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Nadkarni A, Gaikwad L, Sequeira M, D’souza J, Lopes M, Haldankar R, Murthy P, Velleman R, Bhatia U, Naughton F. Text Message-Based Cessation Intervention for People Who Smoked or Used Smokeless Tobacco in India: A Feasibility Randomized Controlled Trial. Nicotine Tob Res 2024; 26:1201-1208. [PMID: 38468498 PMCID: PMC11339165 DOI: 10.1093/ntr/ntae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/20/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Despite the high burden of tobacco use in India, users do not have access to adequate help. This pilot trial aimed to evaluate the feasibility and acceptability of a text messaging intervention for tobacco cessation, generate preliminary estimates of its impact, and fine-tune procedures for a definitive trial. AIMS AND METHODS Parallel two-arm single blind individually randomized controlled pilot trial with nested qualitative study. Participants included adult current tobacco users (smoked and smokeless). Eligible and consenting participants were randomized to receive either (1) text messaging intervention (ToQuit) which covered specific content areas such as psychoeducation about consequences of tobacco use and benefits of quitting and tobacco avoidance strategies or (2) information about tobacco cessation helplines such as the helpline number and the languages in which tobacco cessation support was available (control). Feasibility data included screening and consent rates, treatment dropouts, and outcome ascertainment. The primary abstinence outcome was self-reported abstinence from tobacco in the past seven days at 3 months post-randomization. In-depth interviews were conducted with a subsample of participants primarily to collect acceptability data. The primary abstinence analysis used a chi-squared test and logistic regression (complete case), and qualitative data was analyzed using thematic analysis. RESULTS Ninety-eight participants were randomized into the two trial arms; 77 (79%) completed outcome evaluation. No between-arm differences in abstinence were found though findings favored the intervention (7-day abstinence: ToQuit 23%, control 19%; adjusted odds ratio 1.23, 95% confidence interval 0.38, 3.97). Participants appreciated the language, comprehensibility, and relevance of the messages; and reported overall satisfaction with and positive impact from the intervention on their lives. CONCLUSIONS The findings indicate the acceptability and feasibility of ToQuit and if found effective, it could be a potentially scalable first-line response to tobacco use in low-resource settings. IMPLICATIONS Our pilot randomized control trial provides sufficient findings supporting the acceptability and feasibility of an intervention for tobacco cessation which is suitable for a context which has a shortage of healthcare workers and for individuals who use smoked or smokeless tobacco. This is critical on a background of limited contextually relevant interventions for a problem with a high burden in low- and middle-income countries such as India.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Addictions and Related Research Group, Sangath, Goa, India
| | - Leena Gaikwad
- Addictions and Related Research Group, Sangath, Goa, India
| | | | | | - Megan Lopes
- Addictions and Related Research Group, Sangath, Goa, India
| | | | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Richard Velleman
- Addictions and Related Research Group, Sangath, Goa, India
- Department of Psychology, University of Bath, Bath, UK
| | - Urvita Bhatia
- Addictions and Related Research Group, Sangath, Goa, India
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
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Sigal AR, Cardinali-Re BA, Campana L, Lopez-Santi P, Iomini P, Zanoni CA, Salcerini M, Pozzer L, Traghetti M, Pulido L, Piñeiro DJ, Rosende A, Garcia-Zamora S. [Self-perception of smoking cessation skills among Cardiology residents in Argentina]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:82-87. [PMID: 38046230 PMCID: PMC10688411 DOI: 10.47487/apcyccv.v4i3.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/23/2023] [Indexed: 12/05/2023]
Abstract
Objective To evaluate the self-perception of cardiology residents in Argentina regarding their abilities to help their patients stop smoking, as well as their opinions about their knowledge and skills in this area. Materials and methods A cross-sectional study was carried out using secondary data from a study carried out in five Latin American countries and Spain, focusing on the information provided by cardiology residents in Argentina. Discrete variables were expressed as median and interquartile range, and categorical variables were expressed as percentages, and were analyzed using the chi-square test or Fisher's exact test, depending on the relative frequency of the expected values. Results 447 residents participated; 87.5% routinely provided brief advice to quit smoking, and 11.6% used validated questionnaires to assess the degree of addiction. Furthermore, 32.1% stated that they prescribed pharmacological treatment, but 53.1% were only familiar with a single drug. When asked about their self-perception of getting their patients to stop smoking, the median response was 5 (scale from 1 to 10); only 13.7% responded with a score of 8 or more. Conclusions The present study suggests that cardiology residents in Argentina recognize the importance of carrying out smoking cessation interventions, but a high proportion of them do not feel qualified to do so.
