Incremental Benefits of Multiple Tobacco Control Interventions: A Factorial Randomized Control Trial.

Divya Persai,Anup Karan,Rajmohan Panda

doi:10.31557/apjcp.2020.21.7.1905

Abstract

Tobacco control requires a comprehensive approach. The present study aims to examine the incremental effectiveness of health systems intervention when combined with other interventions in enhancing knowledge and practices of physicians in tobacco cessation. Methods:A randomized control trial was conducted among 437 physicians in 12 districts of two states of India in 2011-13. The interventions consisted of Health Systems (H), Community (C) and Youth intervention (Y). Administrative Blocks /Mandals were randomly assigned to one of the three interventions (HC /HCY/HY) and control units. The health system intervention consisted of training physicians and developing a system of patient support and supervision for tobacco cessation. The primary outcome was change in knowledge and practices of physicians in tobacco cessation. Logistic regression model was applied to assess the impact of single and combination of interventions. Results:An increase in knowledge was observed on effects of tobacco on adverse birth outcomes, advice on NRT and, information provided on chronic disease management among physicians in HC, HY and HCY intervention units compared to control units from pre-intervention to post-intervention. Statistically significant change was observed in knowledge of physicians on effects of tobacco on adverse birth outcomes in HC (OR- 4.75, p-0.02) and HCY (OR- 5.08, p-0.04) intervention units. Conclusions:HCY intervention was most effective in enhancing knowledge and practices of physicians in tobacco cessation. Our study suggests that individual tobacco control interventions when combined together has an incremental effect and increases the likelihood of provision of tobacco cessation services in primary care.

Highlights

Tobacco use is a leading cause of preventable premature death in the world today, claiming 100 million premature lives per year (WHO, 2008)
An increase in knowledge was observed on effects of tobacco on adverse birth outcomes, advice on NRT and, information provided on chronic disease management among physicians in Health System and Community (HC), Health System and Youth (HY) and Health system + Community+ Youth (HCY) intervention units compared to control units from pre-intervention to post-intervention
An increase in knowledge on effects of tobacco on adverse birth outcomes (32%), advice of NRT (13%) and information provided on chronic disease management (8%) was observed among physicians in health system and community (HC) intervention units as compared to control units (Adverse birth outcome: 8%; Advice on NRT:-8%; Information on chronic disease management: 2%)

Summary

Introduction

Tobacco use is a leading cause of preventable premature death in the world today, claiming 100 million premature lives per year (WHO, 2008). Tobacco use is determined by multiple factors and attempts to control the epidemic requires a comprehensive approach one that optimizes synergy from applying a mix of educational, clinical, and social strategies (CDC, 2014). Most strategies to reduce tobacco demand fall into two broad categories i.e. Clinical and population-level interventions. Research has shown greater effectiveness with multi-component interventional efforts that integrate the implementation of programmatic and policy initiatives in tobacco control to influence social norms and systems (National Cancer Institute, 2005; National Cancer Institute 1995). Health systems intervention plays an important role in tobacco control. Individual-level health care provider interventions involve one-to-one interactions between patient and a provider often within a clinical environment.

Methods

Results

Conclusion