|TOBACCO AND WOMEN
|Year : 2010 | Volume
| Issue : 5 | Page : 81-86
Scope and extent of participation of female volunteers in tobacco control activities in Kerala, India
J Sreedharan1, J Muttapppallymyalil1, B Divakaran2
1 Research Division, Gulf Medical University, Ajman, United Arab Emirates
2 Department of Community Medicine, Academy of Medical Sciences, Pariyaram Medical College, P O Kannur, Kerala, India
|Date of Web Publication||9-Jul-2010|
Research Division, Gulf Medical University, Ajman
United Arab Emirates
Source of Support: None, Conflict of Interest: None
Background : In India, NGOs play a key role in creating a supportive environment for the control of tobacco consumption. Aims : This study was conducted to assess the scope and the extent to which community-based women organizations are involved in tobacco control activities. To assess the scope and extent of participation in tobacco control activities according to the sociodemographic characteristics and also the extent to which they have participated in tobacco control activities. Settings and Design : The participants were Kudumbasree volunteers from the rural areas of Kannur district of Kerala state, India. This population-based study adopted a cross-sectional design. Materials and Methods : A self-administered, structured, close-ended, pre-tested questionnaire was prepared and used to collect data from 1000 female volunteers who participated in the study. Statistical Analysis : Chi-square test was used to compare nonparametric variables, such as education, marital status, and age with attitude toward tobacco control activities. Results : Age of the participants ranged from 17 to 53 years. The association between education level and positive attitude to participate in tobacco control activities was found to be statistically significant (P < 0.001). A statistically significant association between participation in tobacco control activities and marital status (P < 0.001) was observed. With regard to education and readiness/willingness to participate in tobacco control activities, in all the education groups more than 90% were willing to participate in tobacco control activities. Among the ever married participants, 98% were willing to participate in antitobacco activities. Old age, husband working in a beedi factory, or not being able to make frequent visits were the reasons reported for their unwillingness of the remaining people. Conclusion : Based on the findings, a set of Kudumbasree volunteers were trained in tobacco and health to work in the community.
Keywords: Community, female volunteers, participation, tobacco control
|How to cite this article:|
Sreedharan J, Muttapppallymyalil J, Divakaran B. Scope and extent of participation of female volunteers in tobacco control activities in Kerala, India. Indian J Cancer 2010;47, Suppl S1:81-6
|How to cite this URL:|
Sreedharan J, Muttapppallymyalil J, Divakaran B. Scope and extent of participation of female volunteers in tobacco control activities in Kerala, India. Indian J Cancer [serial online] 2010 [cited 2019 May 21];47, Suppl S1:81-6. Available from: http://www.indianjcancer.com/text.asp?2010/47/5/81/63868
Publication of the supplement was supported by the funds from the 14th World Conference on Tobacco or Health, March 8-12, 2009, Mumbai. The Guest Editors, Editors, Authors and others involved with the journal did not get any financial or non-financial benefit from the sponsors.
| » Introduction|| |
The definition of Non-Governmental Organization (NGO) as per the World Bank is "They include many groups and institutions that are entirely or largely independent of government and that have primarily humanitarian or cooperative rather than commercial objectives. They are private agencies in industrial countries that support international development; indigenous groups organized regionally or nationally; and member-groups in villages. NGOs include charitable and religious associations that mobilize private funds for development, distribute food and family planning services, and promote community organization. They also include independent cooperatives, community associations, water-user societies, women's groups, and pastoral associations. Citizen Groups that raise awareness and influence policy are also NGOs." 
NGOs play a critical role in ensuring effective policy implementation on issues related to public health. To encourage NGOs in their role toward the achievement of public health goals, World Health Organization (WHO) has established a Civil Society Initiative (CSI) in developed and developing countries. ,, The role of NGOs in the community cannot be overlooked in the field of prevention of many communicable and noncommunicable diseases and in international health, because of their capability to reach all areas of great need, local involvement, low cost of operations, independence, and acceptance by the community, sustainability, and unbiased status as they are from the same community.  NGOs are frequently staffed by community members, which gives them credibility and understanding of the communities they serve.  There is a growing list of NGO projects for AIDS prevention and care that provides critically needed services in many different settings. ,,
Many NGOs are working in India and play a pivotal role in tobacco control. Some of them are Action Council against Tobacco (ACT), Consumer Education and Research Centre (CERC), Cancer Patients Aid Association, Crusade Against Tobacco (CAT), Green Motherland, Health-Related Information Dissemination Amongst Youth (HRIDAY), Students Health Action Network (SHAN), Health Action By People (HAP), Indian Cancer Society, Kerala Voluntary Health Society (KVHS), National Organization for Tobacco Eradication (NOTE), Swasthya, Salaam Bombay Foundation, Voluntary Health Association of India, and others. The major activities of these NGOs are health education, advocacy programs, litigation, focused campaigns, and research. The performance of India-based NGOs in tobacco control activities has been recognized by the WHO, which is supporting the NGOs to continue their work in tobacco control. 
