Tobacco Cessation Project

Introduction

India has the highest number of cancers of the oral cavity (mouth) in the world. Tobacco is one of the primary causes of oral cancer, which constitutes 30-50% of all cancers in India. Tobacco use has also been found to cause damage to non-smokers, for example to spouses and young children in the smoker's environment through passive exposure to cigarette smoke. Simple changes in lifestyles and regular screening can bring down these deaths drastically. "Charotar area," the heart of Anand and Kheda districts of Gujarat,
is a tobacco-growing belt. This area, not surprisingly therefore, has
a high incidence of tobacco consumption, which has led to increased
occurrence of oral cancer among the population of this region.
Tobacco is used in form of Khaini, Bidi, Cigarette, Zarda, Pan Masala,
Gutkha, Gul, Red Tooth Powder (Lal Dant Manjan) etc. The popularity
of chewable tobacco, particularly among the young, is a growing concern
as there is considerable rise in pre-cancerous lesions in the mouth.
Realizing the health hazards of tobacco in the region, the CAM initiated the Tobacco Cessation Clinic in October 2001 with the financial assistance of the World Health Organization (WHO). This clinic is part of outpatient services of the psychiatric department that provides both psycho behavioral therapy and medication to enable tobacco addicts to quit the habit. Motivated individuals, those who wish to stop smoking or stop using any form of tobacco are enrolled in the project. They are provided individual counseling and personal long-term follow-up. Tobacco use history, nicotine dependence, motivation, and self-assessment questionnaires are provided to the individual on the first session.

This session includes a thorough interview and assessment by the trained counselor. The beneficiaries are interviewed to reveal information that will affect the cessation efforts. Questions like, personal reasons for wanting to quit, stage of readiness, psychological reasons for tobacco use, degree of nicotine dependence, previous quit attempts, benefits of and barriers to quitting are asked. Next the counselors help the individual set up their own "customized" treatment Plan. Possible options are discussed, including: behavioral modification strategies, coping skills, individualized quit techniques, and monitored use of medication or a placebo. When appropriate quit date is set, tobacco cessation leaflets and written information is given to help plan and rehearse quit strategies at home. A record of each cigarette / bidi / or tobacco used in any form is evaluated at the next appointment. Other counseling appointments are set depending on the needs of the beneficiaries. Long term Follow-ups to help prevent relapse are undertaken.

Tobacco Cessation Clinic confined to hospital targeted subjects who either came as patients with medical/surgical illness or their relatives. The people in society did not take the advantage of the clinic hence it was decided to move out in community and target all those who are addicted but not having any illness /morbidity secondary to tobacco use.
This was achieved by addressing rural population in nearby villages by house visits, workers of industries in GIDC, and students of schools and colleges

Inception :
October 2001 at Pramukhswami Medical College,
Karamsad Dist: Anand, Gujarat
02692-222310, 222587
Fax.no 223466

Methodology:
1. In the hospital:
TCC confined to hospital targeted the subjects who either came as patient with medical /surgical illness or their relatives. Patients referred to clinic are counseled by psychiatrist, clinical psychologist and referred for the further treatment. The expert doctors made them aware about the hazards of tobacco intake in any form by various charts and posters.

2. In the Community:
The people did not take advantage of clinic hence it was decided to move out in Community and target all those who were addicted but not having any illness/morbidity secondary to tobacco use.
This was achieved by addressing rural population in the nearby villages by household visits by Village health workers who are specially trained by Community Medicine Department for counseling the subjects. In first stage four villages were identified and the VHW's of these villages were trained by community medicine department. The medical officers and the nursing staff of the PHC in these villages were also sensitized and educated. Along with the existing effort of enrolling cases in the hospital's tobacco cessation clinic, the staff approached nearby industries to seek permission from the management to start Tobacco Cessation programme in the premises of industries as well as school and colleges. The workers were sensitized regarding the hazards of tobacco use and those willing to quit were enrolled in the programme. Rests were motivated to quit by several sessions of counseling. Even the students of schools and colleges located in Vidyanager were targeted. Health education programme were conducted in the higher secondary classes and in colleges.
Training of the School Teachers:
The Community Medicine Department has undertaken the task of training the Schoolteachers of nearby schools in-group of 10. These teachers are made aware of various hazards of tobacco use and sensitized regarding the need for tobacco control by a daylong session.

1. Awareness is also targeted in following areas
a) School children
b) College students
c) Industrial workers
d) Anganwadi/health workers
e) Pregnant women regarding second hand smoke
f) PHC staff including Doctors and nurses

Best Practise:

Creating tobacco free industries
Targeting school/college students, as they are the future of the country.
Health education amongst the students and motivating them to take initiative in various similar activities
Teachers training as the students take teacher's messages seriously and the knowledge transferred by them can be implemented more effectively.
Implementing the programme in Villages with the help of VHW's who have a greater rapport amongst their own people and hence more acceptable and effective
Feasibility study of target areas (schools, colleges and Industries) for optimal tobacco related awareness programme.
Identify schools for interventions, which have a minimum strength of 60-75 in grades VIII to XII in urban and rural sectors.
Diversification of community awareness programme into newer peripheral areas. Creating a work force and appointing local volunteers to spearhead the programme.
Monitor index cases that quit the tobacco habit to prevent relapse.
Peruse successful quitter and project them as Role models into the community.
Create NO Smoking Zones in15 selected hotels in the city of Anand/VVNagar

The project runs in 30 industries, 70 schools and colleges and four Extension Centers. Since inception, 3000 patients have been enrolled under the project.. During the year 2005 the percentage of the subjects who stopped intake of tobacco was 23.57%. We found that awareness among the people has definitely improved their understanding.
TCC has managed to make persons give up their habit according to the three years data attached. Dedicated to the goal of reducing the prevalence of tobacco use, the Clinic has also undertaken research towards elucidating the nature of tobacco dependence and the development of pharmacological and psychological treatment approaches.

Contact details
                Dr Girish Mishra
                Professor & Head, Dept of ENT
                Director Cancer Project
                Pramukh Swami Medical College,
               Shree Krishna Hospital, Karamsad
Email address: daxa.girish@gmail.com, daxa.girish@yahoo.com
Phone No: 91 2692 223256
Mobile no: + 91 9825489878