Mishu Masuma Pervin, Jackson Cath, McNeill Ann, Garg Suneela, Borle Amod, Deshmukh Chetana, Singh M Meghachandra, Bhatnagar Nidhi, Kaushik Ravi, Huque Rumana, Fieroze Fariza, Kanan Sushama, Abdullah S M, Mazhar Laraib, Akhter Zohaib, Rehman Khalid, Ullah Safat, Han Lu, Readshaw Anne, Sheikh Aziz, Gill Paramjit, Siddiqi Kamran, Kanaan Mona, Iqbal Romaina
Department of Epidemiology and Public Health, University College London, London, United Kingdom.
Department of Health Sciences, University of York, York, United Kingdom.
PLOS Glob Public Health. 2024 Oct 3;4(10):e0003784. doi: 10.1371/journal.pgph.0003784. eCollection 2024.
Most of the world's 300 million smokeless tobacco (ST) users live in South Asia but ST policies for that region are poorly researched, developed and implemented. Longitudinal studies to understand the uptake and use of ST and smoking, and influences on these, such as health promotion strategies, are lacking. We planned to conduct longitudinal surveys among secondary school students in three countries with the highest ST burden: Bangladesh, India and Pakistan to explore ST and smoking uptake, use and health promoting strategies. Before running that longitudinal study, we assessed the feasibility of conducting such a multi country survey using a mixed-methods design. The survey (and feasibility study) was conducted in 24 secondary schools (eight per country, three classes per school). Three data sources, researcher records/fieldnotes, survey data of 1179 students, and interview/focus group discussion data from 24 headteachers, 64 teachers and 76 students, were used to understand the feasibility of three study tasks: 1) selecting, recruiting, and retaining schools and student participants; 2) survey administration; and 3) robustness of the data collection instruments. The datasets were analysed separately and triangulated. Overall, we could select and recruit schools and students using consistent methods across countries although recruitment was challenged by securing higher authority permissions and parental consent. Recommended improvements were for permission/consent processes. Survey administration was generally feasible and acceptable with recommendations for scheduling and researcher-student ratios. Questionnaire completion was 83%-100% across countries, with suggestions to improve readability and understanding, addressing students' queries and questionnaire simplification. Due to COVID-19, we could not conduct follow-up surveys, so were unable to assess school or student retention. In conclusion, incorporating the lessons learnt from this study would improve the feasibility of conducting such a multi-country survey in the future. Reported benefits included increasing tobacco health risks' knowledge with potential for increased tobacco control support.
全球3亿无烟烟草使用者中的大多数生活在南亚，但该地区的无烟烟草政策在研究、制定和实施方面都很薄弱。缺乏纵向研究来了解无烟烟草和吸烟的使用情况以及影响因素，比如健康促进策略。我们计划在无烟烟草负担最重的三个国家（孟加拉国、印度和巴基斯坦）的中学生中开展纵向调查，以探究无烟烟草和吸烟的使用情况以及健康促进策略。在开展该项纵向研究之前，我们采用混合方法设计评估了开展这种多国调查的可行性。该调查（及可行性研究）在24所中学进行（每个国家8所，每所学校3个班级）。使用了三个数据源，即研究人员记录/实地记录、1179名学生的调查数据以及来自24名校长、64名教师和76名学生的访谈/焦点小组讨论数据，以了解三项研究任务的可行性：1）选择、招募和留住学校及学生参与者；2）调查管理；3）数据收集工具的稳健性。对数据集分别进行分析并相互印证。总体而言，我们能够在各国采用一致的方法选择和招募学校及学生，不过在获得上级许可和家长同意方面，招募工作面临挑战。建议改进许可/同意流程。调查管理总体上可行且可接受，针对时间安排和研究人员与学生比例提出了建议。各国问卷完成率在83%至100%之间，针对提高可读性和理解性、解答学生疑问以及简化问卷提出了建议。由于新冠疫情，我们无法进行后续调查，因此无法评估学校或学生的留存情况。总之，吸取本研究的经验教训将提高未来开展此类多国调查的可行性。报告的益处包括增加对烟草健康风险的认识，有可能增强对烟草控制的支持。
