Smoking Research Proposal - West Bengal

A Research Proposal: Countering the Use of Tobacco What Has Worked and What Hasn't: The Case of West Bengal: What Strategies to Focus On I. The Construct of Study: Tobacco Use: How to Counter it? Oscar Wilde wrote in the 19th century, “You must have a cigarette. A cigarette is the perfect type of a perfect pleasure. It is exquisite, and it leaves one unsatisfied. What more can one want?” That was then. Smoking was considered a patrician luxury. Fast forward to 2013. Smoking and tobacco use are dreaded public health threats. What brought about the change in global attitude towards tobacco use and what is the reason for continued inability to fully grasp the danger in some parts of the world? How serious are the challenges in the developing world and the developed world and what needs to be done to seriously eliminate the global epidemic of tobacco use? The origins of the tobacco can be traced to the Mayans in the Americas from where (following the discovery of America by Columbus), it was exported to Europe and beyond. There is evidence that tobacco was in use in the seventeenth and eighteenth centuries, albeit sporadically (http://globalhealth.stanford.edu/education/tobacco_global_nature.pdf). However, the manner of its use has been varied over the years. It has been, smoked, chewed and snuffed. Cigarette smoking became popular only in the nineteenth century. With the growth of technology, cigarette production significantly increased towards the end of the nineteenth century. Cigarette smoking became very fashionable soon and spread fast, spurred on by aggressive marketing. In the First World War, this was even one of the items in the rations given to soldiers. Its ill effects were quite unknown. Taxes levied on the production and/or consumption of cigarettes was a major part of government revenues in the twentieth century. In Germany, it constituted more than 10% of total Government revenues in the 1930s. In China, even in the early 21st century it was around 10% (Ibid). II. Dangers of Tobacco Use Although the link between tobacco and cancer, especially of the mouth, was not unknown in the eighteenth and nineteenth centuries, it was the rise of lung cancer in the twentieth century (it was almost unknown earlier) that ultimately made it possible to establish the direct link between smoking and cancer (ibid). It is now known that tobacco use results in the highest number of deaths in humans among the killers that claim human lives. Tobacco-related mortality falls under lethal diseases that can be clearly prevented from occurring (http://globalhealth.stanford.edu/education/tobacco_global_nature.pdf). The World Health Organization has estimated that the average of more than 5 trillion cigarettes smoked yearly near the end of the last century would be a prime mover of 10 million casualties by the end of the third decade of the new millennium. There is one case of lung cancer for every three million cigarettes lit (Ibid). Tobacco use (smoke or smokeless) results in many types of cancers. The lion’s share of tobacco related cancer is taken by lung cancer. Tobacco consumption, smoked or chewed, is the primary cause of the worldwide lung cancer scourge (Ibid). Research has continued right through the 20th century to establish the use of tobacco as a major cause of cancer and other ailments like heart disease. Notwithstanding, the many efforts by tobacco companies to obfuscate this fact, there is now worldwide acceptance of this link. The good news is that from the 1980s, smoking in the developed countries has started to systematically decline. The response of the tobacco companies has therefore been to tap into the developing countries of Asia, Africa and South America. However, the world’s leading exporters of tobacco-based products continue to be in the US. According to the WHO, by 2030, tobacco use will cause 10 million deaths per year. In fact, tobacco use, after peaking in the 1990s has started to fall. However, deaths from tobacco use and onset of many heart diseases and types of cancers will continue to increase (Ibid) because of the time lag between the use of tobacco and the start of the disease. According to Robert Proctor (Ibid), about 25 % of such deaths will be from lung cancer and most of them will be from the developing countries. In another way of expressing this statistic, WHO calculates that over the next thirty years 100 million people will die from tobacco use and this number is more than the total combined number of deaths from AIDS, tuberculosis, murders, homicides and car accidents. If tobacco use rates do not decline from what they were at the end of the 20th century, the 21st century could see as many as 1 billion deaths from tobacco use. The key, of course, would be what happens in terms of anti-tobacco use strategies in India, China, Japan and the countries of the former Soviet Union. III. Incidence of Tobacco Use and Trends (a) Tobacco consumption declining in the developed countries The most encouraging trend worldwide, as pointed out earlier, is the fact that the developed countries, have registered significant and steady declines in the incidence of smoking especially over the last 40 years. For example, in the US, in 1965, 42% of adults smoked. In 2006, only 20.8% of adults smoked. In 2012, this number came down to 18% (http://en.wikipedia.org/wiki/List_of_countries_by_cigarette_consumption_per_capita). According to the Center for Disease Control, the number is now stagnating at around 18 % - 19 %, i.e. around one in five adults still smoke in the US (http://www.cancer.org/cancer/news/cdc-adult-smoking-rates-remain-steady). Year to year decreases are, however, inconsistent. About 43.8 million people still smoke in the US. However, among daily smokers, there is a trend towards smoking fewer cigarettes. The proportion of those who smoked more than 30 cigarettes per day decreased from 12.6% in 2005 to 9.1% in 2011. The proportion of those who smoked less than 10 cigarettes increased from 16.4% in 2005 to 22% in 2011 (CDC Ibid). There are also certain demographic and socioeconomic trends noticeable. With age, the extent of smoking goes down. In general, young adults are the most likely to smoke in all countries. Again, the positive trend for the US (and for most developed countries) is that the proportion of smokers aged 18 to 24 years has been decreasing. It decreased in the US from 24.4% in 2005 to 18.9% in 2011, the biggest decline in any age group. This age group had the highest smoking prevalence in 2005, and now has the lowest of any group younger than 65 (CDC: Ibid). There are, however, many regional differences within the country. We will examine this later with a special reference to New York City. In Australia, similarly in 2001, 22.4% of adults smoked. This number came down to 16.1% in 2011-2013. Similarly, unlike in the 17th and 18th century, smoking is less of a patrician pursuit today. Smoking is more common among the most disadvantaged communities. (b) Tobacco use rising in the developing countries As Wikipedia reports, in the developing countries tobacco consumption continues to rise at about 3% - 4% per annum. This is one of the biggest public health challenges today. According to the CDC (http://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/globalsmoking.html), smoking in the developing countries is rising by 4.4% every year. In its report on the Global Tobacco Epidemic 2011 (http://whqlibdoc.who.int/hq/2011/WHO_NMH_TFI_11.3_eng.pdf?ua=1), WHO estimated that of the 6 million people dying every year from ailments caused by tobacco use, most deaths would take place in low and middle-income countries. An article in the Guardian (http://www.theguardian.com/news/datablog/2012/mar/23/tobacco-industry-atlas-smoking), in 2012, reproduces a tobacco map (from the American Cancer Society and the World Lung Foundation), which reinforces this reporting that 80% of these 6 million deaths are now happening in the low and middle-income countries. Per Capita Consumption, Cigarettes Per Person Legend: 8 – 150: Dark Green: 151 – 502: Light Green 503 – 999: Light Blue 1000 – 2000: Dark Blue 2001 – 2865: Very Dark Blue A few selected country profiles are presented below (a detailed table is attached in Annex 1): India
 96 cigarettes consumed per person per year In 2004, 12% male deaths and 0.9% female were caused by tobacco In India, 26.2% of men and 3.6% of women were smoking any tobacco product in 2009. 13.4% of health professionals smoke and illicit tobacco is 10% of the whole market Children and smoking Youths Exposed to Secondhand Smoke in Home, Ages 13–15, - 26.6% Youths Who Have an Object With a Tobacco Logo on It –% Boys’ Current Cigarette Use, Ages 13–15, - 5.4% Girls’ Current Cigarette Use, Ages 13–15, - 1.6% China
 1711 cigarettes consumed per person per year In 2004, 12.1% of male deaths and 10.9% of female deaths were caused by tobacco In China, 51.2% of men and 2.2% of women were smoking any tobacco product in 2009. 11.9% of health professionals smoke and illicit tobacco is 7.6% of the whole market Children and smoking Youths Exposed to Secondhand Smoke in Home, Ages 13–15, - 47% Youths Who Have an Object With a Tobacco Logo on It, - 9.5% Boys’ Current Cigarette Use, Ages 13–15, - 2.7% Girls’ Current Cigarette Use, Ages 13–15, - 0.8% United States of America: 
 1028 cigarettes consumed per person per year In 2004, 22.9% male and 23.3% female deaths were caused by tobacco In United States of America, 32.8% of men and 24.7% of women were smoking any tobacco product in 2009. 3.3% of health professionals smoke and illicit tobacco is 6.4% of the whole market Children and smoking Youths Exposed to Secondhand Smoke in Home, Ages 13–15, - 12% Youths Who Have an Object With a Tobacco Logo on It, - 12.3% Boys’ Current Cigarette Use, Ages 13–15, 9.7% Girls’ Current Cigarette Use, Ages 13–15, - 7.9% Russian Federation
 2786 cigarettes consumed per person per year In 2004 - the latest data available shows that 28.2% of male deaths were caused by tobacco and 4.4% of female deaths were caused by tobacco In Russian Federation, 59.4% of men and 24.3% of women were smoking any tobacco product in 2009. 38.9% of health professionals smoke and illicit tobacco use is 0.5% of the whole market. Children and smoking Youths Exposed to Secondhand Smoke in Home, Ages 13–15, - 76.4% Youths Who Have an Object With a Tobacco Logo on It, - 14.7% Boys’ Current Cigarette Use, Ages 13–15, - 26.9% Girls’ Current Cigarette Use, Ages 13–15, - 23.9% Clearly, the Russian Federation has the highest per capita cigarette consumption. Of the remaining 3, China is the highest, followed by the US and India. When it comes to tobacco consumption, the following are the top tobacco producers in 2009: Top ten tobacco producers, 2009 China Brazil India United States... Malawi Indonesia Argentina Italy Pakistan Zimbabwe Therefore, China was the biggest tobacco producer in 2009 with Brazil and India following behind. Below are some of the findings of the report: • More than 43 trillion cigarettes have been smoked in the last ten years 
 • Tobacco use causes 1.2m deaths annually in China and is the number one killer of the country. The report findings state that this is expected to rise to 3.5m deaths annually by the year 2030
 • Tobacco use is responsible for the greatest proportion of male deaths in Turkey and Kazakhstan at 38% and 35% respectively
 • The greatest proportion of female deaths due to tobacco use were in the Maldives and the United States at 25% and 23% respectively. Today, 84% of smokers live in the developing countries (CDC: Ibid). The CDC report cites a Gates Foundation statistic that in Bangladesh the poorest households spend on tobacco10 times as much as they do on education. Professors Gary Giovino, Sara Mirza et al, writing in the Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961085-X/abstract?_eventId=login) analyze the Global Adult Tobacco Survey (2012) to show that in in 14 low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam), 48.6% of men and 11.3% of women were tobacco users. While 82% favored smoking manufactured cigarettes, in India and Bangladesh, smokeless tobacco and bidis were quite popular particularly among the poor. The figures also showed early initiation rates among women and overall low quit ratios (less than 20% overall) in China, India, Egypt, Russia and Bangladesh. Thus, we see that about nearly half of men in 14 developing countries are tobacco users and that women are starting to smoke at younger ages. Overall, researchers predict smoking will cause one billion deaths in the 21st century (http://scopeblog.stanford.edu/2012/08/22/smoking-rates-increasing-in-the-developing-world/). IV. What has been the Strategy Tool Box and What Has Worked So Far? The literature and the WHO list the following as the key strategies that every country and the global international community should put in place. These are listed as follows: 1. Putting in place surveillance mechanisms that monitor the tobacco epidemic and its incidence worldwide every year. The two main ones are: a. The Global Adult Tobacco Survey or GATS. The WHO defines this as, “The Global Adult Tobacco Survey (GATS) is a nationally representative household survey that was launched in February 2007 as a new component of the ongoing Global Tobacco Surveillance System (GTSS).” It enables countries to collect data on adult tobacco use and key tobacco control measures. Its results help countries in the formulation, tracking and implementation of effective tobacco control interventions, and compare results with results from other countries.
