Tobacco Cessation Clinics Research Articles

The Distribution of Public Tobacco Cessation Clinics in Relation to the Socioeconomic Status of the Malaysian Population

Objective: To identify, locate, and examine the distribution of public tobacco cessation clinics in all Malaysian states using a Geographical Information System (GIS) and determine the relationship between the distribution of public tobacco cessation clinics and the population's socioeconomic status. Material and Methods: All registered public tobacco cessation clinics in each state were identified through the mQuit website. Based on the extracted addresses, each clinic's coordinates (longitudes and latitudes) were traced using Google Maps and transferred into Geographical Information System (GIS) for mapping purposes. Results: Wilayah Persekutuan (W.P.) Kuala Lumpur recorded the lowest ratio of public tobacco cessation clinics to the number of smokers, with 1:25,265 (one clinic to 25,265 smokers), while the highest ratio was in W.P. Putrajaya, with 1:2,118. In relation to socioeconomic status, the highest mean household income was recorded in W.P. Kuala Lumpur (mean gross income: RM 11,692), the same state with the lowest ratio of public tobacco cessation clinics. In contrast, Kelantan had the lowest mean household income (mean gross income: RM 4,214), and the ratio of public tobacco cessation clinics to the number of smokers was 1:8,383. The distribution of public tobacco cessation clinics was highly concentrated in the capital area compared to other areas in Malaysia. Conclusion: This study demonstrated the distribution of public tobacco cessation clinics using GIS. The findings showed an unequal distribution of public tobacco cessation clinics, with low distribution, especially in Sabah and W.P. Kuala Lumpur.

Associations of Smoking Behaviors and Body Mass Index Among American Participants of a Clinical Tobacco Cessation Program: A Pilot Study.

Tobacco usage and obesity remain critical public health issues in the United States. This study examined the relationship between smoking behaviors, specifically-cigarettes per day (CPD) and motivations to smoke-and body mass index (BMI). We hypothesized that motivations related to food or stress, as well as a higher CPD, will be positively associated with BMI. We analyzed the electronic medical records of 204 patients from the Johns Hopkins' Tobacco Treatment and Cancer Screening Clinic (TTCSC) between January and April 2022. Demographic information, smoking behavior, CPD, and motivations to smoke were recorded. Multiple linear regression analysis was performed. We found no statistical significance between motivations to smoke, CPD, and BMI. However, the age at a patient's first visit to the TTCSC was negatively associated with BMI (B = -0.152, P < 0.001). Smoking behaviors were not significantly related to BMI in our sample. It is advisable for clinicians working in tobacco cessation clinics to consider the BMI of individuals who present for cessation services, especially for younger individuals who smoke. They may be more likely to have an elevated BMI at presentation.

Tobacco Cessation Centres: Vital Cog in the Fight against Tobacco Epidemic Preparedness towards a future pandemic

The tobacco crisis, which claims more than 8 million lives yearly and adds 1.2 million more from secondhand smoke inhalation, is a serious concern for world health. The detrimental impact of tobacco usage on health is projected to have an annual economic cost of 1.4 trillion US dollars (health costs plus lost productivity) or 1.8% of the world's GDP. Both smokers and users of smokeless tobacco can profit greatly from quitting. Quitting smoking lowers the likelihood of developing respiratory problems, delays their beginning, and slows the progression of chronic lung diseases. Therefore, the "World Health Organisation (WHO)" and the "Ministry of Health &amp; Family Welfare", Government of India, worked together to open official tobacco cessation clinics throughout India. The goal of tobacco cessation centers was to offer to counsel people trying to stop smoking. This includes monitoring the patient's progress and providing counseling, either by itself or in conjunction with medication.

