Introduction:
Nearly 267 million adults in India use tobacco; prevalence of tobacco-use is 35% in rural areas and 15% among adolescents 13 to 15 years. Creating a tobacco-free environment vis-à-vis tobacco-free schools is critical for preventing tobacco-use among the youth, who constitute 20% of India’s population.

Objectives:
This study tested the effectiveness of a tobacco-free schools intervention in Maharashtra state.

Methods:
A quasi-experimental post-only study was conducted in five districts in Maharashtra. In three intervention districts, one designated teacher from each of 9797 government schools, received a day-long training intervention each year for five years; discussing the harms of tobacco-use and how to implement eleven TFS criteria mandated by national guidelines. In two similar comparison districts, no such intervention was offered. At the end of five years, trained observers verified adherence to the 11 TFS criteria by visiting randomly selected schools in five districts, including 212 schools in three intervention districts and 86 schools in two comparison districts. A chi-square test checked for differences in the proportion of TFS.

Results:
In the intervention districts, 39.2% (83) of schools fulfilled all 11 TFS criteria, 31.1% (66) achieved 7 to 10 criteria, and 29.7% (63) schools completed 6 or less criteria. This was significantly (p<.001) higher than the comparison districts, where no school fulfilled all 11 criteria, 15.1% (13) achieved 7-10 criteria, and 84.9% (73) met 6 or less criteria. Individual criteria difficult to fulfill were: having a copy of the law, connecting with nodal tobacco control officers, and recognizing efforts for tobacco prevention.

Conclusion(s):
The teacher-training intervention helped achieve 100% TFS in two out of five schools; another one in three schools fulfilled 7-10 TFS criteria. The proportion of 100% TFS can be increased and achieved in lesser duration by addressing barriers, which need to be examined in further research.