GATS has been implemented in more than 19 low- and middle-income countries with the tobacco use rates. The list includes India and within India, West Bengal (http://www.who.int/tobacco/surveillance/survey/gats/en/). b. WHO Annual Reports on the Global Tobacco Epidemic. WHO has started issuing them since 2010 and they present the status of anti- tobacco measures world wide also known as MPOWER (explained in the following paragraph) measures. 2. Evidence based and effective tobacco control policymaking and their implementation. This requires having a nationally owned tobacco control strategy whose main policy elements should comprise the following: a. Creating smoke free environments whose goal is protecting employees and the public from secondary smoke inhalation such as heart attacks. These are policies such as banning smoking in public spaces, something that US including New York City has done. These include making all restaurants, bars, parks, offices and other public places smoke free. These encourage people to quit, prevent initiation, and change social norms around tobacco use and exposure. b. Raising the cost of tobacco through taxes and non-tax policies (banning price discounts etc.). These pricing policies make tobacco less affordable and therefore reduce tobacco use and change social norms. c. Promoting and enforcing restrictions on the point of sale: These regulate youth access and seek to counter some $8 billion that the tobacco industry spends on promoting the use of tobacco. d. Restricting access by raising the legal age of smoking e. Media interventions: Banning tobacco advertisements and mandatory statutory warnings on tobacco products (http://cphss.wustl.edu/Products/Documents/CPHSS_TCLC_2014_PolicyStrategies1.pdf). 3. The WHO Framework Convention on Tobacco Control (WHO FTC) along with guidelines provides the member states to constitute the policy template for members to roll out. The term MPOWER is an acronym for the six different steps visualized in the WHO FTC and constitutes a ready reckoner: a. Monitor tobacco use and prevention policies; b. Protecting People from tobacco smoke; c. Offering help to quit tobacco use; d. Warning about the dangers of tobacco; e. Enforcing bans on tobacco advertising, promotion and sponsorships; and f. Raising tobacco taxes (http://www.who.int/tobacco/mpower/publications/mpower_2013.pdf). V. How are tobacco control measures working? Policies and strategies are as effective as their implementations are. The WHO’s report on the Global Tobacco Epidemic 2013, communicates the following headline messages: ➢ Tobacco Companies are still spending tens of billions of dollars on tobacco advertisements, promotions and sponsorships. ➢ One third of youth experimentation with tobacco occurs as a result of exposure to tobacco advertisements. ➢ Complete bans on tobacco advertisements, sponsorships and promotions definitely decrease tobacco use (24 countries have a ban). Partial bans have no or little effect as companies find ways of marketing. ➢ Globally, the population covered by at least one effective tobacco control measure (i.e. one of the MPOWER measures) has more than doubled: about 2.3 billion people are now covered by at least one measure. ➢ Millions of lives stand to be saved: We have the tools and we have the will. We must act together now. Tobacco use is the world’s leading cause of preventable death. Of all epidemics, perhaps, the tobacco epidemic, while, certainly one of the most pernicious and dangerous ones, is at the same time a fully preventable one. Yet, while smoking rates are declining in the developed world, the rate of decline is slow. Most developed countries, including the United States, are facing something of a “last mile” problem as the rates of decline slow down and stagnate. On the other hand, the pervasive influence of tobacco companies is aggravating the situation in the developing world (See Section III above). What is then the state of implementation of MPOWER? A report card by WHO shows a mixed bag. Currently, half of countries – and two in three in the developing world – do not have even minimal information about tobacco use. Even acknowledging that every person has a right to breathe air free of tobacco smoke and evidence from pioneering countries showing that smoke-free laws do not harm businesses and are popular with the public, only 5% of the global population is protected by comprehensive national smoke-free legislation, which enables the creation of smoke free public spaces. Similarly, despite evidence, three out of four smokers who are aware of the dangers of tobacco, want to quit, national comprehensive services such as counseling and education towards this end are available only in 9 countries, adding up to only 5% of the world population. It is well known that relatively few tobacco users fully grasp the health dangers and therefore hard-hitting anti-tobacco ads and graphic pack warnings do reduce the number of children who begin smoking and increase the number of smokers who quit. Pictures speak a thousand words and are therefore more powerful deterrents than words on tobacco packaging warnings. However, only 15 countries, representing 6% of the world’s population, have laws mandating pictorial warnings. Just five countries, with 4% of the world's population, meet the highest standards for cigarette packet warnings. Studies have found that advertising bans can significantly reduce tobacco consumption. However, only 5% of the world’s population currently lives in countries with comprehensive national bans on tobacco advertising, promotion and sponsorship. About half of the children of the world live in countries that do not ban the free distribution of tobacco products. Tobacco taxes are known as the most effective way to reduce tobacco use, especially among young people and the poor. Increasing tobacco taxes by 10% can decrease tobacco consumption by 4% in high-income countries and by about 8% in low- and middle-income countries. Tobacco tax increases also increase government revenues. Only four countries, representing 2% of the world's population have tax rates greater than 75% of the retail price. In countries with available information, tobacco tax revenues are more than 500 times higher than spending on tobacco control. In low-income and middle-income countries, tobacco tax revenues are more than 9000 and 4000 times higher than spending on tobacco control, respectively (WHO: Tobacco Free Initiative: http://www.who.int/tobacco/mpower/facts_findings/en/). VI. The Case for Research in Specific Locales in Developing Countries Clearly, the major burden of gaps in the implementation of policy measures as encapsulated under the acronym MPOWER lie with the developing countries where the prevalence is actually increasing with China, Brazil and India also emerging as the top three tobacco producers of the world (section III above). Tobacco companies are aggressively pursuing markets in the developing countries. By 2030, out of the anticipated 10 million deaths per year, 7 out of 10 deaths will be in the developing countries. (Guindon and Boisclair: Past, Current and Future Trends in Tobacco Use, 2003), WHO Tobacco Control Papers: https://escholarship.org/uc/item/4q57d5vp eScholarship University of California). Research in developed countries shows that the raising of taxes and increasing the prices of tobacco is the most effective way of curbing tobacco use in particular among young people. Youth demand for cigarettes is highly price elastic (World Bank Study cited in Guindon et al Ibid). Yet, developing countries hesitate to implement such measures. Most of the research and evidence base in support of anti-tobacco measures are from developed countries, although, the battleground has shifted to the low-income and middle-income countries. This probably is a reason for sub optimal implementation of anti-tobacco measures in the developing countries. They, therefore, contend that there is a great need for country specific research to provide a firm basis for evidence-based policy making in the developing countries. WHO and the World Bank have already initiated this. WHO has through research in a number of countries demonstrated how reduced tobacco directly impacts on cardio vascular and respiratory diseases and of course on cancer. Their research has shown that the policy package comprising higher tobacco prices through taxation, bans on advertising, and information campaigns through counter advertisements using disturbing pictorial messages is quite affordable while being effective too in most countries. World Bank studies have also confirmed that both price (taxes) and non-price (advertisements bans, information campaigns, smoking restrictions etc.) measures are as effective in developing countries as elsewhere. Yet, many governments continue to go slow because of fears that this might impose an economic cost. As a case in point, India, the third largest producer of tobacco in the world merits a special look and within that, West Bengal, a major tobacco producer and consumer is the special focus of this paper. VII The Situation of West Bengal, India According to the Directorate of Tobacco Development, Ministry of Agriculture, Government of India on an all India basis, the tobacco crop provides employment to over 4.4 million people while the bidi industry provides employment of 6 million unskilled, often, informal sector, home-based workers (http://dtd.dacnet.nic.in/handbook/intro.htm). In India, only 25% of tobacco users smoke cigarettes. The rest smoke hand rolled tobacco called bidi and various kinds of chewed and snuffed tobacco. ( http://npcs.in/profiles/profiles/tobacco-pan-masala-khaini-gutkha-supari-zarda-mouth-freshener-kimam-cigarettes/z,,5c,0,a/index.html). Very recent survey shows about 6 million farmer and 20 million farm labor being engaged in tobacco farming spread over 15 states. Bidi rolling provides employment to 6 million people in addition to 2.2 million tribal people involved in tendu leaf collection. Nearly 4 million people are engaged in the trade and related activities. The main beneficiaries are the small and marginal farmers, rural women and tribal youth (http://www.cghr.org/wordpress/wp-content/uploads/Jha-Estimates-of-the-economic-contributions-of-the-bidi-manufacturing-industry-in-India.pdf). The state of West Bengal is a producer of tobacco crop as well as a major producer of cigarettes, bidi, gutka and other tobacco products. In fact, ITC, the major conglomerate, 56% of whose revenue comes from cigarettes has its headquarters and key production facilities in this state. At the national level, bidi contributes 0.1% of India’s GDP and West Bengal is also the highest producer of bidis in India. A Global Adult Tobacco Survey (GATS) was conducted in West Bengal in 2009-2010 by the International Institute of Population Sciences, coordinated by the Government of India (the International Institute for Population Sciences (IIPS), under the coordination of the Ministry of Health and Family Welfare, Government of India (http://www.cancerfoundationofindia.org/activities/tobacco-control/advocacy/pdf/GATS%202010%20West%20Bengal%20data.pdf ). The key highlights of the findings of this survey are as follows: ➢ 36% of adults (52% males and 19% females) consume tobacco in some form or the other. ➢ Average age of initiation into tobacco use: 18.5 years (19 years for females). ➢ 55.7% of tobacco users consumer tobacco in some form within half an hour of waking up. ➢ 62.4% of adults were exposed to secondary smoke at home. ➢ 29.8% of adults were exposed to secondary smoke in public places. ➢ Adults who noticed any advertisement or promotion: 28.6% for cigarettes; 31.1% for bidis; 36.2% for smokeless tobacco. ➢ Current users who thought of quitting after seeing warning labels: 25.2% for cigarettes; 24.7% for bidis and 17% for smokeless tobacco. ➢ Adults, who saw counter anti-tobacco information on radio or television: 40.7 % (men: 38.7%, women 43.3%). The situation is clearly quite serious. Rates of tobacco use are very high: half of all males and one fifth of women! The age of initiation is quite low. Exposure to secondary smoke at home is too high. Further, almost a third are exposed to smoking in public spaces. There is therefore a huge missed opportunity for government to check this and protect non-smokers. Tobacco promotion advertisements seem quite ubiquitous. This is despite India being a signatory of the WHO Framework Convention on Tobacco Control, which introduced the MPOWER package, which includes interventions to address all these aspects. VIII: Broad Research Needs for low-income and middle-income countries The experiences of the WHO in assisting Member States in the implementation of the provisions of the WHO Framework Convention on Tobacco Control has uncovered a series of research needs and priorities (http://www.world-heart-federation.org/fileadmin/user_upload/documents/Advocacy/Resources/Meetings_-_Activities_and_Partnerships/Research%20priorties%20in%20tobacco%20control_01.pdf ). The following four topics have been identified as the highest priorities for advancing tobacco control in low-income and middle-income countries: 1. Impact of tobacco taxation on tobacco use. 2. Economic impact of tobacco use and tobacco control. 3. Effectiveness of demand reduction interventions. 4. Social determinants of tobacco use. Additionally, the following are also important research areas for poor and low-income countries: 5. Links between poverty and tobacco use 6. What works in communication, education and training 7. Economically viable alternatives to tobacco IX. The Current Research Proposal This proposal is to move beyond a broad descriptive research and instead conduct an action research in selected urban and rural communities of West Bengal. Action Research is defined as “ a disciplined process of inquiry conducted by and for those taking the action. The primary reason for engaging in action research is to assist the “actor” in improving and/or refining his or her actions.” (http://www.ascd.org/publications/books/100047/chapters/What-Is-Action-Research.aspx) The Association of Society & Science and Harlem Children’s Society has the advantage of being involved in community based initiatives to promote attitude changes particularly towards scientific education and creating a scientific temper amongst disadvantaged communities in the districts of 24 Parganas, Bankura and Midnapore for the last 5 years. The Harlem Children’s Society in its part has been at the forefront of efforts to promote STEM (Science, Technology, Engineering and Mathematics) Education in the United States, Kenya, Tanzania, and Punjab etc. for several years. Its work in the US started 14 year’s ago under the leadership of its visionary founder and CEO, Dr. Sat Bhattacharya, a Molecular Geneticist, Doctor and Scientist at the Memorial Sloan Kettering Cancer Center, New York. Dr. Bhattacharya, a Bengali by origin, is well known in the US and other countries as a dedicated and visionary leader who has relentlessly pursued the goal of inculcating a scientific temper and education amongst children and young adults as part of his life’s mission of “Vasudhaiva Kutumbakam”. The research will be unique in the following respect: 1. It will not be a descriptive research but will be an action research, which will try out small scale interventions and test results. 2. It will be carried out by young staff and student interns and volunteers of the society and will seek to involve school students and teachers. 