Prevalence of Oral mucosal lesion in patients with Tobacco related habits among Chidambaram population – A Cross-sectional study

Introduction: Tobacco has been traditionally used in many parts of India which was known to be associated with many oral mucosal lesions which has higher chance for morbidity and mortality. A cross sectional study was conducted in Chidambaram population to find the prevalence of oral mucosal lesion in association with tobacco and alcohol related habits. Methods: A descriptive cross-sectional study was conducted among 2246 participants from in and around Chidambaram who attended the outpatient department, during the period of 2months (December 2019 to January 2020). Data collected using questionnaire adapted from global adult tobacco survey questionnaire followed by oral examination. Result: Among the 2246, 161 participants has the habit of using smoking, chewing tobacco and alcohol consumption. This study has the predominance of participants who have combination habits such as smoking tobacco and alcohol consumption. Among the participants with oral mucosal lesion leukoplakia has higher predominance followed by tobacco pouch keratosis and smoker’s palate. Most of the lesions were present in the buccal mucosa. Conclusion: Prevalence of premalignant lesions in association with adverse habits was significant in our study. This shows necessity for early diagnosis and Awareness should be created to the public through anti-tobacco campaign by the government and private agencies. Tobacco cessation clinics should be opened in all primary health care centre and more knowledge should be created about premalignant lesion to prevent the morbidity and mortality rate.

Knowledge, attitude, and beliefs toward group behavior therapy programs among male adults attending smoking cessation clinics, cross-sectional analysis

BackgroundGroup therapy assists individuals in learning many behavioral techniques for smoking cessation and providing each other with mutual support. Group behavior therapy is not routinely provided as a modality of tobacco cessation assistance in tobacco cessation clinics in Saudi Arabia despite it is effectiveness. Therefore, this study aimed to assess the knowledge, attitude, and beliefs toward group behavior therapy programs among male adults who attend smoking cessation clinics and to identify the associated factors.MethodsA cross-sectional study was conducted with a targeted sample of 229 males aged 18 and above who were attending smoking cessation clinics. The participants were randomly selected. Data were collected using a paper-based questionnaire. One-way ANOVA and chi-square test were used for statistical analysis.ResultsResults showed a high percentage of the study participants were in the age group of 21–40 years. Most of them were consuming 10–20 cigarettes per day. Around 79% of the participants had previous attempted to quit smoking. This study demonstrated a deficit in knowledge about group behavior therapy. The mean score for attitude and beliefs was 5.3 out of 11. Multiple factors influenced their attitudes and beliefs, such as previous attempts to quit smoking (p-value < 0.05) and the number of cigarettes used per day (p-value = 0.03). The knowledge was found to be affected by the level of education (p-value = 0.04).ConclusionThe study demonstrates a deficit in knowledge about group behavior therapy and it shows that the level of education was associated with the knowledge. Additionally, previous attempts to quit smoking and the number of cigarettes used per day, influenced the participants’ attitude and beliefs toward group behavioral therapy. Increase awareness about the role of group behavior therapy in smoking cessation is required before this method is implemented in the routine practice.

Effect of tobacco consumption – A review

There are about 1.2 billion smokers worldwide of which estimated about 4 million died every year. Tobacco consumption is a common habitual concern in India; in two major Forms such as Smoking and Chewing tobaccos. Smoking includes Cigarette, Bidi Hukkah and other forms of consumption while Chewing tobaccos include Khaini, Gutka, Mawa, Dukta, Snuff, Gudakhu and other forms. The cancer reported by Chewing forms of Tobaccos are known as CIT (Chewable Indian Tobacco) Cancers. The CIT cancers more seen in India and adjacent countries like Nepal, Bangladesh, Pakistan, Sri Lanka etc, than western part of the globe. It has been calculated that 26 grams of CIT for 20 years will produce oral cancer in genetically coded people. It is a major problem in Oncology, Oral medicine as well as Public Health. Although tobacco smoking has reduced in the recent past in India, tobacco consumption / smoking is leading preventable cause of death due to cancer in males. Cigarette smoking also complicates morbidities related pulmonary conditions like Asthma, COPD, Cancer and COVID etc. A dynamic comprehensive approach is required for breaking the habit of tobacco consumption in any form. Various studies conducted in the past proposed that intensive tobacco cessation interventions involving behavioural support plays an important role in the treatment of addiction / deaddiction. Public health professionals can play an important role in creating awareness among people regarding the ill effects of tobacco through different community communication technologies. It is important that government has passed trading restrictions in order to curb the tobacco consumption through primordial prevention method. Advertisement and promotion of tobacco products are also banned throughout the country, though it continues in one form or other. Many NGO as well as Government sectors have taken initiatives at central and state level to establish tobacco cessation clinics (TCCs) in fewer instances. Behaviour Chang

