National Tobacco Control Program Research Articles

A realist evaluation of the implementation of a national tobacco control program and policy in India.

There is a growing interest in studying and unpacking implementation of policies and programmes as it provides an opportunity to reduce the policy translation time lag taken for research findings to translate to policies and get implemented and understand why policies may fail. Realist evaluation is a theory-driven approach that embraces complexity and helps to identify the mechanisms generating the observed policy outcomes in given context. We aimed to study facilitators and barriers while implementing the Cigarettes and Other Tobacco Products Act, 2003 (COTPA) a comprehensive national tobacco control policy, and the National Tobacco Control Programme (NTCP), 2008 using realist evaluation. We developed an initial program theory (IPT) based on a realist literature review of tobacco control policies in Low- and Middle-Income Countries (LMICs). Three diverse states -Kerala, West Bengal, and Arunachal Pradesh- with varying degree of implementation of tobacco control law and program were chosen as case studies. Within the three selected states, we conducted in-depth interviews with 48 state and district-level stakeholders and undertook non-participant observations to refine the IPT. Following this, we organized two regional consultations covering stakeholders from 20 Indian states for a second iteration to further refine the program theory. A total of 300 Intervention-Context-Actor-Mechanism-Outcome (ICAMO) configurations were developed from the interview data, which were later synthesized into state-specific narrative program theories for Kerala, West Bengal and Arunachal Pradesh. We identified five mechanisms: collective action, felt accountability, individual motivation, fear, and prioritization that were (or were not) triggered leading to diverse implementation outcomes. We identified facilitators and barriers to implementing the COTPA and the NTCP, which have important research and practical implications for furthering the implementation of these policies as well as implementation research in India. In the future, researchers could build on the refined program theory proposed in this study to develop a middle-range theory to explain tobacco control policy implementation in India and other LMICs.

Interest in Online Tobacco Cessation Services During the COVID-19 Pandemic in India- insights from Google Trends

Abstract Background: With concerns about higher mortality and morbidity attributed to COVID-19 infection among tobacco users, the pandemic has been an opportune time to further our efforts towards tobacco cessation. The present study thus aims to assess the interest in tobacco cessation services during the pandemic. Materials and Methods: An ecological study was done using data from Google Trends for five years. The trends depicting the interest in internet search terms like “Quit-tobacco” and “Quitline” were retrieved and compared over the study period and with the Global Adult Tobacco Survey-India (GATS-II) data estimates (2016–17). The results were reported using descriptive statistics and line graphs. Results: Between 2017 and 21, the search interest regarding quitting tobacco depicted the highest peak corresponding to the second wave of the COVID-19 pandemic. There were significant geographical disparities in the Google searches made across India. As per GATS-II, only 0.2% of the smokers had used a Quitline, corresponding to a smaller peak in Google Trends. Interest in “Quitline” compared to “quit tobacco” was in a ratio of 1:11, and the gap increased further during the pandemic by 1:12. Conclusions: We observed an increasing interest in the searches related to “Quit-tobacco” like terms during the pandemic but an increasing gap in the interest around the “Quitline” searches. The present study hypothesizes that the pandemic increased concerns regarding tobacco, leading to a higher interest in tobacco cessation services, thus calling for a proactive approach to propagate ‘Quitline’ through generous advocacy to have efficient tobacco control per the National Tobacco Control Program.

The National and State Tobacco Control Program: Overview of the Centers for Disease Control and Prevention's Efforts to Address Commercial Tobacco Use.

The National and State Tobacco Control Program: Overview of the Centers for Disease Control and Prevention's Efforts to Address Commercial Tobacco Use.

