Systematic review of school-based tobacco prevention programs for the adolescents in India from 2000 to 2020

In India, 14.6% of adolescents are currently using tobacco in any form and tobacco control is a major public health challenge. The objective of this systematic review is to analyze all the existing literature and evaluate the effectiveness of school-based tobacco use prevention programs for adolescents in India. The review protocol was registered in PROSPERO (CRD42020159535). Studies were selected using database search, manual search, gray literature, reference chasing, and contacting the authors. All randomized controlled trials, cluster-randomized trials, quasi-experimental, and non-randomized studies reporting school-based tobacco use preventive interventions for adolescents in India; articles published in English (other languages where it can be translated to English) published between January 2000 till May 2020 were included. Data was independently extracted by two reviewers. The Risk of bias (RoB) and quality of the study were assessed using appropriate tools. Among 7972 identified articles, only 13 studies met the inclusion criteria. Each study implemented a unique intervention and measured distinct outcomes. Postintervention, all the studies reported improvements in the study group with respect to the reduction of tobacco use and change in the knowledge, attitude, practices, and/or behavior outcome parameters. Twelve study results were based on short-term assessment. Overall, a 5.17-17.0% tobacco use reduction rate was noted. RoB was high for six studies. Key methodological problems related to study design, duration, outcome parameter, follow-up time, type of intervention, and attrition were identified. School-based tobacco use prevention programs for adolescents in India might have shown positive outcomes but are associated with significant limitations.