Determinants of tobacco cessation among patients with chronic diseases (diabetes/hypertension) enrolled in Ministry of Health Tobacco Cessation Clinics, Kingdom of Saudi Arabia from 2012-2017

ABSTRACTObjectives:To investigate factors associated with tobacco cessation among patients with (diabetes or hypertension) who attended Ministry of Health (MOH) Tobacco Cessation Clinics (TCC), Saudi Arabia over the years 2012-2017.Methods:A case control study was conducted with 402 respondents. Data collection took place in Riyadh, Saudi Arabia from January 2018 to April 2018. Cases were patients with diabetes or hypertension who had been abstinent from tobacco for at least 6 months after attending MOH tobacco cessation clinics. Controls were patients with chronic diseases who had not quit tobacco after cessation clinics. Data were collected through a questionnaire by telephone interviews. Descriptive analysis, bivariate analysis, and multivariable regression were carried out.Results:Overall, 85 (21.1%) respondents had successfully quit tobacco, while 317 (78.9%) had not. Among those who had not quit cigarettes, 97 (42.4%) had reduced cigarette consumption, the mean difference in cigarette smoking from before to after MOH TCC was 01.812±5.928 (95% confidence interval [CI]: 2.584-1.040). Most of those who used other forms of tobacco 16 (72.7%) had not changed their consumption. The likelihood of successfully quitting tobacco increased with those lower educational level (adjusted odds ratio [AOR]=17.01, 95% CI: 1.00-289.2, p=0.05) and among those who reported controlled hypertension (AOR=17.8, 95% CI: 1.5-209.6, p=0.02).Conclusion:To increase abstention rates, chronic disease counseling with regular follow-ups, providing toll-free telephone services should be considered. More effort is needed to reduce non-cigarette tobacco consumption.

Comparative evaluation of cognitive behavioral therapy and regular health education in reducing nicotine dependence among cigarette smokers: A randomized controlled trial

Introduction: It is important to introspect if the methods used in tobacco cessation counseling are effective in achieving abstinence and reducing nicotine dependence among tobacco users. The objective of this study was to evaluate the effectiveness of cognitive behavioral therapy (CBT) at tobacco cessation clinics in a teaching dental institution in reducing nicotine dependence among dental patients with the habit of cigarette smoking in comparison to regular health education to quit tobacco. Materials and Methods: This prospective, randomized controlled trial was conducted in a teaching dental institution in the state of Andhra Pradesh. 160 self-reported current cigarette smokers with no tobacco chewing habits participated in the study. 80 each were assigned to the intervention group and control group where CBT for cessation of cigarette smoking and regular health education to quit smoking were provided, respectively. Data relating to frequency of cigarette smoking and nicotine dependence scores using Fagerstrom nicotine dependence scale were collected at baseline. Both the groups were followed up for 4 months in two-monthly intervals. IBM SPSS version 20 software was used for data analysis. Results: While there was no significant difference in the mean nicotine dependence score between the study groups at baseline, a statistically significant difference was observed between the groups at follow up visits. Repeated measures analysis of variance revealed significant reduction in nicotine dependence scores with time in the intervention group (P = 0.004), whereas the differences in the control group between different study time points were not significant (P = 0.39). It was also observed that the frequency of cigarette smoking reduced significantly between the baseline and follow-up visits in the intervention group (Cochran's Q-test; P = 0.028). Conclusion: The findings of this study provide an insight into the fact that CBT as tobacco cessation counseling technique is effective in reducing nicotine dependence among subjects seeking oral health care.

Outcomes of integrating quitline methodology in tobacco cessation delivered through a model tobacco treatment clinic of a private sector hospital at Rajasthan, India.

India despite progress in tobacco cessation delivery in government sector has lagged in private health sector. Adopting a two-fold approach of intensive intervention-based counseling with (or without) pharmacotherapy; and prescheduled proactive follow-ups over the subsequent year, this study reports 337 tobacco patients, each followed for a period of 1 year. It observed a quit rate (QR) of 40.9% for total abstinence at 1 year but with a drop of 15.9% when patients were followed up, up to 6 months (49.6%) versus 6-12 months (34.7%). The pharmacotherapy did not benefit to whom it was prescribed (196 [58.2%] patients; QR: 34.7%) versus the rest to who it was either not prescribed or was declined (141 [41.8%] patients; QR 49.6%). Countrywide tobacco cessation clinics (TCCs) may be established in private sector hospitals, and the component of quitline methodology of making proactive calls may be integrated to improve QR in India.