A Study On Insight Into Cessation Attempts Among Current Smokeless Tobacco Users In An Urban Slum Of Ahmedabad

Introduction:According to GATS-2 report, one out of every five persons in Gujarat uses smokelesstobacco (SLT).Tobacco causes addiction & dependence over a period of time.Tobacco cessation is anintegral part of the National Tobacco Control Programme.Objective:To estimate the proportion ofprevious quit attempts and its determinants among current SLT users of an urban slum inAhmedabad.Methods:A community-based, cross-sectional study using consecutive sampling wasconducted between June 2023 - August 2023 among 250 current SLT users in an urban slum ofAhmedabad( Ward number 15). A pre-tested, semi-structured questionnaire adapted from GATS-2(Global Adult Tobacco Survey-2) Tobacco Questions for Surveys was administered among theparticipants for eliciting sociodemographic characteristics, SLT consumption pattern and quittingattempts. Results:In this study, 68.8% of the participants had at least one past quit attempt out ofwhich 94.7% tried self- control methods. The most common reason for not being able to quit wasperceived as addiction (70.9%). A larger part of SLT users (89%) had noticed warning labels intobacco packets and 18.3% of them reported that they thought of quitting seeing that warning. Threefourth of the participants were advised by at least one person to not consume tobacco products & in60% of the cases, it was the spouse.Conclusions and recommendations:The results suggest that there is an obvious lacuna in the community's utilization of services, despite the fact that National Tobacco Control Programme (NTCP) provides nationwide cessation services. This demonstrates theneed for extensive community-based tobacco cessation activities. Keywords:Smokelesstobacco(SLT), Addiction,Quit Attempt, National Tobacco Control Programme(NTCP)

An interventional study evaluating the NTCP (NATIONAL TOBACCO CONTROL PROGRAM) guidelines-based education model in semi-urban school population.

The present study was carried out to assess the awareness of the adverse consequences of tobacco use in the semi-urban school population in Wardha district because tobacco use in schools is a significant concern and is rising at an alarming rate. The purpose of the current study was to assess the prevalence of tobacco use among students and teachers as well as their knowledge of the negative effects of tobacco use. It also aimed to educate students and teachers about these effects and assess the effectiveness of the intervention. A total of 350 students from a semi-urban school in the Wardha area participated in this study. Pre-tests were administered to a group of chosen kids and instructors to gauge their familiarity with tobacco. After the pre-test data were analyzed, teachers were offered intervention. PowerPoint presentations, posters, and models were used to educate them about the dangers of tobacco usage for dental health. There were discussions, role plays, and skits done. After the instruction, the students took a post-test to gauge how well they understood what they had learned. The recent study is a significant step toward the semi-urban school population quitting smoking. Overall, the study involves testing participants' knowledge, teaching them about tobacco's negative consequences, and inspiring habitual smokers to completely kick the habit. The majority of the NTCP questionnaire's elements were significant when compared to knowledge of tobacco use and its components (*p0.05; significant). The suggested study is a significant step toward the semi-urban school population quitting smoking. The research will provide a genuine and dependable change and help promote optimal dental health.

An interventional study to assess the impact of behavior modification therapy on motivation level for tobacco cessation among adult tobacco users in a resettlement colony of South Delhi.

Tobacco use remains a significant global health challenge, contributing to 8 million annual deaths and potentially reaching 1 billion deaths in the 21st century. Despite taking efforts like India's National Tobacco Control Program, the country faces a persistent 39% tobacco use prevalence, particularly in low-income communities like those from Madanpur Khadar, Delhi. This study explores the effectiveness of behavior modification therapy in addressing this challenge. In a community-based trial, 400 adult tobacco users from Madanpur Khadar were enrolled and randomization and allocation concealment were done (CTRI no.: CTRI/2021/06/034298). Participants were randomly assigned to intervention and control groups during the study period of 18 months. Data on sociodemographic characteristics, smoking behaviors, and motivation levels were collected. The intervention included behavior modification therapy, while the control group received brief advice. Motivation levels were assessed using the contemplation ladder, and carbon monoxide levels were measured with piCO + Smokerlyzer. The study adhered to ethical considerations and obtained approval from Jamia Hamdard's Institutional Ethical Committee. Sociodemographic characteristics revealed a predominantly male (88%) population, aged above 30 years (68.5%), with lower middle class representation (51%). The intervention group exhibited a 7% smoking cessation rate, which is significantly higher than the control group (1%). piCO+ Smokerlyzer confirmed a 41.7% reduction in carbon monoxide levels among participants in the intervention group. High motivation levels correlated with successful quitting, with a 6.5 times higher odds ratio for highly motivated individuals compared to low or moderately motivated ones. The study highlights the cost-effective impact of behavior modification therapy in promoting tobacco cessation, particularly in resource-constrained settings. The significant association between motivation levels and quitting underscores the importance of tailored interventions in public health initiatives aimed at reducing tobacco use.

