Cessation Center Research Articles

Tobacco Use Prevention and Cessation Programme For Pregnant Women Accessing Antenatal Care In Urban Public Health Facilities In Southern India

Abstract Backgrounds and problem By 2030, tobacco use is estimated to kill more than 8 million people worldwide annually, with LMICs accounting for over 80% of those deaths. In India, about 4.6% of women continue to use tobacco mainly (> 80%) in smokeless (SLT) form during pregnancy. This may lead to: higher risk of anemia (∼ 70%), hypertension, and postpartum hemorrhage; poor fetal development; and 2-3 times higher rate of low-birth and stillbirth babies. Importance Anti-tobacco initiatives often focus on smoking over SLT, which is commonly consumed by women. Drivers of SLT use among women include: cultural appropriateness, medicinal benefits, and poor social determinants of health. These factors must be taken into account while formulating effective anti-tobacco interventions for pregnant women, ensuring safe motherhood and neonatal health. Solution We propose integrating oral health interventions in mitigating tobacco use within the existing antenatal care (ANC) model. Women enrolled in public health facilities in an urban poor neighborhood in South India receive oral health education (OHE) integrated into ANC. The intervention promotes oral hygiene habits, dietary advices, improving dental healthcare utilization, and sensitization on the ill-effects of tobacco-use. Training for ANC providers focuses on delivering antenatal tobacco screening, cessation, and referral services. This includes expanding the medical history to record tobacco use, conduct oral examination and referrals to dentists and/or tobacco cessation centres. Final outcomes of OHE will be measured using pre and post KAP surveys informed by WHO Oral Health Surveys; and training programme using in-depth interviews among providers. Desired policy change is the inclusion of tobacco prevention and cessation programme in the Indian ANC guidelines.

Tobacco cessation center in a dental college: An 8 year institution-based study.

Oral cancer is a major health concern in the Indian subcontinent, where it ranks among the top three types of cancer in the country. Tobacco and its products have been implicated as a major etiologic factor behind cancers. It is believed that tobacco is an epidemic in itself taking the death toll to 7 million globally. In India alone, mortality because of tobacco is more than 1.3 million. Dentists are the first to notice any change in the oral cavity or come across any suspicious looking oral lesion and therefore are instrumental in primary prevention and care. The present study data are of the patients enrolled in a Tobacco Cessation Center(TCC) at a Dental College in Meerut in Meerut from May 2012 (since its inception) to March 2020. The following methods of counseling were carried out: group counseling, interactive sessions, audio-visual aids, and individual counseling sessions. Self-training for oral cavity examination was also given after every group counseling session. Behavioral counseling and pharmacological intervention were given as per Fagerström Test for Nicotine Dependence (FTND) score. At the end of 1 year, patients who quit were graded into 0, 1, and 2, with 0 for those who failed to quit, 1 for those who did completely quit, and 2 for those who reduced their habit by more than 50%. The quit rate achieved was 57.6% (complete responders -43.2% and partial responders 14.4%). The relapse reported was 1.8%. A Tobacco cessation Center set up in a Dental College could be of great help in the primary prevention of oral cancer and can bring a drastic increase in quit rates. Proper counseling skills once nurtured in young under-graduates can boost the tobacco-free India campaign.

Factors associated with long-term smoking relapse in those who succeeded in smoking cessation using regional smoking cessation programs.

It is known that approximately 10% of successful quitters relapse annually. This study aimed to investigate the factors related to long-term smoking relapse in individuals who succeeded in maintaining smoking cessation for 6 months after attending a regional smoking cessation program.This study enrolled 943 individuals registered for the regional smoking cessation program at the Busan Smoking Cessation Center in 2018–2019 who maintained smoking cessation for 6 months. A survey was conducted using a smartphone link or through phone calls, and the data for 305 participants who finally completed the survey were analyzed. The questionnaire addressed individual, inter-individual, organizational, and community-level factors related to smoking relapse. Multivariate logistic regression analysis was performed to evaluate the factors associated with smoking relapse by period. The Cox proportional hazard regression model was used for the factors associated with smoking relapse for the entire period.The smoking relapse rate at the time of the survey was 25.4%. In the analysis of smoking relapse by period, relapse was associated with the belief that smoking relieves stress, the number of single-person households, and poor subjective health status. In the analysis of smoking relapse during the entire period, we observed a significant association with the belief that smoking relieves stress (hazard ratio [HR]: 2.65, 95% confidence interval [CI]: 1.52–4.61), single-person households (HR: 1.95, 95% CI: 1.16–3.26), and high levels of emotional stress (HR: 1.72, 95% CI: 1.04–2.85).Long-term follow-up is necessary to prevent smoking relapse in single-person households, individuals who believe that smoking relieves stress, and those experiencing high levels of subjective emotional stress. Interventional therapies for stress relief and awareness improvement in smokers need to be developed.

