Reduction of Tobacco and Alcohol use

by involving users in saving money

and addressing Attitudes and
Perceptions

W.Dhananjaya Patali Perera

 Introduction

Tobacco and alcohol use in Sri Lanka shows a

reduction over the past years . But in some
settings the prevalence is still high. It resulted in
number of acquired personal ,family and social
problems .Finding a solution for this through
Health Promotion approach is the intention of
this project .
 Justification

 Pre study showed that tobacco and alcohol

consumption of Vilachchiya is respectively 74% and
68%.

 The proportion of the family income diverted to

tobacco use is considerably high .in some families it
is about 1/5th of the monthly income .
 Justification continued

 Possibility of family member having a unmet need

due to another family members alcohol and/or
tobacco use is also high .
 Exposure to tobacco smoke has negative health
consequences to users and to the non smokers,
most of the time the exposure to passive smoking is
done at the households and work places .
 alcohol consumption resulted in gender based
violence, sexual abuse, and many social and family
problems .
 Justification continued

• Alcohol has a context of drinking , it varies to age

groups , cultures and ethnicity.
• alcohol dependency also has become a major
health issue .
 Background
Features  
Intervention group 74 individuals who employed as
(Target group 1) civil security force personal
.80 males from Randoowa and other
villages .
Target group 2 (sub group) 56 females

Target group 3 (sub group) 50 Youths

Locations civil security camps at

Vilachchiya , maternal clinics,
schools , village settings
Average monthly income for a 15000-18000Rs
family

Time duration July 2009- June 2010

 Basic Characteristics of the control area and intervention area

Details Intervention area – Control area–

Vilachchiya south 1, Mihinthale PHM area
PHM area
Basic characteristic Sub –urban and rural Sub- urban and rural
Population 7632 individuals 5600 individuals
Age range of males 18-50 years 18-50 years
Monthly income 15,000- 18,000Rs 15,000- 18,000Rs
Female age range 10-50 years 10-50 years
Income methods Salary from CSF, Salary from CSF,
engaging in agriculture engaging in agriculture
and fishery and self and fishery and self
Employment. Employment
 Objectives of the Study

General objectives

 To reduce cigarette consumption by 20% of

males of Vilachchiya south 1, 11 PHM area

 To change the attitudes ,perceptions and

knowledge of towards alcohol use by 20% in
Vilachchiya south 1,11 PHM area .
 Specific Objectives
1. To describe the factors that influence tobacco and
alcohol consumption in the Community
2. To estimate the financial harm created by tobacco
consumption
3. To implement a plan to address underlying
determinants of tobacco and alcohol Consumption
4. To improve the knowledge on the real harms
created by tobacco and alcohol consumption in the
community
5. To engage youths in Vilachchiya in preventing
alcohol and tobacco consumption.
6. To improve family and community well being
 Methodology

 Alcohol and tobacco are taken as two topics.

 Two conceptual models were developed based

on 4 core principles .
 Four principles
Recognition of the situations that have the potential to
affect the health of the population

Identify the most risked group

Formulate interventions that have the capability for achieving

the objectives that are required to secure reduction of the cause

Implement and facilitate the implementation of interventions to

an extent that makes a significant impact and Ensuring long
term sustainability of the intervention
 Formation of volunteer groups to reduce
cigarette use in the community

Reduction of cigarette use by 20% and improvement in

savings

Improvement of knowledge on real harms created by cigarette use

And addressing determinants

Support given by the peer group

Decision to reduce cigarette use

Conceptual
frame work Attitude change of the males towards
cigarette use

for tobacco
Willingness and enthusiasm
prevention of the group
 Social determinants
Value given to the alcohol use in the community, peer pressure,
aloholization of events, group perceptions towards alcohol, value given to
alcohol in the community,

Personal decision Reduction in

Attitude towards alcohol use and
use, skills, knowledge, change in
Supportive
personal perceptions and attitudes,
environment
believes towards alcohol perceptions
use. Willingness to change, and
knowledge
Conceptual
frame work Alcohol consumption

for alcohol
prevention

Reduction of Understanding Reducing the Limiting Counteracting Helping

availability of the real harm attractiveness the unfair promotions users to
alcohol caused by towards privileges reduce
alcohol use alcohol given to or quit
user
 Data collection