EVALUATION OF FACTORS RESPONSIBLE FOR THE OCCURRENCE OF ORAL SUBMUCOUS FIBROSIS IN PATIENTS REFERRED TO DARBHANGA MEDICAL COLLEGE AND HOSPITAL

Oral submucous fibrosis (OSF) is a chronic progressive and irreversible disease affecting the oral, oropharyngeal, and sometimes the esophageal mucous. OSF is a disease that causes changes similar to those of systemic sclerosis (scleroderma) but limited to oral tissues. The disease is seen in those from the Indian subcontinent and from many parts of South-East Asia. It causes significant morbidity (in terms of loss of mouth function as tissues become rigid and mouth opening becomes difficult) and mortality (when transformation into squamous cell carcinoma occurs). The introduction of chewing tobacco containing areca nut into the market has been associated with a sharp increase in the frequency of OSF. Hence based on above findings the present study was planned for Evaluation of Factors Responsible for the Occurrence of Oral Submucous Fibrosis in Patients Referred to Darbhanga Medical College and Hospital.&#x0D; The present study was carried out in the Department of Dentistry, Darbhanga Medical College and Hospital Laheriasarai, Darbhanga Bihar. In the present study 30 cases of the oral submucous fibrosis were enrolled.&#x0D; Oral submucous fibrosis (OSMF) is a chronic insidious disease affecting any part of the oral cavity and sometimes the pharynx. Although, occasionally preceded by or associated with vesicle formation, it is always associated with a juxta-epithelial inflammatory reaction. It is important that preventive efforts be carried out by the concerned authorities and public health professionals in establishing tobacco cessation clinics and tobacco awareness education in such masses (especially the young generation) along with a long standing and a close knit motivation program that enables our future generations to come to avoid the menace of tobacco and its subsequent health effects.&#x0D; Keywords: Oral submucous fibrosis, OSF, oral cavity, Bihar.

The role of dentists in nicotine replacement therapy.

Dear Editor, We read the article titled “Nicotine replacement therapy: A friend or foe” with great interest.[1] As authors pointed out smoking is one of the greatest causes of premature death and preventable illness in both developed and developing countries. Health-care professionals, especially dentists, can play an important role in assisting their patients with tobacco cessation.[2] We would like to share few more literature regarding the role of dentists in nicotine replacement therapy (NRT). Though most of the dental curriculums around the world don't have structured modules to train dentists in specific smoking cessation strategies, multiple studies exploring knowledge, attitude, and practice regarding tobacco cessation methods among dental practitioners have provided encouraging insights. Rajput et al. explored the attitudes, practices, and perceived barriers in Tobacco cessation counseling (TCC) among dental practitioners in India and found that seventy-three percent of the dentists agreed that TCC is their responsibility.[3] Moreover, Madhu et al. studied the attitude and practice of the dental students toward tobacco cessation methods using a cross-sectional design and found that almost 50% preferred to recommend nicotine replacement therapies (NRT) as a tobacco cessation advises to the patients.[4] Existing literature supports the fact that dental practitioners have the motivation and knowledge base to support tobacco cessation in their patients. It is the need of the hour for establishing tobacco cessation clinics in dental clinics especially in rural areas where a dentist does the behavioral counseling during which patients are advised to stop the tobacco use, with structured counseling methods.[5] There are no standardized tobacco intervention model for dental care settings. However, the American Dental Hygienists Association recommends a three-steP “AAR” brief tobacco intervention model for dental care settings: Ask every patient about tobacco use, Advise all tobacco users to quit, and Refer tobacco users to nationally available tobacco quitlines via fax or electronic referral.[6] Moreover, dentists can also assess the severity of tobacco addiction using Fagerstrom scale, i.e., the patient is asked a series of 6 questions and scores are given based on the patient's responses and based on the scoring, the patient can be prescribed pharmacotherapy in the form of nicotine replacement therapy (NRT).[5] There are multiple ways in which a dentist can assist their patient with NRT. One potential model for incorporating the provision of NRT in dental practices is NRT sampling (NRTS), in which a short starter course (e.g., 2 weeks) of NRT is given to all medically eligible smokers irrespective of their motivations to quit or seek treatment. Another specific area were dentists can contribute is in modifications NRT practices such as nicotine replacement therapy with tooth-whitening agents. Availability of NRT with stain removal or tooth-whitening activity would provide an opportunity for dentists to illustrate some early measurable benefits of smoking cessation, reinforce smokers’ commitment to quit, and support them on the path to a stable state of not smoking. Dentists can also play a key role in maximizing the benefits of NRT by educating the public regarding the relative safety of NRT when compared to smoking, as most of the studies from around the world indicate that the public incorrectly believes that nicotine is responsible for most of the cancer caused by smoking. Considering the need of the hour and the multiple role a dentist can play in tobacco cessation, the dental councils should consider including tobacco cessation training modules in the curriculum at the BDS level.[5] Furthermore, conferences, workshops, and CDEs regarding tobacco cessation services also should be promoted among dentists to educate and motivate them to start or continue their tobacco cessation services to their patients.[4] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