Pattern and trend of cancer in Saurashtra region in Gujarat state of India, a hospital-based study.

Cancer is growing concern for every country. Reliable data is a source to define the magnitude of the problem, which then helps to plan for necessary action. This epidemiological study involves the collection and analysis of hospital registry data to assess the quantum of the problem of cancer over a five-year period from 2012-16 and to plan priority action. Hospital-based data for five years from 2012-2016 was retrieved from the department of radiotherapy at M. P. Shah Government Medical College, Jamnagar, Gujarat, India, and analysed to define the magnitude of the problem. All data was studied using Microsoft Excel 2016. A total of 7355 patients were registered between 2012 and 2016, out of which 62 percent were male. Cancers of the cervix and uterus were discernibly less common in the Saurashtra region and accounted for only 12.37% of all cancers in females. Lung cancer was the leading cancer as a single site in males (24.13% of all cancers in males) and breast cancer in females (37.36% of all cancers in females). Head and neck cancer, all sites clubbed, was most common in males (42%). Jamnagar taluka represented around 50% of all cases at the study center. Tobacco-related cancers were most common in the male population, and stringent implementation of a national tobacco control program is the most appropriate measure to curtail incidences and hence mortality in this male population. Non-modifiable risk factors like gender-related cancer were more common in the female population, and resource-appropriate screening is a suitable option for these diseases. A population-based cancer registry is required to further define the pattern pertinently, or an epidemiological study is required to find causes of the noticeably lower incidence of cancer of the cervix,.

Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention

ObjectiveDespite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for...

The OECD report on the evaluation of the national tobacco control programme in France

The OECD report on the evaluation of the national tobacco control programme in France

Shifting the gaze on implementation: examining the association between the implementation of tobacco control laws and prevalence of tobacco using data from a nationally representative survey

BackgroundTobacco use and the associated health burden is a cause of concern in India and globally. Despite several tobacco control policies in place, their sub-optimal and variable implementation across Indian states has remained a concern. Studies evaluating the real-world implementation of policies such as Cigarettes and Other Tobacco Products (COTPA) or National Tobacco Control Program (NTCP) in India and its association with reductions in tobacco use are limited. In this paper, we analyse data from a nationally representative survey to examine how policy implementation is associated with the tobacco use prevalence in India.MethodsWe analysed data from the Global Adult Tobacco Survey (GATS 2016–17) India using multivariable logistic regression. The dependent variables were the use of smoked tobacco, smokeless tobacco, and tobacco in any form. The independent variables were proxies of implementation of the COTPA and the NTCP. We followed a step-wise backward elimination technique to reach the best fit models.ResultsPeople exposed to no-smoking signages had lower odds of using tobacco (OR = 0.70, p < 0.001). People exposed to second-hand smoke (OR = 1.51, p < 0.001) and tobacco product advertisements (OR = 1.23, p < 0.001) had greater odds of using tobacco. Exposure to tobacco advertisements was associated with higher odds of using smokeless tobacco (OR = 1.23, p < 0.001), and smoked (OR = 1.33, p < 0.001) forms of tobacco.ConclusionWe find significant association between the implementation of tobacco control laws/programs and tobacco use in India. Our findings highlight the potential that policy implementation holds in reducing population-level tobacco use thus drawing attention towards the implementation phase of policies. The findings have implications on prioritising enforcement of specific tobacco control measures such as smokefree laws, modifying COTPA signages to encompass all tobacco products including against smokeless tobacco use and strengthening indirect advertising restrictions. Future research could focus on developing and validating predictors specific to policy implementation to support policy evaluation efforts.

