Teacher tobacco use and tobacco use prevention in two regions in India: Qualitative research findings

Background. This paper uses qualitative data to explore differences in tobacco use patterns and tobacco use prevention efforts among teachers in two Indian states with high versus low prevalence of tobacco use. Methods. We conducted a series of 12 focus groups with teachers in 12 schools in Maharashtra and Bihar following a standardized script, and analyzed data using standard qualitative methods. Results. Teachers in Bihar reported higher levels of tobacco use and stronger social norms promoting tobacco use compared to those in Maharashtra; nonetheless, teachers in both states reported strong social prescriptions about teachers' not using tobacco. Few supports were available for cessation. Although focus group participants were generally aware that tobacco use has deleterious health effects, not all were knowledgeable of specific health consequences, in particular resulting from the use of smokeless tobacco. Key barriers to teaching about tobacco use prevention were reported, including the lack of its inclusion in standard curricula and large class sizes; these results also underscore the importance of support for tobacco control policies. Conclusions. These findings point to the need for a multi-pronged approach to tobacco use prevention that involves the government, school administration, as well as teachers, parents, and the broader community, and including support to tobacco use cessation.