3. It will derive the interventions from the MPOWER framework and apply them to smaller scales. The research is proposed to be carried out in a state (West Bengal) which has the distinction of raising tax on tobacco in two budget years in quick succession: 2011 and 2013 (http://articles.economictimes.indiatimes.com/2011-08-29/news/29941217_1_tax-rates-tobacco-tax-administration and http://articles.economictimes.indiatimes.com/2013-03-11/news/37623626_1_cigarette-prices-cigarette-industry-price-hike). In a state, where tobacco production has such a large economic foot print, this is not an easy political decision. It is important to see how this is impacting communities to reduce the tobacco epidemic. The Action research will be trying out different policy initiatives in the selected communities. These will include: • Creating smoke free public spaces. • Preventing the sale of tobacco and tobacco products to persons below 18 from local shops that sell tobacco products. • Preventing the sale of tobacco and tobacco products near educational institutions in the localities • Graphic pictorial counter advertisements and bill boards. The purpose will be to generate evidence that when combined with the raising of tobacco taxes, in which West Bengal is today a leader in the country, can make a very significant difference in tobacco prevalence and use. It is expected with such evidence, the revenues generated from higher tobacco taxes will be used to create other non-price policy initiatives, which can have a transformative effect in terms of reducing tobacco use. The action research will, therefore, in essence respond to the five key provisions of India’s anti Tobacco Law tilted “ Cigarettes and other Tobacco Products Prohibition (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution Act (COTPA), 2003” (http://pib.nic.in/newsite/PrintRelease.aspx?relid=86676). These provisions relate to: 1. Prohibition of smoking in public places 2. Prohibition of direct and indirect advertisements 3. Prohibition of sale of cigarettes and other tobacco products to persons below the age of 18 4. Prohibition of sale of tobacco products near education institutions 5. Statutory display of warning labels, including pictorial displays on tobacco packs The action research will, in effect, implement the provisions of law in a microcosm as it were and demonstrate the effectiveness of such measures. This Act along with its Rules came into effect in 2011 and financial resources were also made available to state governments to combat the problem. X: The Research Hypothesis: The hypotheses that the action research will seek to validate is that, as in the case of developed societies, the non price initiatives viz., combination of banning of advertisements, aggressive anti-tobacco campaigns, checking sales to under 18 youth, smoke-free zones to uphold people’s right to smoke free environments are both (a) feasible and (b) cost effective and (c) in tandem with the Government of West Bengal’s aggressive and bold tobacco tax hikes and can result in significant reduction in smoking and tobacco use prevalence. This, therefore, can constitute a good practice for the rest of India to emulate. The Action Research will also, as by-products, generate lessons on precautions and pitfalls that need to be guarded against in rolling out such initiatives in the state as a whole. XI. Research Methodology A total of three sites will be selected for the research. One in Salt Lake City, one in Jhargram and one in South 24 Parganas. The Action Research will involve the following steps: 1. An initial door to door survey to ascertain tobacco use prevalence both in the selected sample population (experimental group) and in a control group which will comprise a population of similar size and characteristics 2. A set of interventions that involve trying out the following interventions: a. Enforcing the ban on advertisements in respective sample communities b. Ensuring tobacco is not sold to below 18 year olds from the local “paan” and grocery shops c. Ensuring tobacco is not sold at shops near educational institutions d. Working with the local body: municipality or gram panchayat to ensure to establish certain smoke free public areas e. Putting up anti-tobacco hoardings and advertisements with pictorial representations f. Door to door periodic campaigns distributing material to discourage smoking 3. An end of “action research” prevalence survey going back to the same community 4. The action research will be carried out for a whole year The coverage in Salt Lake (Bidhannagar) will be that of a municipal ward and in each of the other locations a gram panchayat electoral constituency. For a gram panchayat this will mean covering adult population of about 1,000. The research will have to be carried out in very close consultation with the concerned local body: the gram panchayat or the municipality as the case may be. This is because only the local government has the authority and capacity to enforce and implement all the actions as listed above under 2 a, b, c, d, and e. The arrangement will be that, under the directions of the state government, the three selected local bodies will carry out these actions in the selected sample populations, which will act as the experimental group. It is proposed that the costs of the interventions in the experimental sample will be borne by the local body directly from its own budget (with assistance from the state government as needed). XIII. Research Budget The budget included in this proposal does not include the intervention costs as it is expected that the local body will fund it out of its own budget (with or without the assistance of the state government as needed). The budget only includes the estimated costs of the Association of Society & Science to carry out the door-to-door before and after prevalence surveys, the campaigns, working with the local bodies to roll out the initiatives, the analysis etc. Budget items Amount Research project leader (1) Rs. 40.000x12 months: 480,000 Deputy Research Leaders (3:one for each site) Rs. 30,000x3x12 months: 1,080,000 Research Analysts (6) Rs. 20,000x6x12 months: 1,440,000 Enumerators/surveyors (lump sum) Rs. 200,000 Rent of project offices with utilities 10,000 x 12=120,000 Cost of stationary 50,000 Cost of transportation 50,000 Cost of laptop/handled computers 2,00,000 Total 3,620,000 XIV: The Research Team

Research Proposal on Tobacco - NYC

A Research Proposal: Countering the Use of Tobacco What Has Worked and What Hasn't: The Case of New York City: The Last Mile Problem: What Strategies to Focus On I. The Construct of Study: Tobacco Use: How to Counter it? Oscar Wilde wrote in the 19th century, “You must have a cigarette. A cigarette is the perfect type of a perfect pleasure. It is exquisite, and it leaves one unsatisfied. What more can one want?” That was then. Smoking was considered a patrician luxury. Fast forward to 2013. Smoking and tobacco use are dreaded public health threats. What brought about the change in global attitude towards tobacco use and what is the reason for continued inability to fully grasp the danger in some parts of the world? How serious are the challenges in the developing world and the developed world and what needs to be done to seriously eliminate the global epidemic of tobacco use? The origins of the tobacco can be traced to the Mayans in the Americas from where (following the discovery of America by Columbus), it was exported to Europe and beyond. There is evidence that tobacco was in use in the seventeenth and eighteenth centuries, albeit sporadic (http://globalhealth.stanford.edu/education/tobacco_global_nature.pdf). However, the manner of its use has been varied over the years. It has been, smoked, chewed and snuffed. Cigarette smoking became popular only in the nineteenth century. With the growth of technology, cigarette production significantly increased towards the end of the nineteenth century. Cigarette smoking became very fashionable soon and spread fast, spurred on by aggressive marketing. In the First World War, this was even one of the items in the rations given to soldiers. Its ill effects were quite unknown. Taxes levied on the production and/or consumption of cigarettes was a major part of government revenues in the twentieth century. In Germany, it constituted more than 10% of total Government revenues in the 1930s. In China, even in the early 21st century it was around 10% (Ibid). II. Dangers of Tobacco Use Although the link between tobacco and cancer, especially of the mouth, was not unknown in the eighteenth and nineteenth centuries, it was the rise of lung cancer in the twentieth century (it was almost unknown earlier) that ultimately made it possible to establish the direct link between smoking and cancer (ibid). It is now known that tobacco use results in the highest number of deaths in humans among the killers that claim human lives. Tobacco-related mortality falls under lethal diseases that can be clearly prevented from occurring (http://globalhealth.stanford.edu/education/tobacco_global_nature.pdf). The World Health Organization has estimated that the average of more than 5 trillion cigarettes smoked yearly near the end of the last century would be a prime mover of 10 million casualties by the end of the third decade of the new millennium. There is one case of lung cancer for every three million cigarettes lit (Ibid). Tobacco use (smoke or smokeless) results in many types of cancers. The lion’s share of tobacco related cancer is taken by lung cancer. Tobacco consumption, smoked or chewed, is the primary cause of the worldwide lung cancer scourge (Ibid). Research has continued right through the 20th century to establish the use of tobacco as a major cause of cancer and other ailments like heart disease. Notwithstanding, the many efforts by tobacco companies to obfuscate this fact, there is now worldwide acceptance of this link. The good news is that from the 1980s, smoking in the developed countries has started to systematically decline. The response of the tobacco companies has therefore been to tap into the developing countries of Asia, Africa and South America. However, the world’s leading exporters of tobacco-based products continue to be in the US. According to the WHO, by 2030, tobacco use will cause 10 million deaths per year. In fact, tobacco use, after peaking in the 1990s has started to fall. However, deaths from tobacco use and onset of many heart diseases and types of cancers will continue to increase (Ibid) because of the time lag between the use of tobacco and the start of the disease. According to Robert Proctor (Ibid), about 25 % of such deaths will be from lung cancer and most of them will be from the developing countries. In another way of expressing this statistic, WHO calculates that over the next thirty years 100 million people will die from tobacco use and this number is more than the total combined number of deaths from AIDS, tuberculosis, murders, homicides and car accidents. If tobacco use rates do not decline from what they were at the end of the 20th century, the 21st century could see as many as 1 billion deaths from tobacco use. The key of course would be what happens in terms of anti-tobacco use strategies in India, China, Japan and the countries of the former Soviet Union. III. Incidence of Tobacco Use and Trends (a) Tobacco consumption declining in the developed countries The most encouraging trend worldwide as pointed out earlier, is the fact that the developed countries, have registered significant and steady declines in the incidence of smoking especially over the last 40 years. For example, in the US, in 1965, 42% of adults smoked. In 2006, only 20.8% of adults smoked. In 2012, this number came down to 18% (http://en.wikipedia.org/wiki/List_of_countries_by_cigarette_consumption_per_capita). According to the Center for Disease Control, the number is now stagnating at around 18 % - 19 %, i.e. around one in five adults still smoke in the US. (http://www.cancer.org/cancer/news/cdc-adult-smoking-rates-remain-steady). Year to year decreases are however inconsistent. About 43.8 million people still smoke in the US. However, among daily smokers, there is a trend towards smoking fewer cigarettes. The proportion of those who smoked more than 30 cigarettes per day decreased from 12.6% in 2005 to 9.1% in 2011. The proportion of those who smoked less than 10 cigarettes increased from 16.4% in 2005 to 22% in 2011 (CDC Ibid). There are also certain demographic and socioeconomic trends noticeable. With age, the extent of smoking goes down. In general, young adults are the most likely to smoke in all countries. Again, the positive trend for the US (and for most developed countries) is that the proportion of smokers aged 18 to 24 years has been decreasing. It decreased in the US from 24.4% in 2005 to 18.9% in 2011, the biggest decline in any age group. This age group had the highest smoking prevalence in 2005, and now has the lowest of any group younger than 65 (CDC: Ibid). There are, however, many regional differences within the country. We will examine this later with a special reference to New York City. In Australia, similarly in 2001, 22.4% of adults smoked. This number came down to 16.1% in 2011-2013. Similarly, unlike in the 17th and 18th century, smoking is less of a patrician pursuit today. Smoking is more common among the most disadvantaged communities. (b) Tobacco use rising in the developing countries As Wikipedia reports, in developing countries tobacco consumption continues to rise at about 3% - 4% per annum. This is one of the biggest public health challenges today. According to the CDC (http://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/globalsmoking.html), smoking in the developing countries is rising by 4.4% every year. In its report on the Global Tobacco Epidemic 2011 (http://whqlibdoc.who.int/hq/2011/WHO_NMH_TFI_11.3_eng.pdf?ua=1), WHO estimated that of the 6 million people dying every year from ailments caused by tobacco use, most deaths will take place in low and middle income countries. An article in the Guardian (http://www.theguardian.com/news/datablog/2012/mar/23/tobacco-industry-atlas-smoking), in 2012, reproduces a tobacco map (from the American Cancer Society and the World Lung Foundation), which reinforces this reporting that 80% of these 6 million deaths are now happening in the low-income and middle-income countries. Per Capita Consumption, Cigarettes Per Person Legend: 8 – 150: Dark Green: 151 – 502: Light Green 503 – 999: Light Blue 1000 – 2000: Dark Blue 2001 – 2865: Very Dark Blue A few selected country profiles are presented below (a detailed table is attached in Annex 1): India
 96 cigarettes consumed per person per year In 2004, 12% male deaths and 0.9% female were caused by tobacco In India, 26.2% of men and 3.6% of women were smoking any tobacco product in 2009. 13.4% of health professionals smoke and illicit tobacco is 10% of the whole market Children and smoking Youths Exposed to Secondhand Smoke in Home, Ages 13–15, - 26.6% Youths Who Have an Object With a Tobacco Logo on It –% Boys’ Current Cigarette Use, Ages 13–15, - 5.4% Girls’ Current Cigarette Use, Ages 13–15, - 1.6% China
 1711 cigarettes consumed per person per year In 2004, 12.1% of male deaths and 10.9% of female deaths were caused by tobacco In China, 51.2% of men and 2.2% of women were smoking any tobacco product in 2009. 11.9% of health professionals smoke and illicit tobacco is 7.6% of the whole market Children and smoking Youths Exposed to Secondhand Smoke in Home, Ages 13–15, - 47% Youths Who Have an Object With a Tobacco Logo on It, - 9.5% Boys’ Current Cigarette Use, Ages 13–15, - 2.7% Girls’ Current Cigarette Use, Ages 13–15, - 0.8% United States of America: 
 1028 cigarettes consumed per person per year In 2004, 22.9% male and 23.3% female deaths were caused by tobacco In United States of America, 32.8% of men and 24.7% of women were smoking any tobacco product in 2009. 3.3% of health professionals smoke and illicit tobacco is 6.4% of the whole market Children and smoking Youths Exposed to Secondhand Smoke in Home, Ages 13–15, - 12% Youths Who Have an Object With a Tobacco Logo on It, - 12.3% Boys’ Current Cigarette Use, Ages 13–15, 9.7% Girls’ Current Cigarette Use, Ages 13–15, - 7.9% Russian Federation
 2786 cigarettes consumed per person per year In 2004 - the latest data available shows that 28.2% of male deaths were caused by tobacco and 4.4% of female deaths were caused by tobacco In Russian Federation, 59.4% of men and 24.3% of women were smoking any tobacco product in 2009. 38.9% of health professionals smoke and illicit tobacco use is 0.5% of the whole market. Children and smoking Youths Exposed to Secondhand Smoke in Home, Ages 13–15, - 76.4% Youths Who Have an Object With a Tobacco Logo on It, - 14.7% Boys’ Current Cigarette Use, Ages 13–15, - 26.9% Girls’ Current Cigarette Use, Ages 13–15, - 23.9% Clearly, the Russian Federation has the highest per capita cigarette consumption. Of the remaining 3, China is the highest, followed by the US and India. When it comes to tobacco consumption, the following are the top tobacco producers in 2009: Top ten tobacco producers, 2009 China Brazil India United States... Malawi Indonesia Argentina Italy Pakistan Zimbabwe Therefore, China was the biggest tobacco producer in 2009 with Brazil and India following behind. Below are some of the findings of the report: • More than 43 trillion cigarettes have been smoked in the last ten years 
 • Tobacco use causes 1.2m deaths annually in China and is the number one killer of the country. The report findings state that this is expected to rise to 3.5m deaths annually by the year 2030
 • Tobacco use is responsible for the greatest proportion of male deaths in Turkey and Kazakhstan at 38% and 35% respectively
 • The greatest proportion of female deaths due to tobacco use were in the Maldives and the United States at 25% and 23% respectively. Today, 84% of smokers live in the developing countries (CDC: Ibid). The CDC report cites a Gates Foundation statistic that in Bangladesh the poorest households spend on tobacco10 times as much as they do on education. Professors Gary Giovino, Sara Mirza et al, writing in the Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961085-X/abstract?_eventId=login) analyze the Global Adult Tobacco Survey (2012) to show that in in 14 low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam) 48.6% of men and 11.3% of women were tobacco users. While 82% favored smoking manufactured cigarettes, in India and Bangladesh, smokeless tobacco and bidis were quite popular particularly among the poor. The figures also showed early initiation rates among women and overall low quit ratios (less than 20% overall) in China, India, Egypt, Russia and Bangladesh. Thus, we see that about nearly half of men in 14 developing countries are tobacco users and that women are starting to smoke at younger ages. Overall, researchers predict smoking will cause one billion deaths in the 21st century (http://scopeblog.stanford.edu/2012/08/22/smoking-rates-increasing-in-the-developing-world/). IV. What has been the Strategy Tool Box and What Has Worked So Far? The literature and the WHO list the following as the key strategies that every country and the global international community should put in place. These are listed as follows: 1. Putting in place surveillance mechanisms that monitor the tobacco epidemic and its incidence worldwide every year. The two main ones are: a. The Global Adult Tobacco Survey or GATS. The WHO defines this as, “The Global Adult Tobacco Survey (GATS) is a nationally representative household survey that was launched in February 2007 as a new component of the ongoing Global Tobacco Surveillance System (GTSS).” It enables countries to collect data on adult tobacco use and key tobacco control measures. Its results help countries in the formulation, tracking and implementation of effective tobacco control interventions, and compare results with results from other countries.