MPOWER Measures and Its Effect on Tobacco Control: A Cross-sectional Comparison of Global Adult Tobacco Surveys, India.

To study the MPOWER measures over time (GATS-1 vs GATS-2) and their effects on tobacco control indicators in India. The study used a cross-sectional design to compare the common questions identified from GATS-1 and GATS-2. Odds ratios for various MPOWER measures were estimated using a multivariate logistic regression model. Compared with GATS-1, the current any tobacco use was reduced by 32% in females and 17% in males in GATS-2 (M-measures). The P-measures have reduced across the survey periods. Under O-measures, compared with mixed users, only the male smokeless tobacco (SLT) users reported receiving more advice from a doctor to quit and reported trying more to stop SLT use. Compared with never users (W-measures), the health warnings were noticed on SLT products more by past users, smokers (males), and SLT users, while it was noticed on cigarette packages more by male past users and smokers. Promotion (E-measures) of cigarette and bidi was reported more by smokers (including mixed users), and promotion of SLT product was reported more by smokers (including mixed users) and male SLT users than by never users. Overall, MPOWER measures have shown improvement, with most changes highly reported by the never users and past users than by the current tobacco users. Stringent methods for the enforcement of MPOWER measures to reach all forms of tobacco users and integration of the National Tobacco Control Programme with other national health programs are imperative for highest achievements. Also, specific targeted strategies for the effective control of SLT use are highly recommended to be included in the MPOWER package.

Programme and policy perspectives towards a tobacco-free generation in India: findings from a qualitative study

ObjectiveThis study explored multistakeholder perspectives on existing adolescent-specific tobacco control policies and programmes, to advance India’s transition towards a tobacco-free generation.DesignQualitative semi-structured interviews.SettingInterviews were conducted with officials involved in tobacco...

Non-pharmacological Interventions for Tobacco Cessation in India: A Systematic Review and Network Meta-analysis.

Non-pharmacological management of tobacco cessation has been reported to yield a high level of abstinence from tobacco usage. However, it is unclear which type of non-pharmacological intervention to be adopted in national tobacco control program. Hence, we undertook this review to identify the best non-pharmacological tobacco cessation therapies for tobacco cessation. Systematic literature search was performed in EMBASE, SCOPUS, PubMed Central, CENTRAL, MEDLINE, Google Scholar, ScienceDirect, and Clinicaltrials.gov from 1964 until September 2022. Randomized controlled trials assessing the effectiveness of non-pharmacological intervention for tobacco cessation in India were eligible for inclusion. Comparative intervention effect estimates obtained from network meta-analyses were represented as pooled odds ratio (OR) with 95% confidence interval (CI). 21 studies were eligible for the analysis. More than half of the studies had high risk of bias. E-Health intervention had the highest OR (pooled OR = 9.90; 95% CI: 2.01 to 48.86) in terms of tobacco cessation rate followed by group counseling (pooled OR = 3.61; 95% CI: 1.48 to 8.78) and individual counseling (pooled OR = 3.43; 95% CI: 1.43 to 8.25). Brief advice or self-help intervention or comparison between each of these interventions against each other (both direct and indirect network) did not yield any significant results. E-Health intervention was the best intervention followed by group intervention and individual face-to-face counseling intervention for tobacco cessation in India. Nonetheless, more high-quality large-scale RCTs either individual or by combining the e-Health, individual, or group counseling interventions are required to provide conclusive evidence and subsequent adoption into the national health programs in India. This study would aid the policymakers, clinicians, and public health researchers in choosing the right tobacco cessation therapy to be offered across various levels of the healthcare delivery system, including major health facilities providing drug therapy (ie, concurrently with pharmacological treatment for tobacco cessation) in India. The study findings can be adopted by the national tobacco control program to decide the appropriate intervention package and identify the areas of focus to perform tobacco-related research in the country.

Assessing the NATIONAL TOBACCO CONTROL PROGRAMME (NTCP) guidelines-based education model in semi-urban school population: An interventional study.

