in knowledge regarding harmful effects of tobacco 7 days after teaching session along with exhibition on harmful effects of tobacco. In a study conducted by Jayakrishnan et al. in 2016, similar significant increase in mean knowledge scores was found after educational intervention in the form of audio-visual aids among higher secondary students. In a study conducted by Saraf et al. in 2015 in middle schools of rural Ballabgarh, postintervention, knowledge about tobacco increased significantly in the intervention group where intervention consisted of school component (policies), classroom (activities), and family component (IEC) as compared to the control school. In a study conducted by Chaudhari et al. in 2016 in Gujarat, they found that baseline knowledge regarding harmful effects of smoking and/or chewing tobacco increased significantly after the educational intervention in the form of lectures, demonstrations, and charts.
In the present study, liver damage as the harmful effect of alcohol was known to the majority of students and the least known harmful effect of alcohol was diabetes. Similar results have been observed by Sogarwal et al. in 2011 among students of both private and government school of class 8th to 10th of five districts of India, Nainital, Wardha, Thrissur, Ratlam, and Nellore where liver diseases were the most commonly known harm of alcohol and diabetes was the least known harm. In another study conducted by Nebhinani et al. in 2011 among school (class 8th to 10th) and college students in Chandigarh majority of the school students knew that substance causes liver damage if used for longer duration. The present study has found lower awareness which may be because they included higher class students in their study.
In the present study, there were a higher proportion of students with satisfactory level of knowledge about alcohol 3 months after intervention in school 2 where the intervention was given in the form of didactic lecture, and the difference was statistically significant (P > 0.05). In a study conducted by Chaudhari et al. in 2015 in Gujarat among high class students, knowledge of the students regarding the hazards of alcohol increased significantly after educational training. In another study conducted by Kumar B et al. in 2013 in Dehradun among senior secondary class students, they found a significant improvement in knowledge regarding harmful effects of alcohol 7 days after teaching session along with exhibition on harmful effects of alcohol. In another interventional study conducted by Jani et al. in 2013 among secondary school students in Vadodara knowledge regarding ill effects of alcohol consumption the mean score improved from baseline after educational training, and the difference was statistically significant. This improvement after intervention is similar to the result of the present study.
| Conclusions|| |
There was a significant improvement in the knowledge regarding smoking and alcohol use among school-going adolescents after IEC activities in the form of didactic lectures, pamphlets distribution and poster display. Thus IEC activity may be one of the tools to improve health literacy regarding harmful effects of smoking and alcohol use among school going adolescents.
The authors wish to thank the Institutional Ethics Committee of VMMC and Safdarjung Hospital, New Delhi, for approving the topic of this study. We also express our gratitude to school teachers for helping us in conducting the study and students who participated in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bloom DE, Cafero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, et al
. The Global Economic Burden of Non-communicable Diseases. Geneva: World Economic Forum; 2011.
World Health Organization. The World Health Report. Reducing Risks, Promoting Healthy Life. Geneva; World Health Organization; 2002.
Carolina Populations Center. The National Longitudinal Study of Adolescent Health. Chapel Hill: University of North Carolina; 1998.
Manganello JA. Health literacy and adolescents: A framework and agenda for future research. Health Educ Res 2008;23:840-7.
Centre for Disease Control and Prevention. Guidelines for school health programs to promote lifelong healthy eating. Morb Mortal Wkly Rep 1996;45:1-33.
George GM, Sharma KK, Ramakrishnan S, Gupta SK. A study of cardiovascular risk factors and its knowledge among school children of Delhi. Indian Heart J 2014;66:263-71.
Sogarwal R, Bachani D, Kumar B, Gupta S. Risk factors of non-communicable diseases among higher secondary school students in selected districts of India. Am J Public Health Res 2014;2:16-20.
Matapathi N, Shenoy KS, Swetha KM, Pushpanjali K. Effectiveness of educational intervention among adolescents pertaining to tobacco consumption in Bangalore city. J Dent Orofac Res 2014;10:4-7.
Sreedhar M, Rao HC, Muraleedhar. A study on awareness of tobacco use risk among high school children, Hyderabad. Int J Res Dev Health 2013;1:50-3.
Singh V, Gupta R. Prevalence of tobacco use and awareness of risks among school children in Jaipur. J Assoc Physicians India 2006;54:609-12.
Chaudhari AK, Rami K, Thakor N. Assessment of knowledge regarding non communicable diseases and their risk factors among students of higher secondary school: An interventional study. Int J Med Sci Public Health 2016;5:115-8.
Jayakrishnan R, Geetha S, Mohanan Nair JK, Thomas G, Sebastian P. Tobacco and alcohol use and the impact of school based antitobacco education for knowledge enhancement among adolescent students of rural Kerala, India. J Addict 2016;2016:9570517.
Kumar B, Prakash R, Prakash K, Muthuvenkatachalam S. Effectiveness of an awareness program about the harmful effects of tobacco and alcohol on knowledge and self-reported practice of adolescent students studying in a selected school of Dehradun India. Int J Nurs Sci 2013;3:57-61.
Saraf DS, Gupta SK, Pandav CS, Nongkinrih B, Kapoor SK, Pradhan SK, et al.
Effectiveness of a school based intervention for prevention of non-communicable diseases in middle school children of rural North India: A randomized controlled trial. Indian J Pediatr 2015;82:354-62.
Nebhinani N, Nebhinani M, Misra AK, Grewal S. Substance-related knowledge and attitude in school and college students. Ger J Psychiatry 2013;16:15-9.
Jani V, Swamy PG, Ravindra HN, Varghese R. Effectiveness of planned teaching programme on knowledge regarding ill effects of alcohol comsumption. J Nurs Health Sci 2014;3:16-21.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]