Emotional and Therapeutic Elements of Cigarette Smoking Control: A Cross Sectional Study

Aim: The aim of this study was to investigate the impact of services rendered by health professionals in reducing cigarette smoking at the smoking cessation centers.
 Methods: Through May 2020 and April 2021, data from hospitals connected with the University of Health Sciences, Lahore, have been collected. During the same time period, information from DHQ and Allied Hospitals Faisalabad were evaluated using a recent retrospective review. Statistical software was used to calculate the incidence and average values. Chi-square also student t tests remained utilized to evaluate associated variables; p 0.06 remained measured statistically.
 Results: The average age of entrance was 39.73 13.21 years (min 14; max 92). Women were older than males at time of admission, although men began smoking earlier. Individuals with fewer than a high school diploma began smoking at a younger age. Once cured through medication also behavioral treatment, the smoking cessation rate remained 38.4 percent (n = 218).
 Conclusion: Approximately 49 percent of smokers stopped smoking after receiving medication and behavioral counseling. The majority of smokers was between ages of 31 and 51. More smoking cessation clinics should be built to provide smoking cessation tools to more informed individuals.

The influence of smoking on oral health and patient evaluation of tobacco cessation help from dentists working in the dental college of Bareilly city

Introduction: Dentists play a key role in assisting patients in quitting smoking. Dentists’ competence in smoking cessation as part of regular patient treatment is studied in this research. Methodology: Two hundred twenty-six patients were selected from the Institute of Dental Sciences Bareilly’s smoke cessation center to complete in-person cross-sectional research about previous dental visits Patients’ smoking patterns, as well as their smoking cessation experience from their dentists, and willingness for dentists to apply smoking cessation recommendations were all covered in the survey. Results: Overall, 38 percent of the subjects were current smokers, 8% were former smokers, and 68% had tried to stop smoking before. Former/non-smokers had significantly greater plaque index, gingival index, and probing depth levels than smokers (p0.05). The dentists’ approach to cessation conversations, on the other hand, was limited to a list of the negative consequences. Only 32% of patients were told about the negative impacts of tobacco, and only a third were encouraged to quit. Conclusions: Smoking causes dental health issues. Dentists in Bareilly City may inquire about their patients’ smoking habits, but they are less likely to provide actual assistance in quitting.

Epidemiological profile of tobacco users attending a tobacco cessation centre at Puducherry, India

Background: Tobacco is a major health burden and an effort has been made to help users to quit tobacco by establishing a tobacco cessation centre in our Institution. A knowledge on the extent of distribution of tobacco use across the various sub-groups of the users would provide clues to behavioural patterns. Objective: To describe the epidemiological profile of tobacco users and to provide a baseline data about the attendees of the cessation centre. Materials and Methods: The data for the present descriptive evaluation were collected by reviewing of case records of participants enrolled from April 2014 to March 2015. Data on demographic characteristics, tobacco use details, substance use details and geographic profile were evaluated. Descriptive statistics were used to present the data using number and percentage. Results: Of the 621 current tobacco users, 95.5% were of male gender. Most participants were married (79.4%), literates (84.9%) and were in the fourth decade of life. 78.1% were exclusive Smokers, 18.2% were exclusive Smokeless tobacco (SLT) users and 3.7% were dual form users. “Peer pressure” was the major reason for initiation of the habit. “Cigarette” was used by 65% of the Smokers and “Betel quid with tobacco” was used by 36.6% of the SLT users. 86.1 and 13.9% of the Puducherry residents were smokers and SLT users respectively. “Oral potentially malignant disorders” were noted in 8% of the users. Conclusion: The observations of the present evaluation provide a baseline data which may serve as a starting point for future epidemiological enquiry.

