tobacco cessation : community based intervention
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Transcript of tobacco cessation : community based intervention
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