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Affiliation(s)
- Alan R Sigal
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Braian Abel Cardinali-Re
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Lucas Campana
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Pilar Lopez-Santi
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Pablo Iomini
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Celeste A Zanoni
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Mariana Salcerini
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Leandro Pozzer
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Manuel Traghetti
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Laura Pulido
- Servicio de Neumonología, Hospital Italiano de Rosario, Rosario, Argentina. Servicio de Neumonología Hospital Italiano de Rosario Rosario Argentina
| | - Daniel José Piñeiro
- Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina. Universidad de Buenos Aires Facultad de Medicina Universidad de Buenos Aires (UBA) Buenos Aires Argentina
| | - Andrés Rosende
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
- Servicio de Neumonología, Hospital Italiano de Rosario, Rosario, Argentina. Servicio de Neumonología Hospital Italiano de Rosario Rosario Argentina
| | - Sebastián Garcia-Zamora
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
- Servicio de Cardiología, Sanatorio Delta, Rosario, Argentina. Servicio de Cardiología Sanatorio Delta Rosario Argentina
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Nadkarni A, Bhatia U, Bedendo A, de Paula TCS, de Andrade Tostes JG, Segura-Garcia L, Tiburcio M, Andréasson S. Brief interventions for alcohol use disorders in low- and middle-income countries: barriers and potential solutions. Int J Ment Health Syst 2022; 16:36. [PMID: 35934695 PMCID: PMC9358825 DOI: 10.1186/s13033-022-00548-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Global alcohol consumption and harmful use of alcohol is projected to increase in the coming decades, and most of the increase will occur in low- and middle-income countries (LMICs); which calls for cost-effective measures to reduce alcohol exposure in these countries. One such evidence based measure is screening and brief intervention (BI) for alcohol problems. Some of the characteristics of BI make them a particularly appealing choice of interventions in low-resource settings. However, despite evidence of effectiveness, implementation of BI in LMICs is rare. In this paper we discuss barriers to implementation of BI in LMICs, with examples from Latin America and India. Key barriers to implementation of BI in LMICs are the lack of financial and structural resources. Specialized services for alcohol use disorders are limited or non-existent. Hence primary care is often the only possible alternative to implement BI. However, health professionals in such settings generally lack training to deal with these disorders. In our review of BI research in these countries, we find some promising results, primarily in countries from Latin America, but so far there is limited research on effectiveness. Appropriate evaluation of efficacy and effectiveness of BI is undermined by lack of generalisability and methodological limitations. No systematic and scientific efforts to explore the implementation and evaluation of BI in primary and community platforms of care have been published in India. Innovative strategies need to be deployed to overcome supply side barriers related to specialist manpower shortages in LMICs. There is a growing evidence on the effectiveness of non-specialist health workers, including lay counsellors, in delivering frontline psychological interventions for a range of disorders including alcohol use disorders in LMICs. This paper is intended to stimulate discussion among researchers, practitioners and policy-makers in LMICs because increasing access to evidence based care for alcohol use disorders in LMICs would need a concerted effort from all these stakeholders.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health (CGMH), Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK. .,Addictions Research Group, Sangath, Porvorim, Goa, India.
