Tobacco Cessation An assessment of role of public health interventions under the National Tobacco Control Programme India

Abstract

newlineAbstract newlineTobacco use is an established risk factor for death and disability. India s National Tobacco Control Programme (NTCP) aims to help persons quit tobacco. Interventions such as quit advice, mass media messages and warning labels that motivate tobacco users to think about quitting and cessation aids such as counselling and pharmacotherapy have been studied under trial (experimental) studies. However, their effectiveness under the programme conditions was not studied at the population level. Given this knowledge gap, the main purpose was to study the effectiveness of interventions for tobacco cessation under the National Tobacco Control Programme (NTCP) at the national level and the implementation process of NTCP at the district level in Maharashtra. newlineThe study used Moore s framework (adopted by the Medical Research Council, UK) as the foundation and pragmatism as the epistemological approach. The study design was mixed methods; the quantitative component included analysis of data from the Global Adult Tobacco Survey (GATS), India, whereas the qualitative component included primary data collection in two high tobacco use districts of Maharashtra, where NTCP has been in operation for a decade. newlineThe study found that quit ratios (smoking and smokeless tobacco) improved from 2009-10 to 2016-17; however, the effect size was small (4.2% and 1%). Smokers who received quit advice, mass media messages (reported motivational), and warning labels (reported motivational) had higher odds of quit attempts with adjusted odds ratios (AOR) of 2.11(1.88-2.37), 1.53(1.33-1.77), and 1.63(1.38-1.92). The AORs were respectively 2.09(1.87-2.34), 1.67(1.50-1.86), and 1.39(1.25-1.55) for smokeless tobacco. The Adjusted Hazards Ratios (AHR) of relapse were better among the smokers who used counselling (0.80; 0.69-0.93) and a combination of counselling and modern medicine (0.77; 0.59-0.99). The AHRs of relapse for smokeless tobacco were better among those who used counselling 0.81(0.70-0.93) or pharmacotherapy 0.79(0.66-0.9