GATS has been implemented in more than 19 low- and middle-income countries with the tobacco use rates. The list includes India and within India, West Bengal. (http://www.who.int/tobacco/surveillance/survey/gats/en/) b. WHO Annual Reports on the Global Tobacco Epidemic. WHO has started issuing them since 2010 and they present the status of anti- tobacco measures world wide also known as MPOWER (explained in the following paragraph) measures. 2. Evidence based and effective tobacco control policymaking and their implementation. This requires having a nationally owned tobacco control strategy whose main policy elements should comprise the following: a. Creating smoke free environments whose goal is protecting employees and the public from secondary smoke inhalation such as heart attacks. These policies such as banning smoking in public spaces, something that US including New York City has done. These include making all restaurants, bars, parks, offices and other public places smoke free. These encourage people to quit, prevent initiation, and change social norms around tobacco use and exposure. b. Raising the cost of tobacco through taxes and non-tax policies (banning price discounts etc.). These pricing policies make tobacco less affordable and therefore reduce tobacco use and change social norms. c. Promoting and enforcing restrictions on the point of sale: These regulate youth access and seeks to counter some $8 billion that the tobacco industry spends on promoting the use of tobacco. d. Restricting access by raising the legal age of smoking e. Media interventions: Banning tobacco advertisements and mandatory statutory warnings (http://cphss.wustl.edu/Products/Documents/CPHSS_TCLC_2014_PolicyStrategies1.pdf). 3. The WHO Framework Convention on Tobacco Control (WHO FTC) along with guidelines provides the member states to constitute the policy template for members to roll out. The term MPOWER is an acronym for the six different steps visualized in the WHO FTC and constitutes a ready reckoner: a. Monitor tobacco use and prevention policies; b. Protecting People from tobacco smoke; c. Offering help to quit tobacco use; d. Warning about the dangers of tobacco; e. Enforcing bans on tobacco advertising, promotion and sponsorships; and f. Raising tobacco taxes (http://www.who.int/tobacco/mpower/publications/mpower_2013.pdf). V. How are tobacco control measures working? Policies and strategies are as effective as their implementations are. The WHO’s report on the Global Tobacco Epidemic 2013, communicates the following headline messages: ➢ Tobacco Companies are still spending tens of billions of dollars on tobacco advertisements, promotions and sponsorships. ➢ One third of youth experimentation with tobacco occurs as a result of exposure to tobacco advertisements. ➢ Complete bans on tobacco advertisements, sponsorships and promotions definitely decrease tobacco use (24 countries have a ban). Partial bans have no or little effect as companies find ways of marketing. ➢ Globally, the population covered by at least one effective tobacco control measure (i.e. one of the MPOWER measures) has more than doubled: about 2.3 billion people are now covered by at least one measure. ➢ Millions of lives stand to be saved: We have the tools and we have the will. We must act together now. Tobacco use is the world’s leading cause of preventable death. Of all epidemics, perhaps, the tobacco epidemic, while, certainly one of the most pernicious and dangerous ones, is at the same time a fully preventable one. Yet, while smoking rates are declining in the developed world, the rate of decline is slow. Most developed countries, including the United States, are facing something of a “last mile” problem as the rates of decline slow down and stagnate. On the other hand, the pervasive influence of tobacco companies is aggravating the situation in the developing world (See Section III above). What is then the state of implementation of MPOWER? A report card by WHO shows a mixed bag. Currently, half of countries – and two in three in the developing world – do not have even minimal information about tobacco use. Even acknowledging that every person has a right to breathe air free of tobacco smoke and evidence from pioneering countries showing that smoke-free laws do not harm businesses and are popular with the public, only 5% of the global population is protected by comprehensive national smoke-free legislation, which enables the creation of smoke free public spaces. Similarly, despite evidence, three out of four smokers who are aware of the dangers of tobacco, want to quit, national comprehensive services such as counseling and education towards this end are available only in 9 countries, adding up to only 5% of the world population. It is well known that relatively few tobacco users fully grasp the health dangers and therefore hard-hitting anti-tobacco ads and graphic pack warnings do reduce the number of children who begin smoking and increase the number of smokers who quit. Pictures speak a thousand words and are therefore more powerful deterrents than words on tobacco packaging warnings. However, only 15 countries, representing 6% of the world’s population, have laws mandating pictorial warnings. Just five countries, with 4% of the world's population, meet the highest standards for cigarette packet warnings. Studies have found that advertising bans can significantly reduce tobacco consumption. However, only 5% of the world’s population currently lives in countries with comprehensive national bans on tobacco advertising, promotion and sponsorship. About half of the children of the world live in countries that do not ban the free distribution of tobacco products. Tobacco taxes are known as the most effective way to reduce tobacco use, especially among young people and the poor. Increasing tobacco taxes by 10% can decrease tobacco consumption by 4% in high-income countries and by about 8% in low- and middle-income countries. Tobacco tax increases also increase government revenues. Only four countries, representing 2% of the world's population have tax rates greater than 75% of the retail price. In countries with available information, tobacco tax revenues are more than 500 times higher than spending on tobacco control. In low-income and middle-income countries, tobacco tax revenues are more than 9000 and 4000 times higher than spending on tobacco control, respectively. (WHO: Tobacco Free Initiative: http://www.who.int/tobacco/mpower/facts_findings/en/). VI: A Global Report Card: There are more than a billion adults (estimated 1.25 billion people) globally who smoke tobacco and one fifth of adolescents in schools who have succumbed to the charms of tobacco (http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-13-international-comparisons-of-prevalence-of-sm). A cross-country global comparison of smoking among grown-ups reveals that smoking rates in that cohort has drastically reduced in USA, Canada, Western Europe, Northern Europe, Australia and New Zealand while the opposite holds true for Asia, Africa and South America (Ibid). The human toll from tobacco consumption, in all its forms, will predictably show a marked shift from the rich countries to the middle and poor countries (Ibid). Four-fifths of global tobacco smokers are in developing and least developed countries. 70% of tobacco-induced deaths are forecasted to be in these countries. The predatory promotion and marketing tactics of tobacco companies in these countries, which also have weak laws, policies and enforcement on the tobacco front, is well known for its notoriety (Ibid). According to Lopez A, Collishaw N and Piha T. (“A descriptive model of the cigarette epidemic in developed countries. Tobacco Control 1994;3:242–7”: http://tobaccocontrol.bmj.com/cgi/reprint/3/3/242.pdf) cited in ibid, tobacco use generally progresses in four stages. In the 1st stage of low prevalence, less than 20% of the population engages in low amount of smoking. In this stage, smoking is a leisure that is exclusively enjoyed by men. Tobacco is not a major cause of health concern for countries in this initial phase (Ibid). Some countries may even encourage and promote tobacco growth and consumption, as it is beneficial for their incipient, agrarian economies to do so. (Ibid). The country fitting into this mold is Zimbabwe (Ibid). Zimbabwe is among the largest producers of tobacco in the world and is a major exporter; concerns about the health consequences of tobacco use are not high on the national agenda. The next stage, or 2nd stage, is when half of the population of males in countries has started to consume tobacco. Tobacco smoking is abundant and the age for the first contact with tobacco is declining. Smoking has become fashionable even among females and is steadily increasing (Ibid). Studies have corroborated a causal relationship between tobacco use and chronic diseases like lung cancer (Ibid). Notwithstanding such research, there is scarce propagation of knowledge of these acute ailments and insignificant steps taken by the government to combat the problem. Japan, China, South-East Asia, Latin America and North Africa fit into this second stage (Ibid). In the 3rd stage, smoking tobacco has reached its peak in humans (males and females) and is already in decline (Ibid). Nevertheless, tobacco related morbidities and mortalities continue to accelerate due to a considerable time lag between the use of tobacco and its pernicious effects. Health-related programs for the benefit of society are in full flow in countries and the educated classes, men and women, frown upon the use of tobacco (Ibid). Anti-tobacco policies are enacted. The countries in this third stage comprise those of East and South Europe (Ibid). In the 4th stage smoking of tobacco sees the maximum drop or reduction in both sexes (Ibid). Deaths due to smoking decrease in men while they increase in women as women were later to take up smoking (Ibid). There are well-equipped health programs to tackle the tobacco menace and continuous monitoring is needed to overwhelm the small, but stubborn, last obstacle (Ibid). USA, Canada, Northern Europe, Western Europe, Australia and New Zealand fall in this last stage (Ibid). Figure 1.13.1 
Four stages of the tobacco epidemic Source: Lopez et al. Table 1.13.1 
Prevalence of tobacco use among adults in selected other countries—males and females, age-standardized† Country Males % Females % Albania 41 4 Bangladesh 47 4 Cambodia 41 7 Chile 42 34 China 59 4 Cook Islands 36 20 Ethiopia 8 <1 Fiji 24 5 Gambia 29 3 India 33 4 Indonesia 66 5 Islamic Republic of Iran 30 6 Israel 31 18 Jordan 63 10 Kazakhstan 43 10 Kenya 27 2 Malaysia 54 3 Mauritius 36 1 Myanmar 47 14 Namibia 39 11 Nigeria 13 1 Papua New Guinea (crude rates) 46 28 Philippines 42 10 Russian Federation 70 27 Samoa 58 23 Singapore 26 5 South Africa 28 9 Sri Lanka 30 3 Thailand 40 3 Ukraine 64 23 United Arab Emirates 17 3 Tanzania 25 4 Vanuatu 49 8 Vietnam 46 3 Zimbabwe 26 4 * Year of study reported, and definition of 'adult' and 'smoker' varies between countries. For further information, refer to primary sources cited by The Tobacco Atlas, which provides prevalence for over 190 countries. † Percentages are rounded Source: The Tobacco Atlas (Third Edition).1 VII The Prevalence in New York City According to the New York City Department of Health and Mental Hygiene the adult smoking prevalence rate in New York City has declined faster than the national rate since 2003. From 2002 to 2010, the adult prevalence rate in New York City declined from 22% to 14%: a 35% decline. During the same period the national prevalence rate declined from 22% to 19%: a 13% decline only. As on 2011, NYC had 850,000 adult smokers, i.e. 450,000 fewer smokers than in 2002. (http://www.nyc.gov/html/doh/downloads/pdf/epi/databrief12.pdf) However, even at this level, smoking related causes still kill about 7000 New Yorkers aged 35 and above every year. The Department of Health and Mental Hygiene estimates that a third of New York City smokers will die of smoking related causes. A disaggregated view of the situation shows that smoking prevalence varies inversely with the level of education. Thus in New York City, those with high school education or less the prevalence is 17% while those with at least some college education, the rate is 12%. In terms of boroughs, the greatest decline in smoking has been registered in Staten Island (50%) followed by Bronx: 36% decline, Brooklyn: 29% decline, Manhattan: 39% decline and Queens: 32% decline. Further, smoking rate declines were higher among young adults in the age group of 18-24 than among older people: (43%) compared with older adults (ages 25- 44: 35% decline, ages 45-64: 34% decline, ages 65 and older: 24% decline. This is very significant. As a New York Times report of 2011 (http://www.nytimes.com/2011/09/16/nyregion/survey-finds-14-percent-of-new-yorkers-smoke-a-decline.html?_r=0) highlighted, “a new generation was not picking up the habit, and might avoid the heavy toll of lung cancer, heart disease and other health problems linked to smoking.” Further the report went on to highlight, “the rate also dropped among public high school students, to a startlingly low 7 percent in 2010, from about 18 percent at the beginning of the decade.” VIII Implementation of Anti Tobacco Measures in NYC: What led to the Decline: The following graph answers this question well. The sharp declines from 2002 coincided well with a number of clear tobacco control measures being put in place: 1. In 2002 a major state and city wide increase in tobacco tax 2. In 2003, a ban on smoking at work places, bars and restaurants 3. In free patch programmes 4. Media campaigns through 2006-2007 5. In 2008-09 state and federal tax increases In May 2011, too late to be reflected in this survey, the city also banned smoking in public parks and beeches to protect people from second hand smoking. Tax increases are also a major factor. In 2010, city, state and federal cigarette taxes amounted to $6.86 a pack, compared with $1.58 in taxes in 2000. IX Reducing Smoking Among Young Adults: Is it Now Flattening? The most critical goal of anti tobacco measures anywhere is to reduce smoking among young adults. This is because most adult smokers get into the habit when they are in their teens. Therefore youth smoking is carefully monitored through the biennial New York Youth Tobacco Survey. Youth smoking is defined as smoking a cigarette on one or more days in the past 30 days. Although the latest data from New York State does show that smoking rates among young adults have at last started declining faster than for older adults, clearly the rate among young adults 18-24 at about 12.6% in 2010 (down from 23.8% in 2002) is still unacceptably high. (Ibid) In 2012 the smoking rate among high school students continued at 11.9%. The reduction from 2010 to 2012 is not significant and this is worrying (https://www.health.ny.gov/prevention/tobacco_control/reports/statshots/volume6/n2_trends_in_smoking_prevalence_among_new_york_youth.pdf). The situation is similar when looking at New York City. After registering rapid decline teen smoking in New York City stopped falling. It reached a remarkably slow prevalence rate of 8.5% in 2011, which is below the national teen smoking average of 18.1% and the NY state average of 11.9%. However, thereafter the decline seems to have flattened off. Actually this is a national, state and city trend and raises questions as to whether something has gone wrong throughout the country. The Wall Street Journal (http://online.wsj.com/news/articles/SB10001424127887323415304578370931423159620) in a report by Sophia Hollander dated March 19th 2013 links this to the decline in the availability of funds for anti smoking efforts throughout the country while the tobacco industry responds with more and more innovative marketing efforts. From $749.7 million in 2002, this declined to $459.5 million in 2013, according to the Campaign for Tobacco-Free Kids. New York state has slashed its funding by more than half since 2008. In 2013 it budgeted $41.4 million, down from $89.2 million in 2008.As against this according to the Wall Street Journal report, tobacco companies spent $8.5 billion in 2010 alone on advertising and promotion. The WSJ quotes a Federal Trade Commission report to say that “The largest expense was funding steep discounts and coupons to compensate for increased taxes (Ibid).” X Stocktaking: New York City New York State has clearly made significant progress in the implementation of anti tobacco measures and the impact is noticeable. When it comes to New York City the robustness of the measures and their impact on the ground are very impressive: the graph on page 13 above from the NYC Community Health Survey, shows the clear inflection points following some of these actions. As the American Lung Association in its state of tobacco control report explains the NY State continued to be proactive in its anti tobacco driver in 2013 when it passed an order to make all hospital grounds completely smoke free. (http://www.stateoftobaccocontrol.org/state-grades/new-york/highlights.html) to protect patients, staff and visitors from secondary smoke inhalation. This was however struck down in court. The state is now garnering strength in the legislature to pass a proper law on this. In New York City, however, such a law has been in place since 2011. Michael Johns, Shanon Farley, Deepa Rajulu, Susan Kansagra and Harlan Juster (http://tobaccocontrol.bmj.com/content/early/2014/04/30/tobaccocontrol-2013-051335.abstract) studied the impact of this legislation (which banned smoking in parks, beaches in 2011) in New York City using the rest of the state as an experimental group and found significant decrease in smoking in these public spaces. In 2011 NYC also celebrated ten years of the Smoke Fee Air Act, which banned smoking in restaurants and bars. Perhaps the most significant and unprecedented step that New York City has taken is raising the minimum legal age for buying cigarettes from 18 to 21. This is a first among the big cities of America. The law took effect on 19th November 2013 and from April 2014 also extends to 29 e-cigarettes as well. While adult smoking rates have been steadily declining in the country, the smoking rate among young people as already discussed earlier in this paper has been steady at about 8.5% since 2007. This law is hoped to cut smoking rates among the 18-20 group by at least half. This when viewed against the other measures which the City has promulgated including the fact that cigarette tax in New York City is the highest in the country ($5.85 a carton, which brings the overall price to around $12), clearly makes NY City a leader in anti-tobacco measures. However, as already noted, both NY state and the city have failed to sustain adequate funding for anti-tobacco efforts in the recent past. For instance, while NY State collects over $2 billion in taxes from tobacco, it is now spending only about $39 million on tobacco control: almost half of what it was sending in 2008. This is at a level considerably lower almost 19% of the amount of $203 million (http://www.tobaccofreekids.org/what_we_do/state_local/tobacco_settlement/new_york) what the Center for Disease Control and Prevention recommends for NY state. (http://news.msn.com/us/new-york-raises-minimum-age-to-buy-cigarettes-to-21-1). Another effect of decline in spending on tobacco control is that the program does not reach the most vulnerable sections of the population, i.e. those with the lowest incomes, who also have the highest rates of smoking. This means the burden of tobacco taxes falls most heavily on the poor. Limited funding prevents the Tobacco Use Prevention and Control Program from reaching the most vulnerable populations with the highest rates of smoking – those areas with the lowest incomes. As a result, increasingly the burden of tobacco taxes falls most heavily on those least able to pay. Thus, while decline in smoking has not occurred among the poor so much, the burden of cigarette taxation is also higher on them (http://acscan.org/ovc_images/file/action/states/ny/NY_Cancer_Brief_1A.pdf). “Since 2000, smoking cessation rates have been greater, and smoking prevalence is now lowest, among New Yorkers with incomes over $35,000 a year. Those with incomes below $25,000 have the highest smoking rates, and smoking prevalence among the very poorest is practically unchanged in ten years. Among those with household incomes less than $15,000 a year, the smoking rate has not changed in the past 10 years. According to the latest Census, over 13 percent of New York households have incomes below $15,000 (Ibid).” The above stocktaking shows a picture, which is characterized on the one hand by impressive overall improvements in terms of smoking prevalence and robust tobacco control measures, in particular, tax and price initiatives. However, on the other hand, a disaggregated analysis shows three major problems, which contribute to the “last mile” challenge that the tobacco epidemic confronts in the US. These are: a. Teenage/young adult smoking prevalence rates are leveling off since 2007 at about 8.5%. Given that most adult smokers start at teenage, this is very worrying b. An income and education based disaggregation shows that smoking decline among the poor and among the less educated has not been as significant as among the rest of the population c. Very clearly, since 2008, spending on tobacco control measures has been registering very significant declines in the entire state of New York adding up to at best 2% of the revenue from tobacco taxes. XI The Case for Further Research in developed countries with particular reference to New York Despite considerable progress in reducing tobacco use, the overhang of tobacco use and the toll are still fairly substantial. Even in 2011, 14,200 New Yorkers were diagnosed with lung cancer and nearly 9,000 died. According to the American Cancer Society, the health care cost on account of ailments from tobacco use in 2011 in New York State cost $8.17 billion (http://acscan.org/ovc_images/file/action/states/ny/NY_Cancer_Brief_1A.pdf). When these costs along with the human costs involved are weighed against the fact that out of the revenue from tobacco taxes, only 2% is being spent on tobacco control measures, and that too in a way that doesn't make much of a dent on the poor and less educated and the teenage smoking rate seems to be stubbornly resisting further decline, the need for further research is underscored. As Derek Yach, Angela Pratt, Thomas Glynn, K. Srinath Reddy make the point that (http://www.globalizationandhealth.com/content/10/1/39: Globalization and Health: Research to Stop Tobacco Deaths 21st March 2014) that research and evidence on the impact of different policy interventions in reducing tobacco use have played a critical role in driving the progress of policy making and implementation in country after country. Therefore, continued attention to research and the collection of evidence on how different policies are working is important not just in developing countries but also in developed countries which as seen earlier are facing the typical last mile problem with heavy costs. The authors have also pointed to the findings of the US Congress that tobacco companies are targeting the youth for focused advertising (Ibid). Member states adopted WHO’s Framework Convention on Tobacco Control in 2003 with express purpose “to protect present and future generations from the devastating consequences of tobacco consumption and exposure”. The FCTC underscores the importance of research and surveillance as crucial for tobacco control. As the authors (Ibid) go on to say, “A decade after the adoption of the FCTC, global tobacco control is at a critical juncture”. For a decade after FCTC, investment on tobacco control continued to increase. Of late, however, there are clear trends, as in New York, of definite and sharp decline in expenditure on tobacco control. Therefore, the need for research to establish the efficacy of specific policy measures is urgent and imperative. XII The Current Research Proposal for New York City In view of the major problems identified in the previous section, as contributing to the “last mile problem”, the Harlem Children Society with its one and a half decades experience of working with young adults and children (promoting STEM education in US and abroad) is proposing to focus on two aspects: A. How one specific selected measure is working to reduce tobacco use: ➢ First, the extent to which the most recent policy measure of raising the legal age of smoking to 21 is working ➢ Secondly, the extent to which this measure is working in some of the most disadvantaged pockets of New York City B. The extent of exposure of low income population in disadvantaged pockets of New York City to the following different anti tobacco measures: ➢ Creating smoke free public spaces. ➢ Preventing the sale of tobacco and tobacco products to persons below 21 from local shops that sell tobacco products. ➢ Preventing the sale of tobacco and tobacco products near educational institutions in the localities ➢ Graphic pictorial counter advertisements and billboards.