Tobacco use among women in Asia is currently low compared with those in western countries. Women are less likely than men to use tobacco, thus have the potential as agents of change in the home, the community, and at national, regional, and international levels. Agencies for women's affairs can play a major role in tobacco control. Youth, women, and women's organizations can be encouraged to actively engage in tobacco control activities. Women fully participate at all levels of policy-making and implementation of tobacco control strategies. National task force committees on tobacco control include representatives from women's organizations. 
Women are the guardians of their communities. In the United States, women comprise more than 51% of the population and in that country it has been said that women have the power to create positive change to make their communities healthy and smokefree.  In Kerala too the percentage of female population is high compared with that of male. Most of the health indicators of Kerala are comparable to many of the developed countries. One of the factors for this achievement could be the high literacy rate among females and utilization of health care services by them. Therefore, women in Kerala can make a difference in tobacco control also.
Kudumbasree is the name of the women-oriented, community-based, State Poverty Eradication Mission of the Government of Kerala. Kudumbasree was conceived as a joint program of the Government of Kerala and the National Bank for Agriculture and Rural Development (NABARD), implemented through Community Development Societies (CDSs) of Poor Women, serving as the community wing of Local Governments. It is a society registered under the Travancore Cochin Literary, Scientific and Charitable Societies Act, 1955. It is one of the largest women's movement in Asia with a membership of 37 lakhs representing an equal number of families. It has a governing body chaired by the state minister of Local Self-Government (LSG). The volunteers are not paid any honorarium by the mission but the members organize and conduct income-generating activities. Kudumbasree volunteers had the opportunity to participate in pulse polio immunization program, mass drug administration in filariasis elimination program, health awareness campaign, and in developing their own unique, sustaining model of local economic development. They are directly involved in the social development of the community and women empowerment.
The mission aims at empowerment of women through forming self-help groups and encouraging their entrepreneurial or other wide range of activities. The purpose of the mission is to ensure that the women should no longer remain as passive recipients of public assistance, but active leaders in women involved development initiatives. The program has 37 lakh members and covers more than 50% of the households in Kerala. This organization launched by the Government of Kerala in 1998 for wiping out completely, poverty from the State through concerted community action under the leadership of LSGs. Each LSG will have one Kudumbasree unit functioning under it. Each Kudumbasree unit will have as many neighborhood groups comprising 10-15 female volunteer members in each group. 
The present study was conducted to assess the scope for including women volunteers in tobacco control activities in Kerala and also to ascertain the extent to which they have participated in tobacco control activities.
| » Materials and Methods|| |
This cross-sectional study was conducted by the Department of Community Medicine, Academy of Medical Sciences, Pariyaram, Kannur, to assess the scope and extent to which community-based female volunteers are involved in tobacco control activities. It was conducted in Kannur district of Kerala state, India. Kannur is one of the northern districts in Kerala state with a population of 2.4 million as per the 2001 census. For administrative purposes, Kannur district is divided into 81 Panchayats and 6 Municipal corporations. Kudumbasree units, consisting of women members from economically backward families, are functioning in all Municipalities and Panchayats. This study was conducted in 5 randomly selected LSG bodies in Kannur district and the study was conducted over a period of 6 months during the year 2007.
A self-administered, structured, close-ended, pre-tested questionnaire was prepared to collect the data. In addition to sociodemographic details, tobacco habit among the participants, extent of participation in tobacco control activities, and the scope of including them in tobacco control activities were obtained in detail. The study was conducted during the weekly meetings of Kudumbasree members. Verbal consent was obtained from the participants before distributing the questionnaire and whoever was willing to participate in the study was included. A total of 1000 Kudumbasree volunteers participated in the study. The purpose of the study was explained to the Kudumbasree workers before administering the questionnaire. The filled-in questionnaire was collected back on the same day.
The data were fed into an excel spread sheet and analyzed using the PASW 17 software (IBM company, Illinois, Chicago). Descriptive analysis was done. Chi-square test was performed to determine the association between the scope and extent of participation of Kudumbasree volunteers in tobacco control activities with sociodemographic variables.
| » Results|| |
In the present study, a total of 1000 female volunteers participated. The sociodemographic characteristics of the participants are shown in [Table 1].
The age of the participants ranged from 17 to 53 years. The mean age of the participants observed was 35.7 years with a standard deviation of 9.9 years. Of the total number, 74% belonged to the productive age group of 25-49 years. In the study group, 69.6% were married, 26.3% were unmarried, 2.6% were widowed, 1% were living separately, and very few (0.4%) were divorced. Most (41.1%) of the participants have had completed high school education, 28.1% had completed higher secondary school education, 19.9% had education up to grade seven, 7.9% were educated up to grade four level, 1.3% had completed up to graduate level, and 1.7% had only informal education.