Awareness in semi-urban school population about harmful effects of tobacco use. Hence, the objectives of the present research protocol are to evaluate the incidence of tobacco usage amongst school children and educators, to evaluate the knowledge of students and teachers regarding the harmful effects of tobacco, to educate students and teachers regarding the deleterious effects of tobacco and to evaluate the success of the intervention. This study will be conducted at a semi-urban school located in the Wardha district. A cluster of students and teachers will be selected and will be given a pre-test to assess their knowledge regarding tobacco. The questionnaire will also help in evaluating the total number of participants consuming tobacco. Teachers will be given intervention when the data from the pre-test has been analysed. They will be educated regarding tobacco and its effects on oral health with the use of PowerPoint presentations, posters and models. Activities such as skits, role plays and discussions will be performed. Teachers will be asked to educate the students regarding the same. After the students are educated, they will be given a post-test to evaluate their understanding after the teachers have educated them. Tobacco users will be motivated to complete the cessation of tobacco. A questionnaire comprises 20 questions that are taken from National Tobacco Control Programme (NTPC) guidelines. The proposed study represents a major step towards tobacco cessation amongst semi-urban school population. Overall, the study includes evaluating the knowledge of participants, educating them regarding the harmful effects of tobacco and motivating the participants who are tobacco chewers to complete stoppage of habit. The study will develop a valid and reliable change and would contribute in the development of good oral health. This research will provide in the Indian context, evidence that will underpin better selection in semi-urban schools of the Wardha district. The proposed study represents a major step towards tobacco cessation amongst semi-urban school population. The study will develop a valid and reliable change and would contribute in the development of good oral health.

Impacto da pandemia da Covid-19 sobre o Serviço e Cuidado à Pessoa Tabagista no SUS

Abstract During the Covid-19 pandemic, the smoker treatment service was impacted. This article evaluated the impact of the pandemic on the service in the SUS. This is an ecological descriptive observational study using the National Tobacco Control Program (PNCT) database for the years 2019, 2020 and 2021, from five states (PA, PB, GO, RJ and RS) for the second four months. Relative differences were estimated in the number of units that offered the service and in the number of consultations for clinical evaluation, first and fourth sessions. For the years 2019 and 2020, there was a percentage difference of -51.9% in the number of units that offered the service in all states studied. For the years 2019 and 2021, the relative difference for the health units was -20.96% and, for the clinical evaluation, the first and fourth sessions were: -54.19%, -55.07% and -61 .31%, respectively. These differences were greater for the capitals when compared to the other municipalities. Despite the negative impact, especially in the first year of the pandemic, the study showed that the services did not interrupt their activities and showed some recovery in 2021. It was also important to note that smokers, despite the recommendations, did not stop seeking treatment.

Situational analysis of the smoking cessation program in a Brazilian capital during the COVID-19 pandemic.

Smoking is a public health problem associated with high morbimortality. Smoking cessation services, although effective, have limited reach and have been compromised by the pandemic. This study aimed to analyze the care for smokers in João Pessoa (PB), Brazil, during the COVID-19 pandemic. A descriptive, exploratory, and quantitative study was conducted in two phases: a survey of health indicators and an evaluation of sociodemographic profiles of professionals and service clients during the study years. Seven professionals, smoking group coordinators, and 20 clients participated in the research. The results showed low program coverage, with a declining number of smokers treated during the pandemic, down from 419 in 2019 to 129 in 2020. Interviews identified the program's positive aspects and limitations, good effectiveness, and low access, especially in primary health care. Tobacco consumption and risk reduction strategies during the COVID-19 pandemic originated from services and professionals involved. We can conclude that the National Tobacco Control Program has an incipient implementation in primary health care in this region and that the number of services offered was reduced during the pandemic, decreasing demand and actions.