Farewell Speech in Honor of Dr. Timney Respected Madam, Distinguished Faculty and Friends Today is a very special day for all of us in Pace University. As we all are gathered here at Pace Law School on this august occasion to mark and honor your retirement from the University, our hearts are filled with gratitude and pride after having had the singular privilege and noteworthy distinction of having interacted with an exemplary and brilliant professor like you. Madam, your erudition and incisive intellect have amply benefitted all of us. Your moral and rational framework to answer every thorny issue has been a hallmark of your personality and teaching. I have taken several of your classes including the Capstone Seminar at Pace and after every course, my analytical and communications skills have improved manifold. Your lucid and logical writing style has taken my writing to a greater elevation. After having completed my masters’ dissertation under your aegis and supervision, I can say with conviction that my research skills have reached a whole new trajectory all together. I will remain eternally grateful to you for having shaped and fortified my intellect in the right direction, just like you have often done for many others. Finally, as I sign off this valedictory speech for you, our hearts are also tinged with sadness and wistfulness as we realize that in your absence, there will be a void, which will be very difficult to bridge. We, the Pace Community, warmly wish you all the best as you bravely embark on the post-retirement phase of your life. Thanking You for Everything You Have Done For Us Remembering You Forever Rajeet Guha and the MPASA

My Capstone MPA Project on Bullying in schools - Unedited and rough version

CAPSTONE RESEARCH PROJECT THE PERSISTENCE OF BULLYING AT SCHOOL AND PUBLIC POLICY RESPONSES: WHAT AILS? RAJEET GUHA SUBMITTED IN PARTIAL FULFILLMENT OF REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC ADMINISTRATION DYSON COLLEGE OF ARTS AND SCIENCES PACE UNIVERSITY DECEMBER 2013 APPROVED BY ------------------------------- Table of Contents Page number List of Tables 3 List of Figures 4 Abstract 5 Chapter 1: Introduction 7 Chapter 2: Literature Review 14 Chapter 3: Methodology 30 Chapter 4: Findings 32 Chapter 5: Analysis of Findings 42 Chapter 6: Conclusions and Recommendations 50 Work Cited 54 Appendix 1 Appendix 2 List of Tables Page Number Table 1: Number of Students Struck Each Year in U.S. Public Schools 20 Table 2: Corporal Punishment in US Public Schools (2005-2006 school year) 22 List of Figures Figure 1: Percentage of Students Between the Ages 12-18 Who Reported Being Bullied in 2005, 2007 and 2009 (National Center for Education Statistics) 15 Figure 2: Chart Generated by Excel Using Published Data on the Incidence of bullying reproduced in figure 1 (National Center for Education Statistics) 16 Figure 3: Estimates of Children reported Being Bullied by State (Chart Generated in Excel Using data from Bully Police USA) 17 Figure 4: Percentage of Children Reported Being Bullied at School: Chart Generated Using Excel Using Child Trend Data Bank 18 Figure 5: Number of Students Struck Each Year in US Public Schools Chart Generated Using Excel from Center for Effective Discipline 21 RAJEET GUHA Capstone Research Project Research: The Persistence of Bullying at School and Public Policy Responses: What Ails? Abstract: This capstone research project looks at the pervasive problem of Bullying in Schools and investigates why despite almost all states in the US adopting anti bullying policies the problem does not seem to go away but in fact its incidence continues to rise. It shows through a careful literature review how a similar problem namely corporal punishment at schools has gone down in all states that have banned corporal punishment at schools despite the fact that its incidence in homes persists. However, notwithstanding the enactment of legislation against bullying in school, similar trends are not being seen in case of bullying and in fact rates of bullying as well as forms of bullying continue to creep up. A primary research was conducted through a questionnaire distributed to anti bullying school counselors/deputy principals/principals of a few schools in the two states of New York and New Jersey. The survey questionnaire was devised using a most common anti bullying policy framework (Olweus Bullying Prevention Program) used in most states and having each question correspond to one policy element of this framework. . Surveys were sent out to a total of nine schools in the two states. Finally, six schools in two states responded to the Survey Monkey Questionnaire. The findings of the research provide evidence in support of the hypothesis that while policies existed in both states, it was the inadequate implementation of the polices, a failure to adopt a proactive approach by the schools, weak accountability of schools to proactively implement the policies and a continuing lack of understanding of the nuances of the problem of bullying that contribute to the persistence and in fact rising trend of bullying in schools. In fact all the schools seemed defensive to acknowledge the extent of the problem and also displayed a lack of clear understanding of what the problem constituted, in all its ramifications. Chapter 1: Introduction 1.1 The Construct of Study While with the march of civilization, human life has become far less violent than before (Solomon, 2011), the extent to which this is mirrored in the lives of children is debatable. A number of single, extremely violent events in schools such as the Newtown, Connecticut event or the Columbine High School massacre have recently focused media and public attention on violence against children. While such types of violence are different from the type under investigation in this paper, they all underscore and highlight the grim reality that even in a twenty first century environment of increasing concern for individual rights, the right to be educated in safety and without violence is not something that can be taken for granted. Even though the world has become kinder and gentler, the youngest, most vulnerable and most innocent among us are often subject to mindless cruelty. This project focuses attention on one of the most common but perhaps most invidious drivers of violence against children: Bullying. 1.2 Defining Bullying As a backdrop for the study of the construct of bullying, the research begins with a related topic, viz., Corporal Punishment. Corporal Punishment has been practiced since time immemorial in homes, orphanages, schools and neighborhoods all over the world and is still pervasive in many societies, including in the United States. It has been an enduring blemish on humankind since the dawn of civilization. Corporal Punishment, or its informal term “spanking,” has been a marked characteristic of both parenting and schooling. The broad definition of corporal punishment that this essay will use is “the intentional application of physical and (psychological) pain (but not injury) as a method of changing behavior” (Guha, 2012). It usually involves parents or teachers striking a child with an implement such as a paddle, which is common in the US. But it can also include other kinds of humiliation such as making the child go into a corner of the room and stand or stay in a fixed posture for some time or do extra work, etc. (Blaya et al, 2008). In the same way bullying also reared its ugly head at about the same time as corporal punishment and similarly precedes written history of humankind. Bullying takes place globally transcending barriers of culture, region, religion and language. This near universal phenomenon takes place across all stages of life in human beings. It is witnessed among siblings, peers in the neighborhood and school, between relationship partners, between spouses, colleagues at work, inmates at prisons and seniors in old age homes. The particular focus in this project, however, is on bullying that children subject on their peers. The definition of bullying that this project will adopt is “a long standing violence, physical or psychological, conducted by either an individual or a group and specifically directed against an individual, who is not able to defend himself/herself in the actual situation” (Blaya et al 2008). Once again, bullying can also be verbal, such as name calling, psychological, such as social ostracism, direct or indirect. Indirect bullying is perpetrated via a third person such as relational bullying, etc. (Smith, 2004). Spreading unfavorable stories and rumors and social exclusion are newer forms of bullying. With the spread of Internet and social media, bullying is taking newer and newer forms thereby baffling policy makers and parents. 1.3 The Problem and Extent: What the Data tell us? A common danger of any everyday occurrence is that people tend to become blasé and callous about what they see around them all the time. Both corporal punishment and bullying belong to this category. Thus, while high profile instances of extreme cruelty get all the media attention, the routine, everyday insidious behavior of spanking and bullying fail to shock us anymore. Thus, in 1999, 94% of American parents (Gershoff, 2002) spanked their children by the time they were 3 or 4 years old. An ABC poll conducted as recently as October 2012 (polled over 1000 parents on telephone) (Crandall, ABC News, 2008) reported that although only 26% approved of corporal punishment at school, over 65% of Americans supported spanking of children in principle and half of them admitted to doing it themselves. The high prevalence of corporal punishment at home is fairly universal across the world. Lansford et al (Lansford, 2011) cite a study according to which 63% of parents across 24 developing countries were reported to have used corporal punishment against their children aged 2 to 4 during a month preceding the date of the survey (Guha, 2012). High prevalence is not limited to developing countries alone. Empirical research has amply demonstrated that 133 million to 275 million children all over the world are subjected to domestic violence yearly. The advanced nations of the world witness 4.6 to 11.3 million cases of child abuse at home yearly. In the developing countries, the figures are much higher. In South Asia, the numbers ranging between 40.7 million to 88 million children getting corporally punished at home is simply appalling. In Sub-Saharan Africa there are 34.9 million to 38.2 million cases every year while in the Latin American and the Caribbean countries there are 11.3 to 25.5 million every year. (Lansford et al, 2011) When it comes to bullying, again the prevalence has been quite high and has been steadily increasing in the US between 2001 and 2007. Statistics from the US Department of Health and Human Services, Office of Adolescent Health 2011, shows that in 2009 one in five high school students was bullied at school during the past year. About 8% of students at high school level admitted to bullying others. The report also talks of increase in cyber bullying. In 2010, one in five adolescents reported having been cyber bullied during the past year, while one in ten admitted to being a cyber bully themselves. The report further indicates that boys were more likely to be bullied physically while girls are more often bullied through the Internet and through psychological means such as social boycott. In 2008 an estimated 20% of children between the ages of 2 and 17 suffered at the hands of bullies (Child Trends Data Bank, 2013). A study conducted in 2005 (Due et al, 2005) shows that Sweden with 5.1% for girls and 6.3% for boys has the distinction of having the minimum incidence of bullying for boys as well as girls, while the Eastern European country of Lithuania has the dubious distinction for maximum incidence of bullying for both sexes with 38.2% for girls and 41.4% for boys. For Hungary, the incidence is 16.7% for boys while it is 13.7% for girls. For Russia, the corresponding figures are 25.3% and 24.2% respectively. This study reports the incidence in US as 16% for boys and 11.3% for girls. Further, as a Plan International Report indicates, school bullying is a worldwide phenomenon including developing countries with percentages ranging from 20% in China to 66% in Zambia. Thus corporal punishment at home and its explicit or implicit endorsement by parents all over the world and bullying at school of children represent two of the most common health hazards as well as human rights violations for children worldwide including in the United States. The fact that this is in spite of increasing human rights awareness and activism and legal reform in many countries (as will be examined in details in the section on literature review later), underscores the seriousness and persistence of the problem. Further, in the US, there are considerable differences in incidence of both corporal punishment at home and bullying at school across different states and regions of the country and the twin forms of violence against children follow similar regional and state patterns (High, 2000 & Center for Effective Discipline, 2010). 1.4 Defining the thrust of research, the hypothesis and the questions The literature review will show a very definitive trend in the two constructs of bullying at school and corporal punishment at home. The conclusion from the review on the basis of publicly available data is that while corporal punishment in schools (and not at home) is definitely declining across regions and states: registering a 18% decline from 1980 to 2005-06 (The Center for Effective Discipline, 2010), there seems to be a steady almost corresponding increase in the incidence of bullying during almost the same period. Thus, while in 2005, one in seven (14%) children reported being bullied (MBNBD, 2013), in 2010 this rose to one in five or 20% (Child Trends Data, 2013). A key point to underscore here is that despite widespread sanction of parental corporal punishment, it has been possible to reduce corporal punishment at school substantially across all regions of America. Obviously the only other variables here that seem to have made the difference are (a) the fact that far fewer parents endorse corporal punishment at school even while they (Crandall, ABC News, 2008) continue to support it at home and (b) the policies and measures adopted in US schools in this regard. The research will make the point therefore that both people’s attitudes and policy responses can make a major difference. This will therefore beg the question as to why similar change is not yet noticeable in case of bullying at school. This will involve a study of the evolution of policy responses to bullying at school, an assessment of how they are working and what further can be done both in terms of policy fine-tuning and change of attitude. After all, if this combination has worked for corporal punishment at school, how to marshal them to end the bullying that children from KG to high school are being subjected to? Given that study after study attests to the harmful and lasting effects of bullying on children, ranging from effects on performance to serious lifelong mental health problems, it is hoped that this research will contribute to enhancing understanding of how to maximize efforts to address this critical health and human rights issue of the times. 1.5 Research Questions This research will seek answers to the following questions: Step1: Through literature review and publicly available data and meta analysis: 1. Are there time and regional trends across states in the US in terms of incidence of bullying at school and corporal punishment both at home and in school? 2. What have been the policy responses and efforts to bring about attitude change to check corporal punishment at school? 3. What are the major policy responses so far for tackling bullying at school? A quick comparative analysis across different states? Step2: Through primary research 4. What has been the impact of policy responses to address bullying in schools? 5. Which strategies have worked and which haven’t? 6. What should be the next steps in this effort? The primary research for seeking answers to questions 4, 5 and 6 will be carried out through an online survey among 5/6 randomly selected public school counselors through the help of the New York and New Jersey School Systems. Through these questions the research will test the hypothesis that the problem does not lie so much in the absence of policies to address bullying but in the way these policies are actually implemented on the ground. Chapter 2: Literature Review 2.1 The scourge of bullying Bullying is a pervasive phenomenon in American schools (National Association of School Psychologists, 2002). Bullying encapsulates demonstration of physical prowess over others, psychological intimidation bordering on physical prowess, hostile behavior, terrorization, coercion, banter and pestering incessantly or intermittently (National Association of School Psychologists, 2002). Bullying is an intolerable and utterly disruptive behavior. It degrades the ambience in the school, adversely impacts academic results of pupils, negatively influences position and status in school, leads to turmoil and torment for the victims of bullying and finally can possibly result in dreadful injuries as a consequence of terrible assault (Ibid). It is absolutely crucial for the physical and psychological health and well-being of students that the practice of bullying is rooted out from schools by the authorities in school. The view that bullying is an innate part of the process of becoming matured human beings and is thus a necessary evil is flawed (Ibid). There can be no justification for bullying. Bullying practices are ingrained from being socialized in environments ranging from the family, school, peers in school or neighborhood and ultimately through print, electronic, online and social media. Like any learned behavior, such behavior can be unlearned through social psychology (Ibid). Young minds can certainly be weaned from the practice of bullying at home or at school. This can be done through transforming the culture of society by using social psychology as a lever to bring about behavioral reform among children at home and school (Ibid). 