As far as occupation is concerned, the majority (51.8%) were house wives. Unskilled workers constituted 28.4%, 4.7% were farmers, and 3.4% were skilled workers. There were no professionals in the group studied.
Among all participants, the mean years of experience as Kudumbasree volunteer were 3.3 years; 52% of the participants had previous exposure to health-related activities [Figure 1]. There was not much difference observed in various levels of education and participation in health-related activities. Chi-square test was applied to test the association between the level of education and participation in health-related activities, which showed that there is no statistically significant association between education level and participation in health-related activities.
As many as 60% of the participants reported that some of their family members were tobacco users. Among them, 60% reported that their husbands use tobacco. About one-fifth of the participants reported that smoking in public places is a nuisance. There was no statistically significant association between education level and attitude toward smoking in public places.
About 10% of them had participated in tobacco control activities at least once. It was also observed that among students only 8% and among house wives about 12% had already participated in tobacco control activities. In the present study, 32% had participated in the awareness class on tobacco and health. Among those who had attended awareness class on tobacco and health, 28% participated in tobacco control activities in their area by creating awareness among the general public by distributing pamphlets and leaflets.
The distribution of participation in tobacco control activities according to education and marital status is shown in [Table 2]. Among those with education level below grade four, very few (8.6%) participated in tobacco control activities. As education level increases participation also increases to 27%. Chi-square test was done to find the association between education level and attitude (attitude is a learned predisposition to respond favorably or unfavorably toward tobacco control activities) to participate in tobacco control activities. The association was found to be statistically significant (P < 0.001).
With regard to marital status, more married and divorced women have actively participated in tobacco control activities compared with unmarried women. There was a statistically significant association between participation in tobacco control activities and marital status (P < 0.001).
The analysis of readiness/willingness to participate in tobacco control activities by education and marital status is shown in [Table 3]. With regard to education and readiness/willingness to participate in tobacco control activities, in all education groups more than 90% were willing to participate in tobacco control activities. Overall, 97% were willing to participate in tobacco control activities [Figure 2]. Among both the ever married and never married participants, nearly 98% were willing to participate in antitobacco activities. There is no statistically significant association between marital status and readiness to participate in antitobacco activities. With regard to unwillingness to participate in antitobacco activities, potential barriers reported were old age, husband working in beedi factory, or not being able to run around.
| » Discussion|| |
In the present study, it was observed that regardless of education level, the participants were willing to participate in health-related activities. A small percentage of participants have participated in tobacco control activities at least once. The study also observed as education level increases, the participation rate also increases. In Kerala in 2005-2006, 1.8% of women and 43.6% of men aged 15-49 years used tobacco in some form. Tobacco use is low in Kerala with respect to all of India, where 11% of women and 57% of men aged 15-49 years use tobacco in some form. (12) In the present study, none of the participants were tobacco users.
Never married women are less active compared with others, such as married, divorced, and widowed in tobacco control activities. Kudumbasree volunteers are actively involved in the implementation of community-based nutrition program at the grass root level. They also participate in rehabilitating the physically challenged group. Kerala has 1.60 lakhs Kudumbasree health volunteers acting as bare foot doctors. They organize and conduct campaigns with the help of health professionals. Hundred percent immunization in the state can be attributed to the role played by these health volunteers. Now, Kudumbasree is focusing on capacity building among volunteers to promote health by changing risk behavior. (13)
Studies in India have reported that NGOs are actively participating in tobacco control activities.  But no studies reported the role of women health workers/volunteers or the women's organizations in tobacco control activities. In Indonesia, when infant mortality and child mortality were high, the government utilized the services of women religious NGOs to improve the condition. Islamic, Hindu, Protestant, and Catholic NGOs participated in the effort. This study concluded that such NGOs should be considered as partners of the government in mobilizing the community to achieve a health target through the incorporation of messages into the regular activities of the religious groups, such as Al Quran reading, Bible classes, and others. (14) The present study observed the barriers that prevent people from participation in tobacco control activities as lack of training, lack of funding, and time constraints.
This study observed a positive attitude among Kudumbasree members toward tobacco control activities. As Kudumbasree is a group of women community volunteers with an overall positive attitude toward tobacco control activities, they are the potential groups to mobilize for these activities. If they are provided with the resources, we can utilize these groups for a great venture. Based on the findings, we have trained a set of 150 Kudumbasree volunteers on tobacco and health to work in the community after discussing with the LSG body.
| » Conclusion|| |
This study concluded that women already working as Kudumbasree health volunteers in Kerala can be used as volunteers for tobacco control activities. Irrespective of their education, age, and marital status, they are willing to participate in antitobacco activities. As Kudumbasree health volunteers are local persons, they can contribute a lot compared with other health workers because of their accessibility and acceptability by the community. These findings encouraged us to train a set of 150 Kudumbasree volunteers for tobacco control activities.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
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