Spirometry feedback as a motivational tool for tobacco cessation

Abstract Background Tobacco use remains a major public health problem especially in developing countries and emerging economies. The evidence about the effect of spirometry on smoking cessation is still controversial. The aim of this study was to determine whether a spirometry and lung age announcement were a motivator for smoking cessation. Methods We conducted a randomized controlled trial among patients who attended the smoking cessation clinic (SCC) at Fattouma Bourguiba University Hospital in Monastir, from June 2017 to February 2020. Participants were assigned into two groups, a control arm receiving standard program and intervention arm receiving standard program and lung age announcement. The primary outcome was the smoking cessation rates after one year of follow-up between the intervention arm and the control arm. Results A total of 500 patients were recruited and randomized with 250 patients in each group. At one-year endpoint, a total of 456 patients were reachable for assessment, 236 in control group and 220 in spirometry group. The loss rate was equal to 8.8% (54/500). Six months smoking rate was 78 (33.1%) in control group and 106 (48.0%) in intervention group (p = 0.002). One-year smoking cessation rate was higher in the intervention group than the control group (25.5% versus 16.5%), with a considerable statistical significance (p = 0.019). Spirometric lung age was significantly higher at paired comparison with chronologic age (58.81vs 46.54; p<.001); the mean difference was 10.24 years but with considerable inter-individual variability. Conclusions Smoking cessation is still a challenging procedure with a high risk of relapse. This study is an additional evidence for spirometry and lung age announcement as motivators for cessation. Key messages Spirometry increased the motivation of smoking cessation. The equipment of smoking cessation centers by spirometry may contribute on tobacco control.

Oral Mucosal Lesions' propensity as an Outcome Eventuated by Exhaled Carbon Monoxide (CO) Levels and Nicotine Dependency.

Objective:This study aims to assess the correlation of exhaled CO and nicotine dependence with the occurrence of oral mucosal lesions while also taking into consideration socio-demographic, clinical and anthropometrical characteristics of participants. Methods:An observational cross-sectional study was carried out among smokers who visited the tobacco cessation center at Tertiary Care Dental Hospital in Goa, India. An intra-oral soft tissue examination for detecting presence of oral mucosal lesions followed by a questionnaire-based interview for the measurement of exposure, sociodemographic factors, body mass index, cooking habits and nicotine dependence was conducted. The exhaled CO levels were measured with a CO breath analyzer. Statistical analysis was performed using IBM SPSS version 20.0 Descriptive statistics were calculated and multivariable analysis was done to assess the association of different variables with oral mucosal lesions and carbon monoxide levels. p-value ≤ 0.05 was considered as statistically significant. Results:Of the 173 subjects enrolled in the study, 69.36% were without any lesions while 30.63% were diagnosed with some lesion. In the regression analysis, the variables of physical activity (present vs absent OR: 5.808), exhaled CO levels (OR: 1.098) and nicotine dependence (mild vs moderate OR: 6.518) were significant risk factors influencing the presence of oral mucosal lesions. Usage of both cigarettes and bidis by smokers exhibited highest mean exhaled CO values of 19.67±1.506 ppm. Exhaled CO levels were significantly higher in smokers who were overweight (14.96±9.14 ppm), physically inactive (13.98±8.26 ppm), highly nicotine dependent (20.67±8.30) and used coal for cooking (12.55±8.17). Conclusion:A robust correlation between exhaled CO levels, nicotine dependence and incidence of oral mucosal lesions was established. The multifactorial tenacity of exhaled CO which is affected by smoked tobacco as well as variables such as physical activity, BMI, cooking habits and type of smoking habit should be noted.

Assessment of nicotine dependence among tobacco users visiting outreach programs in Dharan, Nepal: a cross-sectional study

