Testing the effectiveness of a teacher-training intervention to make schools tobacco-free in India: Results from a quasi-experimental post-only study

Introduction Tobacco-free schools (TFS) are critical for preventing tobacco-use among adolescents, who constitute nearly 21% of India’s population. This study tested the effectiveness of a teacher-training intervention for achieving tobacco-free schools in the state of Maharashtra in India. Methods A quasi-experimental post-only study was conducted in four districts in Maharashtra state. Starting in 2013, designated teachers from 2188 government schools in two intervention districts received a day-long tobacco-free school training intervention each year for five years. About 1707 similar schools in two comparison districts did not receive the intervention. At the end of five years, in 2018, we assessed adherence to 11 TFS criteria by visiting randomly selected schools in the intervention and comparison districts. Results In intervention districts, 37.8% (34) of visited schools fulfilled all 11 TFS criteria, 34.4% (31) fulfilled 7–10, and 27.8% (25) schools fulfilled ≤6 criteria. This was significantly (p