Qualitative data collection

• Focused group discussions

• Open ended questions
• Semi- structured interviews
• Questionnaire
 Evaluation strategy
• Pre evaluation was conducted at beginning of the interventions

• An intermediate evaluation was conduct at the 4 months period

of the project implementation to

• final evaluation was conducted and the data was compared

with the control group,

• Post evaluation was conducted after the interventions

• Pre and post data were compared in order to check for any
possible changes
 Instruments

 Questioners, Interview guides, and observation

guides were used for data collection. Leaflets,
posters, presentations, workshops at maternal
clinics, health promotion camps at school to
address whole health for diffusion of
intervention to the community were used.
House visits were conducted by the researcher
and the volunteers followed by pre guide lines.
 Interventions for tobacco prevention

1. Attachment with the males were done through frequent

visits to the working places ,conducting health
promotion camps and sharing information regarding
consequences of cigarette smoking

2. Facilitating individuals to seek out for most feasible

answers for them.

3. Support to trigger a positive change was provided by the

means of discussions, presentations and health
promotion camps, until the need for reduction and
quitting of cigarette smoking was generated
4 .Each individual agreed to reduce at least one cigarette
per day and save the respective amount of money in a
till box, each individual had to mark the reduced
number of cigarettes per day in a pocket calendar given
to them.
5 .In each month the collected amounts of money
were calculated and used to fulfill a need of the
family.

6 .Supportive environment was created in which

the reduction and quitting was easy.
 Interventions for alcohol prevention
 women plays a big role in preventing alcohol
use as they are they are victimized to alcohol
based violence. The response towards a
drunken husband or a drunken man is changed.

 Knowledge on real harm created by alcohol use

is increased and the attitude on normalizing and
excusing the user was addressed.
 Modes of conducting

 Interactive discussions,
 Scenario discussions
 Health promotion camps
 Role plays
 Results
1.Number of CSF 38 (n=74) 51 %
individuals
who reduced smoking
2.Number of CSF individuals 22 (n=74) 29%
who gave up smoking

3.Number of individuals who 70 (n=74) 94 %

can demonstrate the
economic harm

4. Houses maintaining till boxes 64 (n=74) 86%

Males saying yes , Pre Post
(n=74) (n=74)

Now I have a good understanding of the 30 72

harms created by alcohol and tobacco use (40.54%) (97.29%)
I can name 5 harms created by alcohol and 20 66
tobacco use (27.02%) (89.18%)
I’m helping my friends to reduce and quit 2 39
smoking (27.02%) (52.7%)
I’m using a pocket calendar to mark my _ 52
cigarette reduction (70.27%)
I’m having continuous discussions with my 0 48
friends to reduce alcohol and tobacco use (64.86%)
among us
I have placed my till box in a place where _ 46
every one in my family can see it (62.16%)
I can identify methods used by the media to 0 40
promote alcohol and tobacco products (54.05%)
I know that alcohol users should not be 0 60
excused of neglecting responsibilities (81.08%)
I know alcohol and tobacco users are 10 62
unintelligent (13.51%) (83.7%)
 Changes in households in savings -Randoowa
House January February march April May
spending
1 4320.00 980.00 1500.00 1350.00 1000.00

2 3780.00 1050.00 -- -- --

3 5400.00 700.00 1900.00 1200.00 1500.00

4 3780.00 2400.00 1000.00 -- --

5 2160.00 1000.00 2100.00 2100.00 2100.00

6 1200.00 950.00 840.00 1020.00 --

7 1620.00 -- -- -- --

8 540.00 400.00 350.00 -- --

9 1080.00 840.00 300.00 275.00 190.00

 Attitude change of women

Intervention group Control group

Attitudes (n=56) (n=50)