BackgroundNicotine is a highly addictive substance present in tobacco. This study was conducted to assess the level of nicotine dependence among smokers and smokeless tobacco users visiting dental outreach programs of B.P. Koirala Institute of Health Sciences -Dharan, Nepal.MethodsA cross sectional study was conducted from June 2018 to April 2019. A total of 726 people were selected from participants of dental outreach programs of 6 districts using convenience sampling technique. The data collection was done using semi-structured questionnaire through face-to-face interview by a single researcher. History of tobacco use and level of nicotine dependency was measured using Nepali translated and validated form of Fagerström Test for Nicotine Dependence for smoking and smokeless tobacco. The mean age of the tobacco users was 39.55 ± 15.57. Descriptive statistics including the mean, median, percentage, standard deviations and interquartile range were computed. Chi-square test, Fisher’s exact test, univariate and bivariate logistic regression were used where needed.ResultsNicotine dependence (moderate and severe) was found in 80% of smokeless tobacco users and 48% of smokers. Among the smokeless tobacco users, nicotine dependency was found to be more with increase in duration of tobacco use (AOR = 50.25, 95%CI = 3.51–718.62, p = 0.004), low socioeconomic status (AOR = 6.27, 95%CI = 1.30–30.31, p = 0.02), less number of tobacco packets used per day and tried to quit tobacco use in last 1 year. Among smokers nicotine dependency was found to be significantly higher with smoking more than 10 cigarettes per day (AOR = 7.14, 95% CI = 2.00–25.40, p = 0.002).ConclusionsThe study concluded that level of nicotine dependence for both smoking and smokeless tobacco was high among the people visiting dental outreach programs. It is high time to develop a policy to control tobacco use along with creating tobacco cessation centers. Currently, tobacco control program is mostly focusing on smoking. However, it is also important to incorporate smokeless tobacco control at policy level.

Effectiveness and feasibility of smoking counselling: a randomized controlled trial in an Italian emergency department.

Background5A’s counselling is recommended for screening and treating patients with smoking addiction. The emergency department (ED) setting might be a suitable environment for conducting interventions for smoking cessation. The present study aims to determine the feasibility and effectiveness on smoking cessation of 5A’s counselling administered to ED patients by nurses.MethodsParallel group randomized trial assessing 5A’s counselling for smoking cessation vs. usual care at a University Hospital in the North of Italy. The primary end-point was prevalence of tobacco-free patients. The secondary outcomes at 6- and 12-month follow-up were (i) consecutive past 30-day smoking abstinence; (ii) past 7-day 50%, or more, decrease in daily tobacco consumption over baseline; and (iii) number of attempts to quit smoking.ResultsA total of 480 patients were randomized to intervention (n = 262) or usual care (n = 218). Intention to treat analysis displayed no differences in primary and secondary outcomes between groups. A slight but not statistically significant enhancement in cessation was recorded in the intervention group [relative risk (RR) = 1.04, 95% confidence interval (CI) = 0.58–1.87] at 6 months, whereas a reversed observation at 12 months (RR = 0.86, 95% CI = 0.50–1.47). Similar results were obtained for the secondary outcomes. Per protocol analysis increased the size of the results. Of the 126 smokers receiving counselling, 18 were visited and treated at the local smoking cessation centre, with 12 of them successfully completing the treatment.ConclusionThe results of this study indicate that the ED is not a suited environment for 5A’s counselling.

A New Approach to Tobacco Cessation by Using Chart of 5A's Based on National Guidelines

Background: The use of tobacco is linked to cultural and social practices in India. It is the primary cause of oral cancer. Dental health professionals are trained to identify signs of tobacco use following visual examinations of the oral cavity. Through the establishment of Tobacco cessation centers in dental colleges, the dentist receives training in providing tobacco cessation counseling to tobacco users. Thus each patient that seeks dental treatment in dental colleges is also screened for tobacco use and then counseled as appropriate. Aim and objectives: (1) To assess the nicotine dependence. (2) To assess the prevalence of oral diseases. (3) To carry out a detailed and effective tobacco cessation program.(4) To use the newly made chart of 5A's and assess the usefulness of the chart in tobacco cessation counseling. Materials and Methods: The sample size of 100 patients who were tobacco users age 15 to 80 years was selected. 06 questions from the Fagerstrom test for nicotine dependence were used to elicit the nicotine dependence. The tobacco cessation program and detailed counseling were carried out. Statistical Analysis: Data collected were subjected to statistical analysis. Results: Of 100 patients, 57 were highly dependent, 38 were moderately dependent, and 5 were minimally dependent on Nicotine. After Tobacco cessation counseling patients reported back within 8 months, and their nicotine dependence was assessed again using the Fagerstrom questionnaire and was found that: 28 patients were tobacco-free having 0 scores of nicotine dependence, 67 patients were minimally dependent having scored from 1 to 3, 06 patients were moderately dependent having score from 4 to 7. Not a single patient of 100 was highly dependent on nicotine. Conclusions: Establishing a Tobacco cessation center using cognitive and behavioral counseling through the pictorial chart of 5AS, informative leaflets, awareness videos, and regular follow-up has proven effective in helping tobacco users to quit tobacco.

New Biomarkers Based on Smoking-Related Phenotypes for Smoking Cessation Outcomes of Nicotine Replacement Therapy: A Prospective Study.