STUDY BASED ON DIAGNOSIS AND EVALUATION OF PATIENTS AFFECTED BY ORAL SUBMUCOUS FIBROSIS (OSMF) FROM BIHAR REGIONS

OSMF (Oral Submucous Fibrosis) is a widely recognized precancerous condition which is also looked upon as a potentially malignant disorder of and is characterized by a reduction in mouth opening, having palpable circumoral fibrous bands either on one side or bilaterally along with the sensation of “burning mouth”. The condition is defined as “an insidious, chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with juxta-epithelial inflammatory reaction followed by fibroelastic change of the lamina propria, with epithelial atrophy leading to stiffness of the oral mucosa causing trismus and inability to eat”. The increased consumption of commercially prepared arecanut preparations (Gutkha, Pan masala) specially in the younger generation has led to such high incidence of this diseasein certain areas of India. Based on above reported findings the present study was planned for Study of Cases of Oral Submucous Fibrosis (OSMF) from Bihar Region.&#x0D; All the patients were informed consents. The aim and the objective of the present study were conveyed to them. Approval of the institutional ethical committee was taken prior to conduct of this study. Total 30 cases of the patients suffering from oral submucous fibrosis were enrolled in the present study.&#x0D; In conclusion, the result of present study provides information on the prevalence of oral mucosal lesion in our population. It is important that preventive efforts be carried out by the concerned authorities and public health professionals in establishing tobacco cessation clinics and tobacco education in such masses (especially the young generation) along with a long standing and a close knit motivation program that enables our future generations to come to avoid the menace of tobacco and its subsequent health effects.&#x0D; Keywords: Oral Submucous Fibrosis, OSMF, Oral Cancer, Bihar region, etc.

Prevalence of Tobacco Consumption Among Coal Mine Workers in Neyveli Lignite Corporation, Cuddalore District, Tamil Nadu, India

Background: There is a dearth of literature on prevalence of tobacco consumption among coal mine workers. Aim: To assess the prevalence of tobacco consumption among coal mine workers in Cuddalore District, Tamil Nadu, India. Methods: A cross-sectional descriptive survey was conducted among 603 coal mine workers in Cuddalore District. Simple random sampling method was used to recruit the subjects. Informed consent was obtained from the participants. A pretested questionnaire was used to collect data on tobacco consumption. The data were entered in Microsoft Excel sheet. SPSS software version 20 was used and descriptive statistics was used. Results: All 603 subjects were males. The mean age of the participants was 35.01 (±8.77). Totally, n=197 (32.67%) subjects reported smoking habit. Of those who reported of smoking habit, cigarette smoking was reported by n=172 (87.2%) subjects. Bidi smoking was reported by n=25 (12.8%) subjects. None of the smokers reported of using smokeless form of tobacco. Conclusion: High prevalence of tobacco smoking was observed among the workers. Combined and organized initiatives by the health care professionals, management and the people should be taken to reduce the tobacco consumption. Common risk factor approach and behavior counseling can be advocated to change their attitude toward tobacco consumption. To start tobacco cessation clinics to aid the workers in cessation of tobacco consumption. To advertise about the ill effects of tobacco by displaying pictures and information in public area and work places.