| | - Urvita Bhatia
- Addictions Research Group, Sangath, Porvorim, Goa, India.,Department of Psychology, Health and Professional Development at Oxford Brookes University, Oxford, UK
| | - Andre Bedendo
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil.,Department of Health Sciences, Faculty of Sciences, University of York, York, UK
| | | | - Joanna Gonçalves de Andrade Tostes
- Center for Research, Intervention and Evaluation on Alcohol & Drugs (CREPEIA), Department of Psychology, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Lidia Segura-Garcia
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain.,Clincal Psychology and Health Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marcela Tiburcio
- Department of Social Sciences in Health, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Bhatt G, Goel S, Soundappan K, Kaur R. Theoretical constructs of smoking cessation among current tobacco smokers in India: a secondary analysis of Global Adult Tobacco Survey-2 (2016-2017). BMJ Open 2022; 12:e050916. [PMID: 35105617 PMCID: PMC8804628 DOI: 10.1136/bmjopen-2021-050916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 12/16/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Quitting tobacco smoking is a complex process, and the transtheoretical model describes the various stages of behaviour change that smokers experience to stop smoking. Predictors of intention to quit and stage of behavioural change could assist policy-makers in establishing tailor-made strategies to offer support. OBJECTIVE In the current study, we analysed the determinants of cessation among 9499 current smokers of India recorded during the second Global Adult Tobacco Survey (2016-2017). METHODS Bivariate analysis, multivariate analysis (binary logistic regression was performed for past quit attempts and intention to quit smoking in the future; multinomial logistic regression to understand predictors of various stages of change determining cessation behaviour of current smokers) was undertaken. RESULTS The majority of the smokers was men (91.0%), in 25-44 years age group, (42.3%), daily wagers (37.4%) and resided in the rural area (73.3%), with bidi being the most commonly smoked product (72%). Nearly 72% tried to quit without any assistance with 36.6% (precontemplation), 27% (contemplation), 28% (preparation (or action)) and 8.1% in (relapse) stage. Men ((1.049); 95% CI 1.047 to 1.051), the primary (1.192; 95% CI 1.190 to 1.193) as well as higher education, being married (1.231; 95% CI 1.229 to 1.234) and urban residence (1.167; 95% CI 1.1.65 to 1.168) were found to be associated with higher prevalence of previous quit attempts. The regression modelling found out that intent to quit reduced with increasing age and was similarly prevalent with any level of education. CONCLUSION Understanding stages of behavioural change could assist the stakeholders in developing individualised interventions along with the development of intensive cessation protocols in clinical and public health settings.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kathirvel Soundappan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajbir Kaur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Panda R, Omar R, Hunter R, Prabhu RR, Mishra A, Nazareth I. Exploratory randomised trial of face-to-face and mobile phone counselling against usual care for tobacco cessation in Indian primary care: a randomised controlled trial protocol for project CERTAIN. BMJ Open 2022; 12:e048628. [PMID: 34992102 PMCID: PMC8739426 DOI: 10.1136/bmjopen-2021-048628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Despite widespread use of smokeless tobacco products by people within the Indian subcontinent, there is little awareness among Indians of its health hazards when compared with smoked tobacco. We hypothesise that mobile phone counselling will be feasible and effective for smokeless tobacco cessation intervention in India. This paper presents the protocol of the development and conduct of an exploratory trial before progression to a full randomised controlled trial. METHODS AND ANALYSIS An exploratory randomised controlled trial will be conducted in urban primary health centres in the state of Odisha, India. A total of 250 smokeless tobacco users will be recruited to the study (125 in each arm). Participants in the intervention arm will receive routine care together with a face-to-face counselling intervention followed by advice and reminder mobile messages. The control arm will receive routine care, delivered by a primary care physician based on 'Ask' and 'Advice'. All participants will be followed up for 3 months from the first counselling session. The primary outcome of this trial is to assess the feasibility to carry out a full randomised controlled trial. ETHICS AND DISSEMINATION Ethical approvals were obtained from the Institutional Ethics Committee of Public Health Foundation of India, Health Ministry's Screening Committee, Odisha State Ethics Board and also from University College London Research Ethics Committee, UK. The study findings will be published in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER CTRI/2019/05/019484.
