CC BY-NC-ND 4.0 · South Asian J Cancer 2021; 10(03): 144-150
DOI: 10.1055/s-0041-1731900
Original Article: Cancer Epidemiology, Screening and diagnosis

Evaluation and Impact of ASPIRE: An Interactive Tobacco Prevention Curriculum among University Students in India

Gayatri Vishwakarma
1   Indian Spinal Injuries Centre, New Delhi, India
Sohini Singh
2   Department of Biotechnology, Amity University, Noida, Uttar Pradesh, India
Salma K Marani
3   Youth and Family Cancer Prevention Program, University of Texas, M D Anderson Cancer Center, Houston, Texas, United States
Ashish Arya
3   Youth and Family Cancer Prevention Program, University of Texas, M D Anderson Cancer Center, Houston, Texas, United States
Karen Calabro
4   Department of Behavioral Sciences, University of Texas, M D Anderson Cancer Center, Houston, Texas, United States
Garima Gupta
5   Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
Anurag Mehta
5   Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
V. Alexander
6   Youth and Family Cancer Prevention Program, University of Texas, MD Anderson Cancer Center, Houston, Texas, United States
› Author Affiliations


Online education approach provides innovative opportunities for engaging youths. Web-based, multimedia smoking prevention programs have been tested in high-income countries; however, efficacy of such programs is not well-investigated in low- and middle-income countries. The aim of this study was to evaluate the impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive tobacco prevention curriculum, among university students in India.

A single-subject cohort study where each subject serves as their own control was conducted among university student participants engaged in ASPIRE, 60 minutes per week for five consecutive weeks during July to August of 2019. Assessments were conducted at baseline and immediately after exposure to ASPIRE. To evaluate the program, a structured instrument was specifically designed to measure the outcomes.

A total of 103 university students participated voluntarily. Average age of the participants was 18.3±0.9 ranging from 17 to 20 years. Eighteen percent of students were curious to know about the various smoking products. More males were more susceptible to cigarette smoking as compared to females. The majority of participants felt that ASPIRE was culturally appropriate for young adults in India, but a modified version targeted toward Indian youth would be more acceptable. Pre- to postintervention knowledge of tobacco-related hazards increased from 70 to 97% (p < 0.001).

ASPIRE, a multimedia interactive program, demonstrated its considerable potential to discourage smoking initiation among Indian youth.

Publication History

Article published online:
24 November 2021

© 2021. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Private Ltd
A-12, Second Floor, Sector -2, NOIDA -201301, India

  • References

  • 1 Chandrupatla SG, Tavares M, Natto ZS. Tobacco use and effects of professional advice on smoking cessation among youth in India. Asian Pac J Cancer Prev 2017; 18 (07) 1861-1867
  • 2 Mishra S, Joseph RA, Gupta PC. et al Trends in bidi and cigarette smoking in India from 1998 to 2015, by age, gender and education. BMJ Glob Health 2016; 1 (01) e000005
  • 3 Nagarajan R, Thakur A. Smoking dips 10% in 2 years in India but women smokers up sharply. December 28, 2015
  • 4 Bold KW, Krishnan-Sarin S, Stoney CM. E-cigarette use as a potential cardiovascular disease risk behavior. Am Psychol 2018; 73 (08) 955-967
  • 5 GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet Lond Engl 2017; 389 (10082) 1885-1906
  • 6 Sinha DN, Reddy KS, Rahman K, Warren CW, Jones NR, Asma S. Linking Global Youth Tobacco Survey (GYTS) data to the WHO framework convention on tobacco control: the case for India. Indian J Public Health 2006; 50 (02) 76-89
  • 7 Institute of Medicine, Committee on Preventing Nicotine Addiction in Children and Youths. Growing up Tobacco Free - NCBI Bookshelf. National Academies Press (US); 1994. Accessed March 5, 2021
  • 8 Khandal S, Kar S, Rastogi S, Rastogi S. Why people smoke? - an empirical study in Bangalore. Int J Res Humanit Arts Lit 2019; 7 (04) 419-426
  • 9 Pradhan PMS, Niraula SR, Ghimire A, Singh SB, Pokharel PK. Tobacco use and associated factors among adolescent students in Dharan, Eastern Nepal: a cross-sectional questionnaire survey. BMJ Open 2013; 3 (02) e002123
  • 10 Prokhorov AV, Kelder SH, Shegog R. et al Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high-school students. Nicotine Tob Res 2008; 10 (09) 1477-1485
  • 11 Prokhorov AV, Marani SK, Calabro KS, Ford KH. Theory and Technology-Driven Educational Curricula Addressing Tobacco Use. In: Proceedings of the 4th World Conference on Educational Sciences. Vol 46. Procedia - Social and Behavioral Sciences; 2012
  • 12 Thomas RE, McLellan J, Perera R. School-based programmes for preventing smoking. Cochrane Database Syst Rev 2013; ( (04) CD001293 DOI: 10.1002/14651858.CD001293.pub3.
  • 13 Nădăşan V, Foley KL, Pénzes M. et al The Short-term Effects of ASPIRA: a web-based, multimedia smoking prevention program for adolescents in Romania: a cluster randomized trial. Nicotine Tob Res 2017; 19 (08) 908-915
  • 14 Cohen J. Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Routledge. 1988. Available at
  • 15 Khalil GE, Calabro KS, Prokhorov AV. Development and initial testing of the brief adolescent smoking curiosity scale (ASCOS). Addict Behav 2018; 78: 67-73
  • 16 Pierce J, Farkas A, Evans N, Gilpin E. An improved surveillance measure for adolescent smoking. Tob Control 1995; 4: S47-S56
  • 17 Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK. Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol 1996; 15 (05) 355-361
  • 18 de Josselin de Jong S, Candel M, Segaar D, Cremers H-P, de Vries H. Efficacy of a Web-based computer-tailored smoking prevention intervention for Dutch adolescents: randomized controlled trial. J Med Internet Res 2014; 16 (03) e82 DOI: 10.2196/jmir.2469.
  • 19 Gritz ER, Prokhorov AV, Hudmon KS. et al Predictors of susceptibility to smoking and ever smoking: a longitudinal study in a triethnic sample of adolescents. Nicotine Tob Res 2003; 5 (04) 493-506
  • 20 Prokhorov AV, Kelder SH, Shegog R. et al. Project ASPIRE: an Interactive, Multimedia Smoking Prevention and Cessation curriculum for culturally diverse high school students. Subst Use Misuse 2010; 45 (06) 983-1006 doi: DOI: 10.3109/10826080903038050.