2017 National Survey of Tobacco Cessation Clinics in China: evidence from the combination of nationwidegovernment and clinic on-line survey

2017 National Survey of Tobacco Cessation Clinics in China: evidence from the combination of nationwidegovernment and clinic on-line survey

English

Introduction: Tobacco use can affect human health adversely and can lead to loss of productivity due to tobacco-related illnesses. It is a major cause of premature death across the world and in India. Objectives: (1) To determine the prevalence of tobacco use among adults in rural field practice area. (2) To study the knowledge and attitude regarding tobacco use. (3) To study the willingness to quit tobacco among its users. Methods; Study design: Cross sectional study. Study area: Rural field practice area of Department of Community Medicine. Kasturba Medical College, Manipal University, Manipal. A pretested semi-structured questionnaire was used to collect data from consenting adults during field visits. Tobacco usage status was categorised as per the WHO guidelines and the data was entered and analysed using Statistical Package for Social Sciences (SPSS) version 15.0(SPSS South Asia, Bangalore). Results are presented in frequencies and percentages. Chisquare test was applied to study association of factors with tobacco usage. Results: A total of 223 individuals were included in the study which comprised 139 (62.3%) males and 84 (37.7%) females. Of the surveyed population, 77(34.5%) were ever users of tobacco with 63(81.8%) being current users and 14 (19.2%) ex-users. Majority (89.7%) of the people were aware that tobacco use has harmful effects on health. Among current consumers, 47 (74.6%) of them were willing to quit tobacco. Conclusion: The study shows that inspite of having adequate knowledge regarding the ill-effects of tobacco use; the prevalence of its use is considerably high. Hence, there is a need to convert the knowledge into practice by behaviour change communication and provide timely support services like tobacco cessation clinics in the community.

Evaluation study of the implementation of WHO Framework Convention on Tobacco Control in seven provinces/municipalities in China

To assess the implementation of World Health Organization Framework Convention on Tobacco Control (WHO FCTC) by organizations in seven provinces/municipalities in China. A total of 901 organizations, including hospitals, schools, government departments, health administrative departments and public transportation facilities, were selected by multistage sampling method in five provinces and two municipalities in China, 2010 and 2012. Key informant interview and observation survey were conducted to collect data on implementation of WHO FCTC. Analysis was performed among three clusters of indexes, which were establishment of smoke-free environment, education and training on tobacco control, and tobacco cessation measures. The five types of organizations performed differently in creating smoke-free environment. The ratios of conducting complete smoke-free policy in hospitals, health administrative departments and schools were separately 83.3% (111/192), 81.6% (146/179) and 66.5% (121/182) in 2012, which were comparatively higher than those in governments (32.4%, 33/102) and public transport facilities (25.0%, 27/108) (χ(2) = 174.93, P < 0.01) . As for promotion and training programs of tobacco control information, the ratio of health administrative departments raised from 78.1% (150/192) to 100.0% (192/192), and the difference showed statistical significance (χ(2) = 42.00, P < 0.01). But those departments who provide training to social media only accounted for 11.8% (22/187), which was substantially lower than the percentage of those providing training to themselves (67.7%, 128/189) (χ(2) = 413.99, P < 0.01). Three indexes of tobacco cessation related work--offering help in tobacco use quitting, providing health workers with training on tobacco cessation skills and establishing tobacco cessation clinics, only reached as low as 41.1% (312/760) , 55.6% (104/187) and 45.9% (89/194), respectively. Among the seven provinces/municipalities, Shanghai did better than the others on most of the indexes. 27 out of 28 schools in Shanghai implemented complete smoke-free policy, which was the best among the seven, while only 3 out of 26 in Jiangxi, as the poorest (χ(2) = 47.63, P < 0.01). Meanwhile, all of the 24 schools in Shanghai had health education classes on tobacco control, followed by Zhejiang (23 out of 29), while Jiangxi was also the poorest, only 12 out of 26 (χ(2) = 17.95, P < 0.01). The implementation of WHO FCTC by the five types of organizations in the seven provinces/municipalities has improved to various degrees. Nevertheless, further actions should be taken to promote smoke-free environment especially in certain circumstances such as public transport facilities, to strengthen training programs of tobacco control for social media, and to enhance hospitals' abilities in providing tobacco cessation services.