Análise situacional do programa de cessação tabágica em uma capital brasileira na pandemia da COVID-19

Abstract Smoking is a public health problem associated with high morbimortality. Smoking cessation services, although effective, have limited reach and have been compromised by the pandemic. This study aimed to analyze the care for smokers in João Pessoa (PB), Brazil, during the COVID-19 pandemic. A descriptive, exploratory, and quantitative study was conducted in two phases: a survey of health indicators and an evaluation of sociodemographic profiles of professionals and service clients during the study years. Seven professionals, smoking group coordinators, and 20 clients participated in the research. The results showed low program coverage, with a declining number of smokers treated during the pandemic, down from 419 in 2019 to 129 in 2020. Interviews identified the program’s positive aspects and limitations, good effectiveness, and low access, especially in primary health care. Tobacco consumption and risk reduction strategies during the COVID-19 pandemic originated from services and professionals involved. We can conclude that the National Tobacco Control Program has an incipient implementation in primary health care in this region and that the number of services offered was reduced during the pandemic, decreasing demand and actions.

Gendered Pattern and Predictors of Tobacco use in India: Evidence from the Second Round of Global adult Tobacco Survey.

India has completed the second round of the Global Adult Tobacco Survey (GATS) to monitor adult tobacco use and progress in tobacco control efforts. This study assesses the gendered pattern of tobacco use and its predictors in the second rounds of GATS. Publicly available GATS-2 (2016-2017) data was analyzed which contains self-reported tobacco use information of ≥15 years Indians (n = 74,037). The independent predictors of "smoking only," "smokeless only," and "dual use" among current male and female tobacco users were assessed using the multinomial regression model. The burden of "smoking only," "smokeless only," and "dual-use" of tobacco were 8.9% (8.74-9.15), 16.69% (16.42-16.96), and 3.89% (3.75-4.03), respectively, in the second round with wide regional variation as well as male dominance in use. Region, age, education, caste, and religion were significantly and consistently associated with different types of tobacco use in both genders. Other contextual predictors of tobacco use were residence, marital status, occupation, awareness, and wealth index (WI). Tobacco use predictors and their gendered patterns are contextual. Monitoring the predictors for tobacco use, which may change over time, should be given priority in the national tobacco control program.

Tobacco Cessation and Tobacco Cessation Centre

Tobacco is a small name but widely used addictive substance due to its easy availability, variable forms, and low cost. It not only affects mortality and morbidity caused by various non- communicable disease and cancer but also affect the global economy by increasing health cost and reducing effective earning hours &amp; life expectancy. Government and NGOs have tried to reduce consumption by various modalities, but people haven't utilized facilities due to a lack of awareness, myths, and peer pressure. This articledescribes the tobacco cessation center's history, structure &amp; function with the National Tobacco Control Programme, and penalties for violating the tobacco production act with the aim of increasing awareness of government facilities to prevent the consumption of various forms of tobacco.

Tobacco Cessation Intervention for Young People.

Most adolescent tobacco control programs focus on preventing consumption, but teen smoking persists. It is uncertain whether adult-specific therapies can assist adolescents in quitting smoking. The rising incidence of smoking in low and middle-socioeconomic countries and the challenges of conducting tobacco cessation programs in these settings (due to increasing population, poor lifestyle, lack of awareness and education, professional stress, and non-compliance) need an emphasis on the scope of trials to conduct tobacco cessation in these settings. In the 11th Five Year Plan, the Indian government introduced a new National Tobacco Control Program, which currently spans 108 districts in 31 states across the country. The objective is to review the randomized control trials of selected individuals held in India and assess and evaluate the effectiveness of the steps taken by the government to help people quit tobacco consumption. These programs are important because of the hazards and impact they have on the public health indices of the nation. The government has taken steps like prohibiting smoking in public areas and banning sources. Several programs, particularly those that employed group counselling, included a range of approaches that proved beneficial in helping young people quit smoking. The RCTs mentioned are psychosocially followed by behavioral and pharmacological therapies. The challenges faced are not having participatory health care, motivating tobacco users to quit even in the short-term, adequate coverage; barriers at a different level of implementation (at a regional, state, or national level); and interference by the tobacco industry should be eliminated. The currently functioning programs in India are the National Tobacco Control Program, the National and three Regional Quitlines and mCessation.