Community based group intervention for tobacco cessation in rural Tamil Nadu, India: a cluster randomized trial
Objective: To determine the efficacy of community based group intervention for tobacco cessation and to identify the barriers for cessation intervention among rural men.
Methods: We recruited 400 men (20-40 years) currently using any form of tobacco from 20 villages of the Indian State of Tamil Nadu and randomized them equally into intervention and control groups. A physician offered two sessions of health education five weeks apart along with self-help material on tobacco cessation to the intervention group. The control group received only self-help material. The contents of the sessions included tobacco related health problems, benefits of quitting and coping strategies for withdrawal symptoms. The outcome measures at two months follow-up were self-reported point prevalence abstinence, quit attempts lasting > 24 hours and harm reduction of tobacco use > 50% of baseline. Follow-up data were available for 92%.
Findings: In the intention to treat analysis, self reported point prevalence abstinence of 12.5% in the intervention group was significantly higher than the 6.0% in the control group [Odds Ratio (OR) 2.39; 95% confidence interval 1.09-5.22]. Harm reduction was three times (OR 2.63, 95% CI 1.36-5.08) and quit attempts were two times (OR 1.66, 95% CI 0.97-2.84) higher in the intervention group than the control group. Time constraints, alcohol consumption and urban migration were found to be important barriers for group based tobacco cessation intervention.
Conclusion: Community based group intervention has the potential to increase the coverage of tobacco cessation services for men in rural Tamil Nadu.
(Clinical Trial Registration Number CTRI/2010/091/000221)
Tobacco has been projected to cause one billion preventable deaths in the twenty-first century, of which more than 70% will occur in low and middle income countries.1 The largest increase in tobacco related mortality has been projected to occur in India and China.2 The annual smoking-associated deaths in India were projected to be one million in this decade.3 As per the Global Adult Tobacco Survey (GATS) the current tobacco use in any form was 47.9% among adult males in India.4 The prevalence of tobacco use was significantly higher in rural, poorer, uneducated population compared to urban, wealthier and more educated population. 5 All forms of tobacco use were increasing in India and the largest increase was in the age group 15-24 years.6
Cessation by current smokers is the only way to avoid substantial proportion of tobacco related deaths worldwide before 2050. Tobacco cessation is rare in most low and middle income countries. For example the quit rate at population level in India was reported to be only two percent. Unless there is widespread cessation among smokers, 450 million deaths will occur in the world by 2050. Prevention of these deaths requires adult cessation.7 Seventy percent of the one million smoking related mortality in India was projected to occur in the middle age of 30-69 years.3 Half of the long term smokers will die during their productive middle age, losing 20-25 years of life.8 The benefits of smoking cessation were found to be largest in those who quit in the younger age group of 25 to 34 years.9 Therefore any cessation intervention needs to focus on the younger age group.
The evidence base for tobacco cessation interventions is limited in low and middle income countries.10 A few available studies reported quit rates although the primary objectives were not tobacco cessation intervention. A community based intervention study among rural tobacco users for primary prevention of oral cancer reported a quit rate of two percent in Ernakulam district (Kerala), one percent in Bhavnagar (Gujarat) and five percent in Srikakulam (Andhra Pradesh) at the...
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