Pre post Pre Post

Alcohol and tobacco 20% 70% 27% 32%

users are weak
Alcohol and tobacco 20% 63% 18% 25%
users Should not be
excused
alcohol and tobacco 10% 72% 5% 20%
users are unintelligent
Alcohol and tobacco 20% 80% 25% 35%
users divert
A considerable amount
of families income to
substance use
 Knowledge Change of women

Intervention group Control group

(n=56) (n=50)

Knowledge about Pre post Pre Post

Strategies used by 4% 65% 10% 14%

tobacco and alcohol
companies to attract
youth and children

Harm caused by 48% 72% 50% 55%

tobacco and alcohol
use
 Assessment of youths and children

Sample tobacco and Media promotes Why People become

Size alcohol alcohol troublesome and
companies target and tobacco use aggressive
school children after drinking
and youths alcohol
pre post pre post Pre Post

Marks 13 14 11 12 4 25
Obtain
by the
Student
s
 Well being assessments

Percentage of males who say, that they are happy after reducing 68%
alcohol and tobacco use

Percentage of women who says that their responds changed towards the 60% (n=56)
husband who has reduced alcohol and tobacco use

percentage of civil security force personal who express they are happy 84% (n=74)
after they started to reduce tobacco and alcohol use

Percentage of families expressing that they are happy 64% (n=21)

Enthusiasm towards continuation of interventions Males 85%

(n=74)
Females 82%
(n=56)

Percentage of children who say that they are more happy 23% (n=22)
 What they say
• Chief of one of the camps reported that,

“I use tobacco and alcohol since I’m about 18, when the
researcher came to my office I had a cigarette packet on my
desk and I covered it with a news paper and talked with him,
but now I’m changed a lot after this intervention I started to
reduce my cigarette use and saved money in a till box and I
wanted to see what happened. In the 1st month my savings
was about 800Rs. I came to realize what a stupid thing I did
earlier. As I’m the chief I surely know that there are about 20
soldiers who have stopped smoking in my unit”
• a Male said that
“there is a micro finance –self employment program conducted
by a Bank in the area most of us are part of that program, this
month I paid the installment of my loan form the money I
saved in the till box by reducing cigarettes “

•Another soldier said that

“At the tea time I’m going to a near by boutique to get sugar and
other ingredients to make tea, we collect money to those. earlier
most of the time we buy cigarettes for the balance, now we do
not do that anymore , interestingly if someone requested to buy
cigarettes others oppose to that idea, now we some times buy a
biscuit packet from the balance”
• Another male said that

“ I have two children and they are very young , I came to

know about direct and indirect ways of media
influencing alcohol use and I realize how they
promote and glamorize it , I was afraid about my
children. But now I’m trying to convince and make
them to realize how it is done, I’m sitting in front of
the TV with them and have a discussion o that issue
as much as I can”
• A student from Rahula Vidyalaya expressed
that,
“after I realize how to calculate the economic
harm from cigarette use I got so enthusiastic
and I wanted to measure very one in my village
so I went to house by house and I calculate
about 113 peoples cost on cigarettes
surprisingly it was about 18,76200Rs. I showed
this figures even to district secretariat”
 Discussion

 Holistic approach was used for the intervention.

 A significant reduction of smoking was observed that
exceeded expected results .
 As civil security personal were mobile to various
locations introduction of pocket calendar greatly helped
to keep a track on the developments .
 Reduction and quitting of cigarette use had an added
advantage to house holds , It decreased passive
smoking risk of children and women .
 This shows that pressure of the peers also contributed
to the reduction of cigarette use of target population
 Discussion continued

 attitudes towards alcohol use was changed significantly

among men and women
 Financial harm is seen as one of the major threats to the
well being of families
 Knowledge on what alcohol does to the people was
increased in greater scale
 Community participation through out the intervention
was at the highest standards and the later the
ownership of the intervention is given to the community
 Recommendations

 Money saving method was proven to be

successful in reducing tobacco use .
 Holistic approach provided the passage to
improve the awareness on whole health of the
community .
 Involving youths as volunteers was a successfully
method to sustain the process .
Thank you …