Introduction:Identifying a potent biomarker for smoking cessation can play a key role in predicting prognosis and improving treatment outcomes. This study aimed to evaluate the contribution of new biomarkers based on the levels of Cotinine (Cot) and carbon monoxide (CO) to the short- and long-term quit rates of nicotine replacement therapies (Nicotine Patch [NP] and Nicotine Lozenge [NL]).Methods:In this prospective interventional study, 124 smokers under treatment with the 5A’s method were selected from an outpatient smoking cessation center in district 18 of Tehran City, Iran. The study was conducted from April 2016 to December 2018. They were divided into NP (n=56) and NL (n=61) intervention groups. The levels of Cot and CO were measured using ELISA and breath analysis at the beginning of the study. Three markers were calculated: Cot/CO, Cot to cigarette per day ratio (Cot/CPD), and CO/CPD. Binary logistic regression models and generalized estimating equations models were analyzed by SPSS software, version 21 to determine the chances of quitting smoking.Results:Of the NP participants, 30.4% and 19.6% were abstinent after 2 and 6 months, respectively, while NL was found less effective with 19.7% for 2-month follow-up and 13.1% for 6-month follow-up. The 6-month success of quitting attempts was significantly different for the NP participants at the second half of Cot/CO (P=0.029). Of the NL participants, CO/CPD would be a superior predictor for smoking cessation success (P>0.05).Conclusion:The findings of this study suggested two markers of Cot/CO and CO/CPD in this order for the optimum treatment outcomes of NP and NL.

The barriers for tobacco cessation counseling in teaching health care institutions: A qualitative data analysis using MAXQDA software.

Introduction:Recently, Dental Council of India directed all the teaching dental institutions in the country to set up tobacco cessation centers (TCC). International experiences suggest that there are many barriers for the provision of tobacco cessation counseling at dental clinics. In this context, it is important to understand the dental students’ attitudes toward this initiative of tobacco cessation counseling at dental settings.Materials and Methods:This qualitative study to document the dental students’ perspectives toward the provision of tobacco cessation counseling using focus group interviews was conducted in two teaching dental institutions in the state of Andhra Pradesh, India. 133 house surgeons from two dental institutions participated in the study and were interviewed as 13 focus groups. MAXQDA (version 12, VERBI GmbH, Berlin, Germany) was used for data analysis. All the interviews were audio recorded and the transcripts were open coded by three independent investigators.Results:The response rate in this study was 78.45%. The following themes were extracted from the views and opinions shared by the students: the reluctance of patients to discuss tobacco-related problems; tobacco use among students discouraging them to actively participate in counseling; an opinion that dental clinics are not suitable for the provision of tobacco cessation counseling; belief among students that they are not qualified enough.Conclusion:The directives given by the Ministry of Health and Family Welfare in association with Dental council of India to set up TCC at every teaching dental institution are laudable and demonstrate the commitment at policy level toward bringing down tobacco consumption in the country. However, few reforms need to be made in the curriculum to better execute the delegated responsibilities, which include orientation programs for dental students on the scope of the dental profession and workshops on tobacco cessation counseling.

Assessment of Relationship of ABO Blood Groups in Oral Cancer Patients - A Retrospective Study.

Introduction:India is a high-risk region for oropharyngeal cancer (OC) due to high prevalence of tobacco, betel nut, and alcohol and accounts for 30% of all new cases of oral cancer annually.Materials and Methods:Records of all 73 diagnosed cases of different types of OC and oropharynx patients were analyzed who reported in “Tobacco cessation center”’ of the Institute between January 2017 and December 2019. The patients’ demographic details, blood groups, oral habits, and clinicohistological records were obtained from the medical records available in the hospital.Results:OC incidence was 3.75 cases/year with male-to-female ratio 3.29:1. Mean age was 51.25 ± 13.6 years. The most common site of tumour presentation was mandibular alveolar ridge. Combined use of tobacco/betal nut/alcohol constituted the major cause for the development of oral squamous cell carcinoma (OSCC). Majority patients were presented in Stage II (43.8%). Histopathological reports were suggestive of maximally well-differentiated (52.1%) OSCC. People with blood group A+ve had 3.22 times higher risk of developing OSCC compared to people of other blood groups.Discussion:Male: female ratio was reported higher than in most of other studies. Mandibular alveolus was the most frequent site because most of the patients tend to keep the tobacco quid in the buccal vestibule with close proximity to alveolus. The relative downregulation of glycosyl transferase that is involved in the biosynthesis of A and B antigens as seen in association with tumour development could be the reason for increased OC reported in blood group A subjects.

