Beyond Tobacco Prevention: A Qualitative Study of a School-Based Life Skills Intervention for Economically Disadvantaged Youth in Mumbai, India

Objective: Low socioeconomic status young people in low- and middle-income countries use tobacco at higher rates than their wealthier peers. School-based tobacco use prevention interventions that employ a life skills approach are effective at preventing tobacco use. In India, the Salaam Bombay Foundation (SBF) has implemented a multiyear, multicomponent life skills education programme in Mumbai schools to prevent tobacco use. A quantitative evaluation found that SBF programme exposure was associated with not only reduced tobacco use but also improved life skills, self-esteem and self-efficacy. To illuminate how programme exposure engendered these effects, we compared the experiences and perceptions of eighth and ninth grade students (ages 13-15) between SBF and non-SBF schools. Methods: We divided Mumbai into four quadrants or regions and randomly selected one SBF and non-SBF school from each quadrant; 10 participants were then randomly selected from one class per school. A total of eight group discussions (N = 80 participants) were conducted using mind-mapping with a focus on students' daily life, future aspirations and non-academic school programming. Researchers analysed the data thematically. Results: Despite similar home lives, SBF students were profoundly more optimistic about their future than non-SBF students. SBF students attributed this increased optimism and agency to opportunities to actively advocate against tobacco, formal recognition in a published newsletter, a sense of belonging to a 'Super Army' and supportive mentorship provided by their Super Army and peer leaders. The SBF programme created a safe space in which to build resilience. Conclusion: These findings can guide development of programmes for vulnerable populations with broader goals than tobacco prevention.