2.2: Prevalence of bullying at school and corporal punishment: time and regional trends across states A. Bullying data analysis As a first step, it would be important to understand trends: both time trends and regional trends and then juxtapose these trends with the adoption of legal and policy measures across states to see if there is any clear correlation and /or causation. Subsequently the same analysis will be carried out for corporal punishment at school and the literature review will show that policy measures have begun to show results, quite impressive ones at that, in so far as corporal punishment at school is concerned. The literature review will also show that in so far as bullying at school is concerned, there is no let up in prevalence so far. In fact, prevalence seems to be increasing, albeit with state-wise differences. Publicly available data from 2000, across states of the US, collected by Bully Police USA (High, 2000) clearly shows how widespread and dangerous the trends of bullying were 13 years ago. On an average nationally 18.9% school age children (from 2000 census) from ages 5-18 in US schools reported being bullied. The prevalence in states varied between 22.8% in Utah to 14.4% in DC. The next set of data examined was the data published by the National Center for Education Statistics (National Center for Education Statistics, 2012) on bullying for the years 2005, 2007 and 2009. A chart has been produced on the basis of that data and presented below: Figure 1 Percentage of students between the ages 12-18 who reported being bullied in 2005, 2007, and 2009 (disaggregated by sex) (Source: National Centre for Education Statistics, 2012) The most revealing aspect of the data is that 5-7 years later there was clearly sharply rising prevalence of bullying at school. While national estimates were about 19.8% of children (in the age group 5-18) reporting bullying in schools in 2000, in 2005 this went up to 28% (in the age group of 12-18); to 32% in 2007 and then there was a 4% dip to 28% in 2009. Although the age group covered in 2005-2009 was 12-18 as compared to the age group of 5-18 in the 2000 data, there is no indication of any improvement in statistics if the 5-11 years cohort had been added. In fact, as the National Association of School Psychologists (National Association of School Psychologists, 2002) explain, physical bullying grows in elementary school, reaches the highest in middle school and goes down in high school. The trend line generated below from this data shows the stubbornly high prevalence of bullying in schools across the US. Figure 2 Chart generated by Excel using published data on the incidence of Bullying reproduced in Figure 1 above. (Source: National Centre for Education Statistics, 2012) In terms of state trends, the 2000 data shows, while there were state-wise differences, such differences were not all that sharp, ranging from 14.4 % in DC to 22.8% in Utah and Alaska. Thus, in 2000, Alaska, Utah, Idaho (21%), New Mexico (20.8), Texas (20.4%), Louisiana (20.2%), Mississippi (20.1%), California (20%), South Dakota (20%), Wyoming (19.8%), Nebraska (19.5%), Minnesota (19.5%) and Kansas (19.5%) were the worst performing states hovering above or around the national average. Clearly, the stereotypical expectation of conservative Southern attitudes towards spanking driving up bullying at school is not fully borne out in the data. Similarly, the best performing (relatively: as 14-16% is also very large translating to one in 6 children) states in 2000 were, DC (14.4%), West Virginia (16.7%), Florida (16.9%) and Massachusetts (17.3%). Attitudes towards corporal punishment at home, however, continue to be a strong Southern characteristic. A chart derived from this state wise prevalence is shown below. Figure 3: Estimates of Children Reported Being Bullied by State (Chart generated on Excel using data from Bully Police USA (High, 2000) The next set of statewide break up in fact reinforces this non-stereotypical trend. According to the Random Facts website, in 2007, the states that were the most afflicted with bullying were California, New York, Pennsylvania, and Washington. Child Trends Data Base presents data as recently as 2008 and that shows an average victimization rate amongst male children from the age of 2 to 17 from physical bullying of 17%, 21% from teasing or emotional bullying and about 2% from Internet bullying. A chart derived in excel from their study (showing sex disaggregated data) is shown below: Figure 4 Percentage of Children Reporting Being Bullied at School(2008) Chart generated using Excel from Child Trends Data Bank The National Association of School Psychologists therefore underscores a few key facts about bullying. About 30 % of American pupils are at the giving or receiving end of bullying. Between grades 6 to 10, about 3.7 million students are bullies while 3.2 million students are bullied according to the American Medical Association (cited by National Association of School Psychologists). From 1992 onwards, 250 students have been shot to death in schools. Bullying in the past has often triggered such tragic incidents. There is a strong correlation between being a bully in school and leaving school before graduation. A similar strong correlation is also witnessed between being a victim of bullying and the inability to graduate from school. Harmful psychosocial adaptation and strong criminal tendencies have been associated with bullies and victims. Verbal abuse remains uniform in elementary school. Younger pupils are more likely to be hectored than the older ones. About a quarter of American teachers either condone or endorse bullying. Teachers intercede in 4 out of 100 cases in bullying. 66 % of pupils are firmly convinced that school response to bullying has been callous and unproductive. A grading by BullyPolice.org based on legislation and its content has carried out a rating of all states. So far, 49 states have passed legislation against bullying at school: the most recent being South Dakota in 2012. According to this grading, based on legislation, the best performing states according to the quality of legislation are: West Virginia, South Dakota, North Dakota, New Mexico, Florida, Kansas, Maryland, DC, Alabama, Texas and South Carolina: all graded A or above. The worst are Illinois, Alaska, Minnesota, Vermont, Iowa, Connecticut, Maine, Washington, Montana, New Hampshire and New York and Pennsylvania: all graded C or below (Montana being graded F). B. Corporal Punishment Data Analysis When it comes to corporal punishment, estimates and trends of both CP at home and CP at school will be juxtaposed with policy measures and legislation in the different states of the US. According to Center for Effective Discipline (Center for Effective Discipline, 2010) in 1976, a total of 1,521,896 children were subjected to corporal punishment at school, which reduced to 223,190 in 2006, representing a dramatic reduction of 85%. YEAR # WHITE % # BLACK % TOT. KIDS HIT % 1976 992,675 65 447,314 29 1,521,896 3.5 1978 940,467 65 411,271 29 1,438,317 3.4 1980 901,032 64 403,386 29 1,408,303 3.4 1982 no statistical projection was made this year 1984 852,427 64 374,315 28 1,332,317 3.3 1986 659,224 60 345,411 31 1,099,731 2.7 1988 549,572 61 255,296 28 898,370 2.2 1990 346,488 56 208,543 34 613,760 1.5 1992 295,050 53 215,684 39 555,531 1.3 1994 256,363 54 182,394 39 470,683 1.1 1997 241,406 53 178,114 39 457,754 1.0 1998 199,572 55 135,523 37 365,058 0.8 2000 181,689 53 132,065 39 342,038 0.7 2003 159,446 53 115,819 38 301,016 0.6 2004 143,002 53 104,627 38 272,028 0.57 2006 119,339 53 79,613 36 223,190 0.46 Table 1 Number of Students Struck Each Year in U.S. Public Schools Center for Effective Discipline (Center for Effective Discipline, 2010) In the following figure this data has been plotted in Excel and a trend line generated, which can be compared with the bullying trend line shown above (Figure 2). The dramatic fall in corporal punishment as contrasted with the still very high bullying rates is quite striking. Figure 5 Number of Students Struck Each Year in US Public: Excel generated using data from Center for Effective Discipline (Center for Effective Discipline, 2010) The following table shows the state-wise breakdown of the total number of children who were subjected to corporal punishment in 2006: State Number of Students Hit Percentage of Total Students Alabama 34,097 4.6 Arkansas 22,575 4.7 Arizona 16 <0.0 Colorado 8 <0.0 Florida 7,303 .3 Georgia 18,404 1.1 Idaho 131 .05 Indiana 613 .05 Kansas 54 .01 Kentucky 2.210 .3 Louisiana 11,091 1.7 Missouri 5,194 .6 Mississippi 38,214 7.5 North Carolina 2,736 .2 New Mexico 749 .2 Ohio 672 .04 Oklahoma 15,153 2.4 South Carolina 1,421 .2 Tennessee 14,901 1.5 Texas 51,170 1.1 Wyoming 0 0 Table 2 Corporal Punishment in U.S. Public Schools
2005-2006 School Year: data released March 2008: Center for Effective Discipline July 1, 2010 In 2008, these were the only states that reported instances of corporal punishment at school. If on this table is juxtaposed the 31 states, which have banned corporal punishment, only two such states are in this list: Ohio and Wyoming with almost no or almost negligible number of cases of corporal punishment in schools. All the remaining 19 states are ones, which permit corporal punishment in schools. Secondly the ten worst performing states during 2005-06 were Mississippi (7.5%), Arkansas (4.7%), Alabama (4.5%), Oklahoma (2.3%), Tennessee (1.5%), Texas (1.1%), Georgia (1.1%), Missouri (.6%) and Florida (0.3%) (Ibid): all except Ohio and Wyoming were southern states. Both the non-southern states had either none or very small incidence levels. As mentioned earlier, the regional and state wise trend of school corporal punishment clearly mirrors the commonly expected north-south divide. 2.3. Policy responses to check corporal punishment at school The use of corporal punishment by schools is covered by the Latin term “loco parentis” meaning schools have the same right as parents over minors. (Wikipedia on Corporal Punishment) States have the power to ban corporal punishment in schools and 31 states have already done so. The first state to ban was New Jersey in 1867. The next state to ban it was Massachusetts more than 100 years later in 1971. These bans are imposed through a range of statutes, codes, penal laws and administrative regulations. The state to ban it most recently is New Mexico in 2011. Usually private schools are exempt from state regulation although in some states like New Jersey and Iowa, even private schools are prohibited from imposing corporal punishment. States, which allow it generally, require schools to get permission from the parents who can choose whether they will let their children be subjected to corporal punishment at school. It is up to the school principals to impose such punishment. Most of the schools, which allow it, are in rural areas and many of these rural areas have only one elementary and one high school. Therefore, parents don’t have an option to send students to any other school. Generally, the rules require that male teachers punish only male students while female teachers punish only females. Even in states, which allow corporal punishment, the urban schools don’t practice it. In 1977, the highest court in the US, viz., the Supreme Court held (in Ingraham vs. Wright) corporal punishment in Florida’s public schools to be within the realm of legality. Till today there is no federal law to ban corporal punishment. Efforts in Congress have so far proved futile. It is the initiative of the states that has checked and substantially reduced its use. This is also symptomatic of the American Inter Governmental System where education matters fall within the jurisdiction of states. In over 35 countries, corporal punishment at home is prohibited. USA is not one of them. It is legal in almost all states. Delaware is the only state that has banned it in 2012. (Wikipedia on Corporal Punishment at home) As seen earlier, about 56% of Americans polled by ABC in 2012 supported corporal punishment in principle as a way to discipline children and change behavior. Corporal punishment is believed to lead to immediate compliance. However, it negatively affects inculcation of morality in children. It is often a response to increased aggression. Aggression in the child can also be a reaction to parental corporal punishment. (Psych Page www.psychpage.com ) Thus, the two have a symbiotic relationship. It has been robustly linked to long-term anti-social behavior. As Gershoff (Gershoff, 2002) has found in her meta analysis, corporal punishment significantly erodes the relationship between parents and children; adversely affects mental health; and foments long term abusive mannerisms and attitudes in those being subjected to corporal punishment. Straus and Stewart according to Gershof (Gershoff, 2002) discovered that 95% of American parents smacked their children till the age of 4. When it comes to 5 year olds, they are subjected to corporal punishment twice each month. According to the US Department of Health and Human Services, 1.3% of children either face domestic abuse or parental neglect. The war against corporal punishment at home has to be conducted on many fronts. Parents and caretakers must be provided with other innovative choices to reform their children than resort to the barbaric practice of corporal punishment. In this, the public representatives should try to engage their constituents to legislate reforms, which abolish corporal punishment at home and school. Teachers as well as parents need to be enlightened about the deleterious health outcomes of corporal punishment. The laws of the states should be amended to unequivocally make hitting a child at home or school a misdemeanor. The relative success achieved in significantly reducing hitting of children at school through its banning in 31 states should be replicated for corporal punishment at home. (Center for Effective Discipline,) 2.4. Policy responses to bullying at school As Emily Bazelon (Bazelon, 2013) points out in her recent bestselling book, “Sticks and Stones”, America took time to wake up to the menace of bullying. A quarter of century had to pass after the Scandinavian countries implemented effective measures to deal with bullying and a number of terrible incidents had to occur including the Columbine massacre before the US took notice. Colorado, California, Mississippi, Connecticut, West Virginia, Louisiana, Oklahoma, Minnesota, New Jersey, Illinois and Delaware all enacted anti-bullying legislation in the early 2000’s. According to Bully Police USA, a major anti-bullying advocacy group, all but one state, Montana, has enacted such legislation: the earliest being Georgia (1999), New Hampshire (2000), Colorado, Louisiana, Mississippi, Oregon and West Virginia (all in 2001). The most recent state to pass such a law is South Dakota in 2012. Bully Police has rated states based on the comprehensiveness of their anti-bullying laws. The portmanteau of policy and legal actions of the states rated A++ consists of a number of elements. First and foremost, state laws must mandate every school district to establish a policy forbidding bullying on school property. The policy must clearly state what is bullying, the punitive action for indulging in bullying, clear procedures for inquiring into such incidents and protection against reprisal of those reporting incidents of bullying as well as punishments for making false allegations. The policies are also to lay down complaint and reporting procedures, identify designated school officials to receive such complaints and provide immunities from damages for those responsible for taking action provided it is done in good faith. The best laws also provide for technical assistance including training for implementing the anti-bullying policies. Dan Olweus (Olweus, 1993), the famous Swedish psychologist (As cited in Emily Bazelon, 2013), focused world attention on the topic in 1978 and called for all schools to put in place a campaign to eliminate bullying. He explained that anti-bullying measures must embrace three inter-related levels: 1. The entire school: for example clear rules against bullying, increased oversight during break periods etc. 2. At the class room level: this has to be done through repeated teacher led meetings with students 3. At the individual level: procedures for tackling individual cases of bullying, necessary follow-up with bullies, victims and families, etc. Olweus ( Olweus, 1993) also provided what is the best definition of bullying as comprising three necessary elements to qualify as bullying as separate from conflicts between individuals. These three elements are: physical or psychological abuse; with a repetitive pattern (as opposed to one off incidents); and involving asymmetry of power between the bully and the bullied. 2.4. The Problem: the persistence of bullying: The literature review has shown that bullying is quite an intractable problem in the United States. Though, a late starter in acknowledging and addressing the problem, compared to countries in Europe, anti-bullying policies are today almost universal in this country and have been so for slightly more than a decade. However, unlike corporal punishment, there is still no evidence of a real dent having been made. What explains this? In fact there are no regional trends when it comes to bullying. The usual explanation of a southern culture does not work in this case. Olweus (Olweus, 1993), as cited in Bazelon (Bazelon, 2013), explains this as a problem of poor implementation. Bazelon also talks of other different strategies to combat bullying. Her sense is that schools often change strategies when new principals take over. Her suggestion is “select a strategy and adhere to it rather than moving on to a different strategy every few years.” Eliminating bullying is a long-term commitment. Implementation takes time and there cannot be short cuts. Attitude change requires steadfast and unwavering commitment over a long period. Primary research will examine how ant-bullying policies are being actually implemented in schools and whether there are gaps, which need to be filled. Chapter 3: Methodology 3.1. Hypothesis: After having examined the huge wealth of literature and secondary analysis of the problem of bullying--its prevalence, time and regional trends and the legal and policy measures rolled out in the different states--the question persists as to why bullying continues at such high levels with no apparent effective dent made so far. This is unlike corporal punishment at schools, which shows appreciable decline and, where it still persists, there is a clear correlation with region-specific cultural mores. Bullying defies any such clear typecasting correlations apart from the fact that the US has been a late starter to acknowledge and address the issue. The hypothesis of this project is that what is being faced is more a problem of implementation and therefore the analysis needs to move from the big and middle worlds that the introduction and literature review sections have covered so far to the small world in which policies are implemented, viz., the school level. After all, as Olweus (1993) had said, if the goal is to bring about a sustained change in attitudes of teachers, children (bullies and the bullied) and parents, success cannot be gauged by what laws and policies the legislature has passed but by the actual outcomes of such laws and policies through their actual implementation and this is what the primary research will seek to find out. 3.2. Research questions: The primary research questions therefore are: 1. What has been the impact of measures to address bullying in schools? 