Background:
Tobacco and supari (areca nut or betel nut) use has been reported with a high prevalence among students in secondary schools in Mumbai, India. Supari, which is classified as carcinogenic, is one of the most widely consumed addictive substances in India after nicotine, ethanol and caffeine.
A study was conducted to evaluate the efficacy of a school-based psychosocial intervention for all forms of tobacco and supari cessation among students.

Methods:
A quasi-experimental trial with three measurements - at baseline, Post-test1 and Post-test2 was conducted in 12 schools serving students with similar socioeconomic profile in 2015-16. Six schools were randomly selected for the cessation intervention and 6 matching schools were selected based on location and medium of instruction in comparison group. In the interventions schools, students who self-reported tobacco or supari use at baseline were assigned to receive a 6-session group cessation intervention designed specifically for adolescents and school settings. All schools receive a life-skills and tobacco prevention program called Super-Army.

Results:
1313 students completed the baseline in intervention schools; 212 self-reported tobacco/supari use, of which 133 enrolled and received both Super-Army in classroom and 6 psychosocial cessation sessions in group setting. In comparison schools, 1320 students completed baseline; of which 191 reported tobacco/supari use and received only the Super-Army prevention messages in classroom.
At Post-test 1, conducted 4 weeks after sessions ended, reported use in intervention schools dropped by 30% and in comparison schools by 28%. At Post-test 2, conducted 16 weeks later, in intervention schools self-reported use dropped further by 45%. This was significantly different from comparison schools where users dropped by 13%.

Conclusions:
Although classroom-based life-skills curricula have an immediate impact on tobacco/supari use, the addition of a specialized cessation intervention, even if psychosocial in nature without replacement therapy, seems to have a durable effect on reducing use.