Effectiveness of cognitive behavioral therapy and basic health education for tobacco cessation among adult tobacco users attending a private tobacco cessation center.

Background:India being major consumer of tobacco faces various problems involved for its cessation. Over the time enormous methods have been evolved which may aid in tobacco cessation.Materials and Methods:The present study was conducted among 100 adult tobacco users attending tobacco cessation clinic. The individuals where randomized into 2 counselling groups: Group A - Basic health education (BHE) and Group B Cognitive Behavioral Therapy (CBT). Baseline evaluation of demographic parameters, smoking/smokeless behavior was recorded and Fagerstrom's test for Nicotine Dependence (FTND) was utilized to assess subjects’ nicotine addiction levels. Follow up was done at intervals of 2 weeks and 4 weeks to assess the reduction in the mean FTND score. Appropriate statistical test was utilized to evaluate the results.Results:The majority of individuals in the study were male in age group of 41-60 years. The reduction in mean FTND score was found in both Group A and B on follow-up. But when both groups were compared, reductions in mean Fagerstrom scores were found to be more in CBT group than in BHE group at all time intervals.Conclusion:Individuals in both the group have quit the tobacco use by both the interventions followed by proper schematic follow up.

Effectiveness of cognitive-behavioral therapy compared with basic health education for tobacco cessation among smokers: A randomized controlled trial

Background: Tobacco is a risk factor for oral cancer, adult periodontal diseases, and cleft lip and palate in children. Tobacco cessation counseling has been shown to improve the likelihood of achieving success for quitting the habits. Aim: This study aimed to assess the effectiveness of cognitive-behavioral therapy (CBT) compared with basic health education (BHE) for tobacco cessation among smokers in Bengaluru city. Materials and Methods: A randomized controlled trial was conducted over a period of 6 months among smokers attending a tobacco cessation center in a dental college in Bengaluru city. The participants were assigned to either CBT or BHE groups with 1:1 allocation sequence ratio. Randomization and allocation concealment were done by an investigator who had no clinical involvement in the trial. Nicotine dependence was assessed using the Fagerstrom's Addiction Scale for smokers, while motivational levels were assessed using Transtheoretical model. The groups were followed up for 4 and 12 weeks. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS 22.0, IBM, Armonk, NY, USA). Paired and unpaired “t“-tests, Chi-square test, Fisher's exact test, and analysis of variance test were applied. Statistical significance was considered atP < 0.05. Results: Majority of the study participants started smoking at an early age and had long duration and cigarette smoking years. Among CBT group, the mean Fagerstrom's addiction score at baseline (4.8 ± 7.3) significantly reduced (3.8 ± 3.1) at the 1st follow-up and at the 2nd follow-up (3.5 ± 8.9) (P < 0.001). The proportion of smokers with frequency more than ten cigarettes per day reduced from baseline (P = 0.16) to the 2nd follow-up (P = 0.07) in CBT group compared to BHE group. Conclusion: CBT is effective in reducing tobacco habits and addiction levels when compared to BHE among smokers. Tobacco cessation counseling using CBT has been found to reduce smoking habits, thereby improving the possibility of quitting the habits.

Smoking cessation practices and perspectives among in-patients in a tertiary teaching hospital setting

Background: The objective of the present study was to assess the in-patient’s perspectives about smoking cessation and the services they received.Methods: A descriptive study was carried out in a hospital attached to a Medical College. An interview schedule was administered in person to in-patients to assess their perspectives towards smoking cessation and services received.Results: Of the 141 in-patients interviewed, 40% were active smokers. Almost 3/4th of active smokers had moderate to high nicotine dependence. About 92% of active smokers reported being asked about smoking status and being advised to quit, but only 23% received assistance, and 8% had a follow-up arranged. Health was the top reason for the willingness to quit. Around 90% of study participants had no awareness about tobacco cessation centres and services.Conclusions: An in-patient setting has a higher proportion of smokers than the general population. These in-patients should be a prime target for cessation programs as there are relatable health reasons and opportunity for the delivery of comprehensive smoking cessation services based on 5 A’s protocol, which is currently lacking. Creating better awareness regarding smoking cessation centres and services available is necessary.