2. Which strategies have worked and which haven’t? 3. What should be the next steps in this effort? 3.3. Research design and participants: The research seeks to understand how anti-bullying policies are being actually implemented on the ground and their impact. The research findings are expected to throw light on how schools are implementing the state policies and what practical improvements can be brought about in such implementation. Finally, the project will not attempt action research but simply focus on descriptive research, i.e. observe the situation as it is and will not seek to modify or alter the situation. The main participants are six school principals/deputy principals/counselors from New Jersey and New York City, drawing from contacts facilitated by colleagues, friends and acquaintances. A survey questionnaire was emailed to these selected principals/deputy principals/counselors and the tool used was the Survey Monkey. Additionally, face-to-face interviews were conducted with two school principals/deputy principals. These interviews complemented the survey in terms of more information about which types of bullying (physical, relational, psychological and cyber) are actually being impacted upon and which are not and also the support and resources that counselors have at their disposal to address the problem. By looking at the responses from participants, the research seeks to arrive at answers to the three broad questions that this research seeks answers to through its primary research. 3.4. Survey Questions and Data collection As the literature review brings out, the policy bag for combating bullying in schools encompasses many tools and components (Page 15). The survey questionnaires (detailed out in appendix 1) comprise questions relating to all the components of the policy bag and seek to find which of these are being actually implemented and which are not. In drawing up these questionnaires, the different steps suggested in the Olweus (1993) bullying prevention program and the different components set out in the New Jersey legislation (updated in 2010) on bullying prevention have been drawn upon. The questionnaire also correlates findings on the quality of implementation of policies with the counselors’/principals’ perceptions of how effective anti-bullying measures have actually been in practice. Chapter 4. Findings 4.1 The Questionnaire and Respondents The research questionnaire was sent to 9 schools: 6 in New York City and 3 in New Jersey including one private school in New Jersey, one charter school in New York city and the remaining all public schools, including high schools and one middle school. It was emailed to Principals and Deputy Principals in most cases and only in one case to the Guidance Counselor. It became clear during initial interactions that in most cases the response could only come from the highest level in the school, i.e. Principal/Deputy Principal. Even when it came from the School Counselor, it could not be sent without the Principal’s approval. Survey Monkey was used to administer the survey. The potential respondents were emailed with a link to Survey Monkey. Full confidentiality was maintained because from the Survey Monkey responses it is impossible to know the identity of the respondent. One disclaimer needs to be added. No attempt was made to survey or interview students. It was felt, first of all, that a general trend of bullying rates not declining across the country was already established in the literature review. Secondly, subjecting a student who had been bullied to a survey or interview ran the risk of making such a student relive the bullying episode and getting re-traumatized. The questionnaire (Appendix 1) consisted of a total of 25 questions and the questions belonged to three categories: (a) Questions 1 through 18, listed out the major elements of a recommended policy mix identified in the literature review for addressing bullying in schools (Olweus 1993 Bullying Prevention Program) and sought to ascertain whether all or some of these elements were being implemented in the schools being surveyed. This included questions 1 (a) and 1(b) which required respondents to provide the definition adopted by the schools. These two are fundamental in the sense that they guide and determine all other actions. Some of the other questions related to the quality of implementation of policy elements related to actions and approaches that needed to be taken or adopted when confronted with incidents of bullying such as questions 7, 8, 15, 16, 17 and 18. Others such as 3, 4, 9, 10, 12, 13 and 14 related to recommended proactive policy measures to prevent bullying before it could occur and exercising vigilance and creating the right attitudes. (b) Questions 19 through 24 sought to obtain the perceptions of the respondents about the extent of prevalence of bullying, the intensity of the problem in its different types of manifestation and the availability of resources at the school level for staff to address the problem. (c) Question 25 solicited open-ended suggestions if any from the respondents. The next section will provide a detailed analysis of the answers to questions in the three categories of questions described above: definition (existence and quality), policy elements that guide reactions to the problem, policy elements that guide proactive approaches to prevent the bullying and perceptions of the respondents about the existence and intensity of different forms of bullying. The responses are analyzed and grouped into four analytical categories: 1. Areas where anti bullying policies seem to be working well, 2. Areas where clear implementation gaps exist, 3. Areas where some improvements are possible and 4. Overall perceptions about the intensity of the problem. All questions except the one requiring reproducing of the adopted definition and the one requiring open-ended comments were in the form of multiple-choice answers. A total of six schools responded to most of the questions. A seventh school actually skipped all questions. Two schools provided open-ended comments in the survey one of whom sent it by email because of some technical problems accessing the writing space in the survey monkey. 4.2 Findings of Survey 1. Question1: Is there a clear definition of bullying adopted for your school? Five out of six schools reported in the affirmative while one reported that there was no definition. In the space below the question five definitions were provided. The first definition is a long one and is actually a full reproduction of the official definition that the New Jersey law against bullying provides. (Bully Police USA, 2002): i. Harassment, intimidation or bullying is defined as any gesture, written, verbal or physical act or electronic communication, whether it be a single act or a series of incidents, that is reasonably perceived as being motivated either by an actual act or perceived characteristic, such as race, color, religion, ancestry, national origin, gender, sexual orientation, gender identity and expression, or a mental, physical , or sensory handicap or by any other distinguishing characteristic, that takes place on school property, at any school-sponsored function or on a school bus or off school grounds that: a.) a reasonable person should know, under the circumstance, will have the effect of harming a pupil or damaging the pupil's property or placing a pupil in reasonable fear or harm to his/her person or damage to his/her property; or b.) ha s the effect of insulting or demeaning any pupil or group of pupils in such a way as to cause substantial disruption in, or substantial interference with the orderly operation of the school. Any incident of harassment, intimidation or bullying needs to be reported to building administration immediately. An investigation will follow. The second respondent provides a very short definition: ii. Bullying includes verbal or written forms of teasing as well as physical threat. The third respondent does not provide the actual definition but refers again to the New Jersey state Act and is therefore in effect identical to that provided by the first respondent: iii. Any gesture, any written, verbal or physical act, or any electronic communication as defined by NJSA18A:37-14. The fourth respondent does not provide the definition but refers to the regulations of the NY City School Chancellor: iv. As defined by Responsive Classroom and Dept. of Education Chancellor's Regulation. The fifth respondent provides the following definition: v. The school expects students to conduct themselves in keeping with their levels of development, maturity and demonstrated capabilities with proper regard for the rights and welfare of other students and school staff The definitions will be analyzed in details in the following chapter 5. Respondent school number six had not adopted a definition for bullying according to the response. 2. Question 2: Formation of Bullying Prevention Committee: four and therefore most (66.67%) schools reported having formed them while two reported as not having formed them. 3. Question 3: Distribution of anonymous questionnaire among students to establish baseline about prevalence, types and nature of bullying: Only two reported this as a relevant policy component in their school while four reported in the negative. Thus in an overwhelming majority i.e. 66.67 % of schools this policy requirement was not complied with. 4. Question 4: The school is graded every year by some external authority on its performance in addressing bullying: three schools, i.e. 50% of respondents report this as a regular practice while the remaining (Two schools) report it as not happening regularly while one school reported it as never having happened. 5. Question 5: Regular training is organized for members of the bullying prevention committee: Four schools i.e. 66.67% reported it as a very relevant or pertinent policy element for their schools while two schools, i.e. 33.33% reported that this policy element was not at all relevant for their schools. 6. Question 6: Adoption of school wide rules against bullying: Four schools i.e. 66.67% reported this as a most relevant policy element for their schools, i.e. such rules were clearly in place and followed. 7. Question 7: School teachers and guidance counselors are regularly trained on how to grapple with bullying: Five schools responded to this and out of the five, four schools, i.e. 80% reported this as a most relevant element of their anti bullying policies. 8. Question 8: Principal has designated one staff member as the school’s anti bullying specialist: all six respondent schools i.e. 100% reported this as a most relevant element of their anti bullying policy mix, i.e. it is being implemented. 9. Question 9. A school safety team has been set up to promote a bully free environment in the school: Three schools, i.e. 50% report it as a most relevant element of their policy mix, i.e. it is being actively implemented. One school reported that it is not relevant, i.e. not being implemented. Two schools report it as being moderately relevant, meaning, that it is not very actively implemented. 10. Question number 10: A week of respect is observed in the school starting from the first Monday of October each year: three schools, i.e. 50% report this as most relevant, i.e. it’s a regular practice while two schools report this as not relevant at all i.e. not a practice while one school reports it as being moderately relevant which is interpreted as meaning it may only be only irregularly practiced. 11. Question 10 was by mistake repeated in the survey and showed the same results. 12. Question number 12: Staff including drivers, teachers and administrators are regularly educated about bullying: about half of the schools, i.e. 50% report this as a most relevant element of their policy mix while two schools report it as moderately relevant, i.e. interpreted as an occasional practice (not so regular) an one reported it as not relevant (i.e. not ever practiced). 13. Question 13: Information meetings are regularly held with parents: Only two schools, i.e. 33.33% report this as most relevant i.e. a regular practice while three report i.e. 50% this as moderately relevant, i.e. interpreted as an occasional practice and not a very regular one while one report that this is not relevant, i.e. interpreted as not observed at all. 14. Question 14: Regular class room meetings are held with students to develop empathy and knowledge about the problem of bullying: Four out of six respondent schools (66.67%) report this as a most relevant policy element while one report this as moderately relevant and one reports this as not a relevant policy element. 15. Question 15: Clear procedures laid down for complaints against bullying: all six respondents (100%) report this as a most relevant policy element. 16. Question 16: Regular interventions are held with both bullies and the bullied by the counselor: An overwhelming majority five out of six schools, i.e. 83.33% report this as a most relevant policy element in their schools while one respondent reports this as a moderately relevant policy element. 17. Question 17: Discussions with parents of both the bullies and the bullied are organized: An overwhelming majority i.e. 5 out of six or 83.33% respondents report this as a most relevant policy element while one reports this as moderately relevant. 18. Question 18: Clarity exists on what constitutes cyber bullying: again five out of six respondents or 83.33% of responds report this as almost relevant element of their policy mix while one respondent reports this as a moderately relevant policy element. 19. Question 19: The intensity of the problem of bullying in your school: All six respondents report that this is not an intense problem in their schools. 20. Question 20: Trends in physical bullying (hitting, punching, shoving, kicking etc.): three out of six respondents, i.e. 50% of respondents report that this as a declining trend while another 50% report this as a stationery trend. 21. Question 21: Verbal bullying (abuse, name calling, insult etc.): five out of six respondents i.e. 83.33 % report this as a stationery trend while one reports this as a declining trend. None report this as a rising trend. 22. Question 22: relational bullying (social boycott of one person from a peer group, spreading rumors etc.): four out of six respondents (66.67%) report this as a declining trend, stationery trend while two report this as a declining trend. 23. Cyber bullying (use of on line especially social networking websites to bully: such as Facebook, hi5, Orkut, email, text messages, smart phones: three out of six schools, i.e. 50% report this as a declining trend while two report this as a stationery trend while only one reports this as a rising trend. 24. Do you feel you have adequate support and resources from the school management to effectively discharge your duty: Five out of six respondents i.e. 83.33% strongly agreed with the statement while one agreed. 25. If you have other suggestions about the nature of bullying in yiur school or about what policies can work, please feel free to write in the space below: only two responded: one in the text box provided and one unable to access the text box reported on email. These are provided below: “While many incidents are investigated as "bullying" in our middle school, very few are actually found to constitute bullying. This is because the majority of incidents involve conflict (two-sided) not bullying (one-sided). We find that when middle school aged friends have a "falling out", they often resort to name-calling both in person and online. We investigate these incidents as potential bulling but more often than not they are disciplined as code of conduct violations not bullying (usually the students are friends again before the punishment is even handed down).” By email: “We have one person in charge of dealing with issues related to bullying and she has attended workshops to ensure she incorporates the best procedures in her session. We do not have a committee in place. If you have suggestions towards this end we would be very receptive to this information. We welcome this and if you are interested in speaking with myself or guidance further we would also be open to this.” Chapter 5. Analysis of Findings On a careful consideration of the survey monkey generated data, within of course the limitation of a very small sample, redeemed in part though by the fact that the response was totally anonymous, the following preliminary analysis is offered: 1. Areas Where the Anti Bullying Policies are Working Well According to the survey results, anti bullying policies do seem to be working well in certain areas: such as a. Question number 7 deals with regular training on how to grapple with bullying. About 80% of respondents report compliance. b. Designation of a staff member as the school’s anti-bullying specialist (Question number 8:100% responses report this as having been complied with) c. Laying down of clear procedures for dealing with complaints against bullying (Question number 15: 100% report compliance on this policy element) d. Regular interventions held with both bullies and the bullied by the counselor (Question number 16: 83% report compliance) e. Discussions organized with parents of both the bullied and the bullies (Question number 17: 83% report compliance) f. Clarity regarding what constitutes cyber bullying (Question number 18: 83% report clear understanding ) 2. Areas of Policy Implementation with Gaps and Inadequacies: 1. Existence of clear definition of Bullying 1(a) and 1(b): This is a fundamental first step for grappling with the problem of Bullying. Five out of six schools surveyed report having a “clear” definition of bullying. This is certainly prima facie a positive implementation of anti-bullying policies, which require schools to have a definition. However the fact that one school out of such a small sample doesn’t have any definition is a problem and shows the inadequacy of policy implementation. This is further compounded by the quality of the definition of Bullying: This is the biggest area of