English

Tobacco has been recognized as a universal demerit good and it is well acknowledged fact that tobacco use in any form is potentially harmful from both economic and human development considerations. Government of India has enacted various legislations to curb tobacco use in recent times. The tobacco cessation clinics were set up in diverse settings to help people stop tobacco use. The present concept of mobile tobacco cessation clinic can be looked as an innovative step forward in reaching the youth population.

Smoking Cessation Intervention in Rural Kerala, India: Findings of a Randomised Controlled Trial

Prevalence of tobacco use is higher in the rural than urban areas of India. Unlike tobacco cessation clinics located in urban areas, community-based smoking cessation intervention has the potential to reach a wider section of the community to assist in smoking cessation in the rural setting. The present study aimed to assess the effectiveness of a cessation intervention in rural Kerala state, India. Current daily smoking resident males in the age group 18-60 years from four community development blocks in rural Kerala were randomly allocated to intervention and control groups. The intervention group received multiple approaches in which priority was given to face-to-face interviews and telephone counselling. Initially educational materials on tobacco hazards were distributed. Further, four rounds of counselling sessions were conducted which included a group counselling with a medical camp as well as individual counselling by trained medical social workers. The control group received general awareness training on tobacco hazards along with an anti-tobacco leaflet. Self-reported smoking status was assessed after 6 and 12 months. Factors associated with tobacco cessation were estimated using binomial regression method. Overall prevalence of smoking abstinence was 14.7% in the intervention and 6.8% in the control group (Relative risk: 1.85, 95% CI: 1.05, 3.25). A total of 41.3% subjects in the intervention area and 13.6% in the control area had reduced smoking by 50% or more at the end of 12 months. Lower number of cigarettes/ bidi used, low nicotine dependence and consultation with a doctor for a medical ailment were the statistically significant predictors for smoking cessation. Rigorous approaches for smoking cessation programmes can enhance quit rates in smoking in rural areas of India.

Initiating tobacco cessation services in India: challenges and opportunities.

Tobacco use contributes significantly to the diseases burden in India. Very few tobacco users spontaneously quit. Therefore, beginning 2002, a network of 19 tobacco cessation clinics (TCCs) was set up over a period of time to study the feasibility of establishing tobacco cessation services. Review of the process and operational aspects of setting up TCCs was carried out by evaluation of the records of TCCs in India. Baseline and follow-up information was recorded on a pre-designed form. During a five-year period, 34 741 subjects attended the TCCs. Baseline information was recorded in 23 320 cases. The clients were predominantly (92.5%) above 20 years, married (74.1%) and males (92.2%). All of them received simple tips for quitting tobacco; 68.9% received behavioural counselling for relapse prevention and 31% were prescribed adjunct medication. At six-week follow-up, 3255 (14%) of the tobacco users had quit and 5187 (22%) had reduced tobacco use by more than 50%. Data for three, three-monthly follow-ups was available for 12 813 patients. In this group, 26% had either quit or significantly reduced tobacco use at first follow-up (three-months), 21% at the second (six-months) and 18% at the third follow-up (nine-months) had done so. It is feasible to set up effective tobacco cessation clinics in developing countries. Integration of these services into the health care delivery system still remains a challenge.

Tobacco cessation services in India: Recent developments and the need for expansion

Tobacco use is a major cause of preventable death and disease in India. Unfortunately, very few people in India quit tobacco use. Lack of awareness of harm, ingrained cultural attitudes, and lack of support for cessation maintains tobacco use in the community. The significant addictive property of nicotine makes quitting difficult and relapse common. Health professionals have received little training, and very few thus carry out proper assessments and interventions among tobacco users. Evidence from the developed countries suggests that brief interventions delivered by diverse health professionals are effective in tobacco cessation. Combining pharmacologic approaches with behavioral counseling produces better results than a single strategy. In India, early experiences with tobacco cessation occurred in the context of primary community education for cancer control. More recently, tobacco cessation clinics have been set up to develop models of intervention, and train health professionals in service delivery. These need to be expanded at the primary, secondary, and tertiary care levels, and cost-effective community tobacco cessation models need to be developed. Tobacco cessation forms one of the critical activities under the National Tobacco Control Program. Tobacco cessation needs to be urgently expanded by training health professionals in providing routine clinical interventions, increasing availability and subsidy on pharmacotherapy, developing wide-reaching strategies, such as quitlines and cost-effective strategies, such as group interventions.