Approaching nicotine dependency and affecting factors in smoking cessation centers

Amac: Sigara bagimliligi tum dunyada ve ulkemizde halen yaygin bir saglik sorunudur. Son zamanlarda dunyada ve ulkemizde sigara bagimliligi ile ilgili yurutulen eylem planlari farkindalik yaratmis ve sigara birakma poliklinikleri acilmistir. Bu poliklinikler toplum tarafindan buyuk ilgi gormektedir. Bu calismanin amaci sigara birakma polikliniklerine basvuran hastalarin sosyodemografik ozelliklerini belirlemektir. Hedef kitlenin ozelliklerinin bilinmesi sigarayla mucadelede gerceklestirilecek eylem planlarinda ise yarayabilir. Gerec ve Yontem: Tanimlayici, kesitsel ve prospektif nitelikteki bu calisma Ocak 2012-Mart 2012 tarihleri arasinda Ankara Egitim ve Arastirma Hastanesi Aile Hekimligi Sigara Birakma Poliklinigi’nde yapildi. Katilimcilara sosyodemografik ozellikleri iceren anket sorulari soruldu. Ayrica katilimcilara Fagerstrom nikotin bagimlilik testi uygulandi. Toplanan verilen SPSS 16.0 programiyla analiz edildi. Bulgular : Toplam 126 kisi calismaya alindi. Katilimcilarin %61,9’u kadin %38,1’i erkekti. Yas ortalamasi 39,3’du. Fagerstrom puanlari ortalama 7,51’di. Ortalama sigara kullanma miktar ve suresi 13,46 paket/yildi. Hastalarin yarisindan fazlasi daha once sigara birakmayi denemis basarili olamamislardi. Ayrica hastalarin sadece ucte biri sigarayi birakabilecegi konusunda kendine guveniyordu. Hastalar en sik ozenti nedeniyle sigara baslamislar ve en cok da saglik endisesi nedeniyle sigarayi birakmak istiyorlardi. Sonuc: Ozenti nedeniyle baslanan ve yuksek derecede bagimlilik yapan sigara en cok saglik uzerine olumsuz etkisi nedeniyle birakilmak istenmektedir. Sigara birakma polikliniklerine daha cok bagimlilik duzeyi yuksek kadin hastalar basvurmaktadir. Sigarayla mucadelede bu bilgiler isiginda bir politika izlenmesi yararli olacaktir.

Early weight gain after stopping smoking: a predictor of overall large weight gain? A single-site retrospective cohort study

ObjectivesMost people gain weight on stopping smoking but the extent of weight gain varies greatly. Interventions aimed at all quitters to prevent weight gain on cessation have proven unpopular but...

Prevalence of and factors contributing to anxiety, depression and cognitive disorders among urban elderly in Odisha – A study through the health systems’ Lens

IntroductionGrowing geriatric mental health needs of urban population in India pose several programmatic challenges. This study aimed to assess anxiety, depression and cognitive disorders among urban elderly, and explore availability of social support mechanisms and of a responsive health system to implement the national mental health programme. Methods244 respondents were randomly selected from Berhampur city. We administered a semi-structured interview schedule to assess substance abuse, chronic morbidity, anxiety, depression and cognitive abilities. Further, in-depth interviews were conducted with 25 key informants including district officials, psychiatrists, and programme managers. We used R software and ‘thematic framework’ approach, respectively, for quantitative and qualitative data analysis. Ethical standards were complied with. ResultsAbout half of the respondents were economically dependent; 57.3% had moderate to severe anxiety; 46.7% had moderate to severe depression; while about 25% had severe cognitive impairments. We found association of chewing tobacco (1.34(0.28–2.40)) and depression (0.52(0.37–0.68)) with anxiety; negative perception about elderly-friendly society (1.64(0.75–2.53)) and physical inactivity (2.88(1.60–4.16)) with depression; and age (-0.11(-0.20 – -0.02)) and physical inactivity (-3.44(-5.13 – -1.74)) with cognitive disorders. Qualitative analysis revealed lack of awareness, social stigma, poor availability of trained human resources, and poor political commitment as important systemic barriers to early detection and treatment of mental ailments among the elderly. ConclusionEstablishing tobacco cessation centres, sensitizing community about mental health needs of elderly, incentivizing physical activity of elderly, integrating mental health with primary care, multi-skilling providers and developing a cadre of community counsellors need urgent attention of policy makers and programme implementers.