inadequacy in policy implementation. It is obvious from the findings that despite New York State and the City as well as New Jersey having laid down policies on Bullying, this does not translate and percolate to the ground uniformly. This is clear from an examination of the definitions provided which are reproduced below for comparison and analysis: a. Respondent 1: Harassment, intimidation or bullying is defined as any gesture, written, verbal or physical act or electronic communication , whether it be a single act or a series of incidents, that is reasonably perceived as being motivated either by an actual act or perceived characteristic, such as race, color, religion, ancestry, national origin, gender, sexual orientation, gender identity and expression, or a mental, physical , or sensory handicap or by any other distinguishing characteristic, that takes place on school property, at any school-sponsored function or on a school bus or off school grounds that: a.) a reasonable person should know, under the circumstance, will have the effect of harming a pupil or damaging the pupil's property or placing a pupil in reasonable fear or harm to his/her person or damage to his/her property; or b.) has the effect of insulting or demeaning any pupil or group of pupils in such a way as to cause substantial disruption in, or substantial interference with the orderly operation of the school. Any incident of harassment, intimidation or bullying needs to be reported to building administration immediately. An investigation will follow. b. Respondent 2: Bullying includes verbal or written forms of teasing as well as physical threat. c. Respondent 3: Any gesture, any written, verbal or physical act, or any electronic communication as defined by NJSA18A:37-14. d. Respondent 4: As defined by Responsive Classroom and Dept. of Education Chancellor's Regulation. e. Respondent 5: The school expects students to conduct themselves in keeping with their levels of development, maturity and demonstrated capabilities with proper regard for the rights and welfare of other students and school staff These definitions will be examined by comparing with the criteria of good definitions articulated by Dan Olweus ( Olweus, 1993) cited on page 22 of the project. The definition of bullying needs to comprise three necessary elements to qualify as bullying as separate from conflicts between individuals. These three elements are: physical or psychological abuse; with a repetitive pattern (as opposed to one off incidents); and involving asymmetry of power between the bully and the bullied. From this point of view, the definition provided by respondent 5 does not approximate the definition of Bullying. The definition provided by respondent number 1 is very comprehensive: it covers the aspect of physical and/or psychological abuse and electronic communication as a means of Bullying. In fact it is the definition prescribed under the New Jersey (Bully Police USA, 2002) “Act concerning the adoption of harassment and bullying prevention policies by public school districts.” New Jersey is also one of the first states to extend the application of this law to even private schools (Page 18 of this project). The definition adopted in New York, which is referred to by respondent 4, defines Bullying as (National School Boards Association, 2012) : “Harassment: (1) creation of a hostile environment by conduct or by verbal threats, intimidation or abuse that has or would have the effect of unreasonably and substantially interfering with a student’s educational performance, opportunities or benefits, or mental, emotional or physical well-being; or (2) conduct, verbal threats, intimidation or abuse that reasonably causes or would reasonably be expected to cause a student to fear for his physical safety; such conduct, verbal threats intimidation or abuse includes but is not limited to that based on a person’s actual or perceived race, color, weight, national origin , ethnic group, religion, religious practice, disability, sexual orientation, gender or sex.” However neither of these definitions include two crucial elements: the repetitive nature and the asymmetry of power listed by Olweus ( Olweus, 1993). Probably this is what tends to hinder the understanding of Bullying and explains an open-ended comment by respondent number 6 which says: “While many incidents are investigated as "bullying" in our middle school, very few are actually found to constitute bullying. This is because the majority of incidents involve conflict (two-sided) not bullying (one-sided). We find that when middle-school aged friends have a "falling out", they often resort to name-calling both in person and online. We investigate these incidents as potential bullying but more often than not they are disciplined as code of conduct violations not bullying (usually the students are friends again before the punishment is even handed down).” With Olweus’s ( Olweus, 1993) definition criteria, it is clear that the kind of situation described by respondent number 6 is not Bullying not because of any fuzzy reason of overlap with “two-sided conflict” as described by the respondent but because it is not repetitive and does not involve asymmetry of power. 2. Policy provisions which call for a proactive approach to detecting and addressing Bullying: The other policy areas where considerable deficits in implementation are noted are those articulated under questions 3, 4, 9, 10, 12, 13 and 14. These provisions are what distinguish between a proactive anti-bullying approach and a reactive approach. The following enumeration will explain: a. Question 3 requires surveying students through an anonymous questionnaire to create a baseline on the prevalence and type of bullying. The results show 67% report that this does not happen in schools: only 33% report compliance. Not involving students to proactively understand the problem and anticipate is a major gap in policy implementation. b. Question 4 is about external grading of schools in respect of performance in addressing bullying. Half of schools report not being graded. This is again a case of non-implementation of a policy directive, which is likely to result in poor accountability. c. Question 9 is about the setting up of a school safety team to promote a bully free environment in the school. 50% report non-compliance: again a case of slippage in terms of a proactive approach. d. Question 10 is about observing a week of respect every year: a step towards inculcating mutual respect a crucial attitude that can go a long way in obviating bullying. Only 50% report compliance. e. Question 12 is about regular orientation of all staff about bullying. This is again an important step to promote a proactive approach that seeks the support of all staff and not just one anti-bullying specialist or the class teacher. Only 50% report compliance. f. Question number 13 is about holding regular information meetings with parents. This is also a critical and proactive step to prevent bullying by engaging parents. Only 33% report compliance showing very poor implementation. g. Question number 14 is about holding regular classroom meetings with students to develop mutual empathy and knowledge about the problem of bullying. Almost one third of respondents report that such meetings are not held regularly. This again is a proactive step to promote a bully free environment. 3. Areas Where Policy Implementation Need Some Improvement: a. Question number 6 is about the adoption of schoolwide rules about bullying. About one third report not adopting school wide anti-bullying rules. This is surprising and clearly shows sloppy implementation on the part of some schools. Similarly questions 2 and 5 are about formation of bullying prevention coordination committees and their training. In both cases, one third of respondents report non-compliance. This again shows unsatisfactory performance in terms of policy implementation. 4. Overall Perception of the problem of bullying and its intensity: 1. There is an overall sense of a conservative response to questions sometimes bordering on denial of the seriousness of the problem. It is however not clear whether this is by deliberate intent or for lack of a nuanced understanding of the issue. This conclusion is prompted by four sets of responses. a. First in response to question 19 as to whether the problem of bullying was intense, every respondent has reported that the problem was not intense. In issues like bullying, where there is often a shroud of silence, a stronger acknowledgement of the issue would perhaps be a more constructive response. After all, even one student bullied is one too many. The data generated by the National Centre for Education Statistics, 2012 (page 10 above) reports a bullying incidence of 29% for girls and 27% for boys in 2009. This is high and when viewed against a rising trend nationwide and New York as being cited as one of the worst affected states (page 12), makes this response of describing the problem as not intense as one of serious understatement. b. Secondly, in response to question number 21 on verbal bullying, no responder acknowledged it to be a rising trend: the majority felt it was a stationery trend while one felt it was declining. This again seems to be quite out of touch with reality when viewed against the extensive literature review undertaken in this project. Emily Bazelon in her best-selling book “Sticks and Stones” says that name calling has become a major problem especially with social media where name calling is no longer a one off “ephemeral” (Bazelon 2013 page 9) event but leaves a permanent and lasting trail. c. The response to question 22 similarly on relational bullying is an understatement when viewed against available evidence from the literature review. Relational bullying is reported in the literature as a new and rising trend (page 3 of this paper) catalyzed particularly by social media. The response in the survey, however, has a majority reporting it as a declining trend while none see it as a rising trend. d. Finally the response to question 23 on cyber bullying has about half of the respondents reporting it as a declining trend while the remaining are divided into reporting this as stationery trend and in case of one respondent only it is reported as a rising trend. This overall response is clearly counterfactual. Chapter 6. Conclusions and Recommendations: To summarize, the analysis of survey data points to the following broad directions: 1. Lack of clear and good definition and understanding: What underpins this scenario is actually a profound confusion and lack of clarity about the understanding of the term bullying. This is exemplified in both the way it is defined in the schools and in the open-ended comments received from respondents. When it comes to the definition, the problem lies in the very statutes and policies wherein bullying has been defined in the two states. Two crucial elements, i.e., the aspect of the asymmetry of power and the aspect of repetitive nature of the problem, are missed out in the definitions. 2. Approach reactive not proactive: Secondly, in terms of enforcement and redressal action, or in other words policies, which lay down how schools should react to bullying when it occurs, the performance is good and schools are taking the provisions seriously. However, implementation failure is marked when it comes to those provisions which stipulate a pro-active and preventive policy that seeks the involvement of students, parents and all sections of school staff and which seek to inculcate values of empathy and love. The implementation of these policies is perfunctory at best. 3. Defensiveness and denial: There persists in school managements certain defensiveness in acknowledging the problem of bullying. The defensiveness became evident not only in a tendency for denial but also in considerable caution in sending out information without highest-level approval and sign off: this was obvious to the research during the process of approaching schools. The defensiveness of schools in this issue is also evident in the apparent reluctance to subject themselves to any external grading in this regard. Secondly this tendency to understate the problem became evident in responses which counterfactually painted too rosy a picture. As Bazelon (2013) puts it, both exaggeration and understatement of the problem should be avoided because their outcomes can have deleterious effects on children. Conclusions: To recapitulate, this research project through its literature review section had carried out a comparative analysis of corporal punishment at school and bullying in school. Publicly available data clearly showed that while corporal punishment in schools had gone down fairly dramatically across the country, bullying in schools had been rising across the country. Further while the incidence of corporal punishment at schools had gone down, available evidence pointed to the fact that corporal punishment at home had not declined and in fact showed predictable regional trends (the so called north-south divide) with the southern states showing stubbornly higher incidence of corporal punishments at home than the northern states. This was markedly contrasted with a nationwide decline in corporal punishment at schools across all states without any noticeable difference (figure 5 on page 16 and table 2 on page 17). The most important variable, which could have made this possible, despite parental attitudes resisting change, is policy and the power of effective implementation. Corporal punishment in schools has gone down because of good policy and good implementation, which could overcome regional biases and attitudes. As a student of public administration, this offered an exciting possibility of testing the power of policy implementation in a similar area: an area that has come up for more and more scrutiny as a human rights and mental health issue: bullying at schools. Accordingly, the key elements of present day anti bullying policies were mapped and used as a framework for primary data collection from schools. The schools were selected based on friends having contacts and in particular contacts from the Harlem Children’s Society, New York, a leading NGO promoting STEM education in the US and several other countries.. The application of public policy toward bullying was tested through a survey administered to a total of nine initially willing schools. Finally six schools from New York City and New Jersey responded. The analysis of data in the previous section has clearly demonstrated the hypothesis that one important reason why anti-bullying policies have not yet had a significant impact on the incidence of bullying at schools is inadequate and perfunctory implementation, especially of the proactive elements of the policy framework, weakness in the policies in terms of effectively defining the problem and a general defensiveness among school leadership to seriously acknowledge the problem. Recommendations; Drawing from the analysis, a key first step would be to strengthen the systems of accountability of schools to demonstrate effective implementation of anti bullying policies. Thus provisions such as annual assessment/audit and grading of schools in terms of not only the incidence of bullying, because bullying gets typically underreported particularly when policy implementation is perfunctory, but also in terms of evidence and record of implementation of all elements of the policies need to be instituted. The second step would be to hold serious and regular training and orientation of staff. The third step would be to hold principals, class teachers as well as the school counselors responsible and not just the school counselor. Fourth, it would be important to make compliance with all elements of the anti-bullying policies a part of the performance assessment of the staff. Finally, since incentive systems are key, schools should be provided resources and tools to implement all aspects of the policy framework. Works Cited Bazelon, Emily. (2013). Sticks and Stones: Defeating the Culture of Bullying and Rediscovering the Power of Character and Empathy. New York, NY. Random House. Blaya, Catherine & Debarbieux, Eric. (2008). Expel Violence! A Systematic Review of Interventions to Prevent Corporal Punishment, Sexual Violence and Bullying in Schools. Retrieved from http://plan-international.org/learnwithoutfear/files/expel-violence-english Bully Police USA. (2002). Child Trends. (2013). Comparative Cross Sectional Study in 28 Countries. European Journal of Public Health, 15, 128-132. Corporal Punishment. (2011). Online Encyclopedia on Early Childhood Development. Retrieved from http://www.child-encyclopedia.com/pages/PDF/Lansford-Tapanya-OburuANGxp1.pdf Crandall, J. (2008). Poll: Most Approve of Spanking Kids. ABC News. Due, P., Holstein, B.E., Lynch, J., Diderichsen, F., Gabhain, S.N., Scheidt, P. & Currie, C. (2005). Bullying and Symptoms among School-Aged Children: International Gershoff, E.T. (2002). Corporal Punishment by Parents and Associated Child Behaviors and Experiences: A Meta Analytic and Theoretical Review. Psychological Bulletin, 128, 539–579. doi: 10.1037/0033-2909.128.4.539 Guha, Rajeet. (2012). Ethics of Corporal Punishment, Term Paper for Dr. Gregory Holtz, Pace University, Fall 2012. Greydanus, D.E., Pratt, H.D., Spates, C.R., Blake-Dreher, A.E., Greydanus-Gearhart, M.A. & Patel, D.R. (2003). Corporal Punishment in Schools. Journal of Adolescent Health, 32, 385-393. High, B. (2000). Estimates of Children Involved in Bullying State by State. Retrieved from http://www.bullypolice.org/BullyingNumbers.pdf Make Beats Not Beat Downs. (2013). National Association of School Psychologists. (2002). National School Boards Association. (2012). Office of Adolescent Health. (2011). Olweus D, Bullying at School: What we know and what we can do: Blackwell Publishing (1993). Robers, S., Zhang J., Truman, J. & Snyder, T.D. (2012, February). Indicators of School Crime and Safety: 2011. Retrieved from http://nces.ed.gov/pubs2012/2012002rev.pdf Random History. (2011). Smith, P.K. (2004). Bullying: Recent Developments. Child and Adolescent Mental Health, 9,3 Retrieved from www.researchgate.net Solomon, Andrew. (2013). The Brutal Years. [Review of the book Sticks and Stones: Defeating the Culture of Bullying and Rediscovering the Power of Character and Empathy]. The New York Times. Sunday Book Review, March 3rd, 2013 The Center for Effective Discipline. (2010): (Taken from online website of the Center for Effective Discipline, a program of the non profit organization The Center for Effective Discipline which provides educational information to the public on corporal punishment and bullying at schools.)