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Addressing tobacco use & dependence in primary care: a priority for tobacco control in the country.

Year: 2014
Type: article
Abstract: There are 27.5 crores adult tobacco users (rural-21.6 crores, urban-5.9 crores) in India and this is a major public health challenge1. In India, about a quarter of deaths among middle-aged men are caused by smoking2,3. Additionally, tobacco use causes huge economic loss to the tune of 6011 crores (1 billion USDs)4. Tobacco cessation leads to short-term health benefits and curbs the tobacco death burden in the long term5,6. Tobacco cessation has immediate health benefit and can reduce tobacco-related mortality in short term in comparison to other preventive measures for tobacco control7,8. A wide range of pharmacologic and non-pharmacologic treatments have been successfully used to assist patients in quitting tobacco, the most effective approach to tobacco cessation appears to result from a combination of these modalities9,10. Physicians, nurses, pharmacists, and other healthcare providers all have the potential to lead successful tobacco cessation interventions11. It is without doubt now that the most effective preventive intervention that a clinician can provide for tobacco using patients against heart disease, cancer, cerebrovascular disease, chronic obstructive pulmonary disease and tuberculosis is an empathic tobacco cessation intervention1. Nicotine replacement therapies (NRT) have been shown to further double the chances of successfully quitting smoking when used in conjunction with physician's advice12. The cost-effectiveness of NRT in low and middle income countries was estimated to be 16600 (USD 276) per disability-adjusted life year saved13. Keeping this in mind the Government of India and World Health Organization (WHO) had started tobacco cessation services as early as in 2002. Currently 19 Tobacco Cessation Centers (TCC) are functional in the country14. A study conducted by Kumar et al15 in Delhi compared the effect of counselling alone with counselling and medication (bupropion) on abstinence rates. Findings of the study suggested that continuous abstinence rate in the counselling group at 1, 3, 6, and 12 months was 17, 17, 16, and 15 per cent, respectively, whereas in the counselling + medication group the rates were 60, 58, 54, and 53, respectively (P<0.001 for all comparisons). The abstinence was validated by breathe carbon monoxide (CO) level measured during each visit15. These results also suggested the usefulness of both behavioural counselling as well as medication led cessation approaches in specialized tobacco cessation centers in India. However, these centers which are co-located within tertiary care health facilities have access to the tobacco users who are predominantly males, relatively older age group (mean age 37) and urban residents16. Thus, these centers do not meet the criteria for an appropriate public health response to cessation. These interventions now need to be scaled up at a population level so that there it can reach to a large number of tobacco users. The health ministry should look for effective ways in which successful and low cost tobacco cessation services can be a routine part of service delivery. Primary health care holds the promise of the delivery of low cost cessation service reaching large numbers of tobacco users especially in rural/semi-urban areas. However, the effectiveness of cessation services in primary care is yet to be tested. While primary health care does hold some promise for the delivery of cessation services, there are several structural problems which plague primary care including the shortage of trained human resources and qualified counsellors. There are other concerns of the extrapolation of the TCC models in primary health care settings. The TCC models are “top heavy” models, have never been evaluated for cost-effectiveness and operate in a controlled environment. These conditions cannot be replicated at the primary care level and thus severely limit their expansion for wider coverage.
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W1659556498
FWCI:
Cites: 14
Cited by: 1
Related to: 10