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Item A qualitative study of mental health problems among children living in New Delhi slums(Transcult. Psychiatry, 2024) Prerna Martin; Emily E. Haroz; Catherine Lee; Paul Bolton; Kiran Martin; Rosemary Meza; Elizabeth Mccarthy; Shannon DorseyChildren living in urban slums in India are exposed to chronic stressors that increase their risk of developing mental disorders, but they remain a neglected group. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived and prioritized locally to tailor interventions for this population. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of children living in Indian slums, including local descriptions, perceived causes, impact, and coping behavior. Local Hindi-speaking interviewers conducted 77 free-list interviews and 33 key informant interviews with children and adults (N = 107) from two slums in New Delhi. Results identified a range of internalizing and externalizing symptoms consistent with depression, anxiety, and conduct problems in children. Findings included both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., madness or anger, pain in the heart and mind) not typically included on western standardized measures of psychopathology. Mental health problems appeared to be highly interconnected, with experiences such as harassment and fighting often described as both causes and impacts of mental health symptoms in children. Community perspectives indicated that even in the face of several unmet basic needs, mental health problems were important to the community and counseling interventions were likely to be acceptable. We discuss implications for adapting mental health interventions and assessing their effectiveness to reduce the burden of mental illness among children living in urban slums in India.Item An examination of the effectiveness of health warning labels on smokeless tobacco products in four states in India: findings from the TCP India cohort survey(BMC Public Health, 2016) Shannon Gravely; Geoffrey T. Fong; Pete Driezen; Steve Xu; Anne C. K. Quah; Genevieve Sansone; Prakash C. Gupta; Mangesh S. PednekarBackground: In 2009, after many delays and changes, India introduced a single pictorial health warning label (HWL) on smokeless tobacco (SLT) packing-a symbolic image of a scorpion covering 40% of the front surface. In 2011, the scorpion was replaced with 4 graphic images. This paper tested the effectiveness of SLT HWLs in India and whether the 2011 change from symbolic to graphic images increased their effectiveness. Methods: Data were from a cohort of 4733 adult SLT users (age15+) of the Tobacco Control Project (TCP) India Survey from 4 states. The surveys included key indicators of health warning effectiveness, including warning salience, and cognitive, emotional, and behavioral responses to the warnings. Results: The HWL change from symbolic to graphic did not result in significant increases on any of the HWL outcome indicators. A substantial minority of SLT users were unaware that SLT packages contained HWLs (27% at both waves). Noticing the warnings was also remarkably low at both waves (W1 = 34.3%, W2 = 28.1%). These effects carried over to the cognitive and behavioural measures, where among those who noticed HWLs, about one-third reported forgoing SLT at least once because of the HWLs, and fewer than 20% reported that HWLs made them think about SLT risks or about quitting SLT. Even fewer reported avoiding HWLs (8.1 to 11.6%). Among those who quit using SLT by post-policy, awareness that SLT packaging contained HWLs was significantly greater at post-policy (86.8%) compared to pre-policy (77.8%, p = 0.02). Quitters were also significantly more aware of the post-policy HWLs compared to those who continued to use SLT (p < 0.001). Conclusions: Health warnings on SLT packages in India are low in effectiveness, and the change from the symbolic warning (pre-policy) to graphic HWLs (post-policy) did not lead to significant increases of effectiveness on any of the HWL indicators among those who continued to use SLT products, thus suggesting that changing an image alone is not enough to have an impact. There is a critical need to implement SLT HWLs in India that are more salient (large in size and on the front and back of the package) and impactful, which following from studies of HWLs on cigarette packaging, would have strong potential to increase awareness of the harms of SLT and to motivate quitting.Item Is Agri-residue Burning a Menace for Air Quality and Public Health in Delhi, India?(Atm髎fera, 2024) Jabrinder SinghSkies over Delhi become blurred and visibility is significantly reduced and the air is hefty and causes a burning sensation in the eyes. As every year in November, a thick blanket of smog veils Delhi and its surrounding National Capital Region-NCR of India, which constitute the world抯 most polluted megacity. According to a senior pulmonologist and member of the WHO commission on global air pollution and health, patients experiencing breathing problems increase by 30-40 percent every year during October-November. But Delhi抯 smog wasn抰 always this bad in early winter; it started only about 10-15 years ago. Satellite images show high Aerosol Optical Depth (AOD), as soon as farmers start burning paddy straw and stubble (agri-residue) in agricultural fields, and air quality severely deteriorates. The agri-residue smoke from agricultural areas surrounding Delhi, combined with urban pollution from vehicles, industry, and fireworks from the Diwali festival, increase pollutants to the severe category. Smoke from farm fires after harvest contributed about ? 26-50% of the PM2.5 (tiny particles that damage lungs and can worsen cardiac ailments) to Delhi抯 air in November 2023. The average resident of this megacity is on track to lose ? 8 years of life expectancy if high pollution levels persist (EPIC, 2023). Authorities in this smog-ridden capital, even imposed emergency school closures of 7 to 15 days in 2016, 2017 and 2023 to mitigate health issues in the population, who flooded emergency wards at hospitals.