Community Based Intervention for Tobacco Cessation: A Pilot Study Experience, North East India

2009-2010

Dr. Srabana Misra Bhagabaty: Assistant Professor cum In-Charge, Department of preventive oncology, Dr. B. Borooah Cancer Institute

Published in : Asian Pacific Journal of Cancer Prevention, Vol. 16, 2015 , page 811-814Got the certificate of excellence for best paper presentation at the international conference : Global

Cancer Summit, Bangaluru 2015

Dr. Srabana M Bhagabaty

with alarmingly High Prevalence of Tobacco Use in the region and poor health seeking behavior reflecting least utilization of the clinic based tobacco cessation service this intervention research design

means to

To assess impact when care providers go out to the community to provide tobacco cessation help in areas with high tobacco consumption and least motivation towards quitting or availing cessation clinic help.

Some community based tobacco cessation intervention studies has been conducted outside India but only few studies in India.

In North East India this is a first such kind of pilot study to see the feasibility of implementation of such intervention designs in the region and other parts of the country

Dr. Srabana M Bhagabaty

Objectives of this study

Finding out the practicability of providing tobacco

cessation intervention at community level.

To analyze the success of tobacco cessation services extended to the community level.

Iii Comprehending the prospect of implementation of Community based tobacco cessation intervention at large scale and to suggest recommendations for better tobacco cessation service

Dr. Srabana M Bhagabaty

Methodology

Dr. Srabana M Bhagabaty

• Community based intervention study

• Study sample : 800

• Duration of the study : one year

• Study period: 2009-2010

Dr. Srabana M Bhagabaty

Methodology…

• Study area: Assam : It was carried out in South, East, West and Central urban blocks of Guwahati Metro.

• Tool of data collection : Predesigned pretested proforma

• Data entry and analysis: SPSS

Dr. Srabana M Bhagabaty

Methodology…

The inclusion criteria for the study

Tobacco users of both sex, aged >15 years and permanent residents of study areas willing to take part in the study.

The exclusion criteria were Non users of tobacco, past users of tobacco, tobacco users

of age less than 15 years, not willing to get tobacco cessation intervention, not permanent residents of the study areas.

Dr. Srabana M Bhagabaty

Methodology…

Staff recruitment – training – survey subject registration

Four Medical social workers (MSWs) wererecruited and trained up

They conducted door to door survey in the study area and registered the study subjects ( 200 study subjects per MSW)

Dr. Srabana M Bhagabaty

Methodology…

During registration :

Information communication and education materials on tobacco hazards were offeredto the study subjects

A date and time for counseling was fixedaccording to the convenience of thesubjects a keeping in mind time frame ofthe study . Dr. Srabana M

Bhagabaty

Methodology…

Community intervention

:Mode : Tobacco cessation counseling

:BY: The MSW (200 each)

:At : The community setting ,homes of the study

subjects. Dr. Srabana M

Bhagabaty

Methodology…

Follow up

By : Direct contact

Intervals and duration :

0-2 weeks, 2- 4 weeks, 4-6 weeks, 6weeks-2months, 2-3months, 3-4 months, 4- 6 months, 6-8 months.

When contacted for follow up the study subjects ,needed re-counseling was given to them whereneeded

Dr. Srabana M Bhagabaty

Methodology…

RESULTS

AND

DISCUSSIONS

Dr. Srabana M Bhagabaty

• The survey covered 750 households

• 87% of these households with a nuclear family

• Persons in the age group >15years and permanent residents of these areas were 2100 out of which 860 were current tobacco users

• 60 of these 860 could not meet the inclusion criteria

Results and discussions….

Dr. Srabana M Bhagabaty

Dr. Srabana M Bhagabaty

0%

10%

20%

30%

40%

50%

60%

70%

80%Age Distribution of the study subjects

15-19 years:

3%

Results and discussions….

20-39

Years : 78%

40-59Years: 18% >60

years: 1%

81%

19%

MALE FEMALE DISTRIBUTION OF THE STUDY SUBJECTS

MALE

FEMALE

Dr. Srabana M Bhagabaty

Results and discussions….

literacy status of the study subjects

Dr. Srabana M Bhagabaty

42%

33%

14%

4%4% 3%

College

Higher secondary

High school

Middle school

primary school

Illiterate

Results ….

Monthly income of the subjects

Dr. Srabana M Bhagabaty

<Rupees 2000

Rupees 2001-5000

Rupees 5001-10,000

> Rupees 10,000

3.00%

55.25%

35.88%

5.88%

Results ….

• Study population showed current tobacco use of 36%

• Only 1/4th of the subjects (current tobacco users) visited any health care provider during last 12 months

!!!Only 3% of current tobacco users( both smoking or smokeless type) got any kind of advice to quit the tobacco use habit

Dr. Srabana M Bhagabaty

(Manuals for training in cancer control: Manual for tobacco cessation: national cancer control programme : Directorate general of health services: MOHFW: govt. of India.)

15.00%

15.50%

16.00%

16.50%

17.00%

17.50%

18.00% Tobacco cessation centers (TCC)from India, have reported overall quit rates of around 16% and study result was 17.87% at six weeks post intervention

Study result

TCC results

Tobacco quit rates at six weeks post intervention

Dr. Srabana M Bhagabaty

The final outcomeResults of follow up at eight months post intervention

Outcome Number Percentage Quit Tobacco 376 47%

Reduced tobacco use (More than 50%)

415 52%

No material change 0 0Lost to follow up 0 0

Relapse 6 1Total 800 100

Dr. Srabana M Bhagabaty

• 100% motivation and 99% changed for better. 47% quitted completely or they were at the verge of quitting the habit with visible big reduction (52%) in their tobacco consumption both in quantity and use times per day

Conclusions

• Lost to follow up was zero and relapse rate was negligibe

Dr. Srabana M Bhagabaty

Dr. Srabana M Bhagabaty Dr. Srabana M Bhagabaty

Conclusions

• For a better motivation, follow up and a better quit rate in a defined population, the community based tobacco cessation interventions could be an answer

Recommendation Such vigorous intervention designs should be

given more emphasis on for Implementation, in a specified community with a very high tobacco consumption rate, cultural acceptance of tobacco and less motivation towards quitting.

Use pharmaceutical adjuncts along with counseling at the community settings needs further research to see impact for a even better quit rate and feasibility of implementation

Dr. Srabana M Bhagabaty

Better results towards awareness generation about tobacco hazards and benefits of quitting.

To address needs of the needy bypassing all the barrier limiting the mass from seeking

tobacco cessation help.

For attaining high tobacco quit rate and lesser lost to follow up and close monitoring of maintenance of tobacco

cessation

Dr. Srabana M Bhagabaty

TO GET

>Dr. Amal Chandra Kataki, Director Dr. B.Borooah Cancer Institute >Dr. Sekhar Shalkar , National organisation for Tobacco Eradication India, GOA

>Manoj Kalita,Population based Cancer Registry, Dr. B.Borooah Cancer Institut

Acknowledgement

Dr. Srabana M Bhagabaty

Dr. Srabana M Bhagabaty

THANK YOU

Dr. Srabana M Bhagabaty