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Affiliation(s)
- Rajmohan Panda
- Research, Public Health Foundation of India, Gurgoan, Haryana, India
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rajath R Prabhu
- Research, Public Health Foundation of India, Gurgoan, Haryana, India
| | - Arti Mishra
- Research, Independent Consultant, New Delhi, India
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
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Jain G, Narasimha V, Arya A, Pandi A, Varshney S. Technology-based tobacco cessation training in Indian context. Indian J Public Health 2022; 66:498-500. [PMID: 37039181 DOI: 10.4103/ijph.ijph_2009_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In tobacco use disorders (TUDs), technology-based training of health-care professionals can reduce the treatment gap and bring attitudinal change. The study aimed to assess the practices and determine the change in knowledge and attitude among health-care professionals following an online training program (OTP). Half-day OTP on tobacco cessation using prepost quasi-experimental study design with a structured questionnaire-based assessment was conducted. Among 293 completed surveys, knowledge post-OTP was higher but insignificant (P = 1.2). Post-OTP, participants felt less angry and disappointed toward tobacco users (mean of difference (MOD) =0.21, P = 0.0007); more sympathetic and concerned (MOD = -0.22, P = 0.0005); and acknowledged tobacco users deserve the same medical care as nonusers (MOD = -0.177, P = 0.001). Post-OTP scores in attitudes did not change significantly for the responsibility domain (P < 0.05). In practice, relatively greater number of health-care professionals asked about tobacco use and advised cessation, however lesser assessed, assisted, and referred. To conclude, technology-based training program can result in attitudinal changes toward tobacco users.
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Santos MDDV, Santos SV, Caccia-Bava MDCGG. [The prevalence of strategies for cessation of tobacco use in primary health care: an integrative review]. CIENCIA & SAUDE COLETIVA 2019; 24:563-572. [PMID: 30726388 DOI: 10.1590/1413-81232018242.27712016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/23/2017] [Indexed: 11/22/2022] Open
Abstract
The habit of tobacco use/smoking, which is a major concern of Primary Health Care (PHC), is a serious public health problem and the main avoidable cause of death in the world. The relevance of actions, whose focus is to facilitate the cessation of this habit, motivates the discussion of studies that have different approaches to tackle this issue by seeking to train PHC professionals accordingly. A search was conducted in the Lilacs, MEDLINE and Web of Science databases for recent scientific publications (2010-2015). The key words were combined with Boolean operators and, after analysis of the articles found, 75 are discussed in this article since they have strategies with a higher prevalence in PHC. The conclusion drawn is that the brief or intense individual approach using the 5A method (Transtheoretical Model) is the most widely adopted, as well as bupropion and nicotine replacement patches. The increasing use of hard technology requires new studies that examine their impact on the treatment of smokers. It was clearly revealed that there is a need for health professionals to be better prepared to address the issue with the users, in addition to a lack of stimulus and proper conditions to work in the PHC team directly reflecting scientific advances in clinical practice.
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Affiliation(s)
- Meire de Deus Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
| | - Stella Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
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Nims L, Jordan TR, Price JH, Dake JA, Khubchandani J. Smoking cessation education and training in obstetrics and gynecology residency programs in the United States. J Family Med Prim Care 2019; 8:1151-1158. [PMID: 31041266 PMCID: PMC6482793 DOI: 10.4103/jfmpc.jfmpc_451_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND OB/GYN physicians should be involved in providing smoking cessation counseling to their patients who smoke, especially pregnant patients. However, the smoking cessation practices of OB/GYN physicians seem to be dependent on their education and training and not much is known about their training during medical school. Therefore, the purpose of this study was to assess the smoking cessation education provided by OB/GYN residency training programs in the United States. METHODS The investigators developed and mailed a valid and reliable survey to all allopathic and osteopathic OB/GYN Residency Directors in the US (n = 275). The internal reliability coefficients (Cronbach alpha) for the four major subscales ranged from 0.63 to 0.90. Best practices in survey research were used to achieve a final response rate of 58%. RESULTS The majority of residency programs (60%) did not have a formal, structured curriculum in tobacco topics and/or smoking cessation. In contrast, 40% of programs reported having a formal, structured tobacco education curriculum. Sixty-five percent of programs did not formally evaluate residents' competence in providing smoking cessation counseling to patients. A range of 42% to 57% of residency programs reported spending less than one hour/year on teaching various basic science and clinical science topics related to tobacco use. The majority of residency programs spent no time teaching residents about the socio-political aspects of tobacco use cessation. Lack of teaching time was identified by the majority (51%) of the residency directors as a barrier to teaching smoking cessation. CONCLUSION Although OB/GYN physicians are expected to provide smoking cessation counseling to their patients, the majority of OB/GYN residency programs in the United States provide minimal education and training in this area. Therefore, continuing medical education on smoking cessation counseling should be broadly implemented for OB/GYN physicians.
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Affiliation(s)
- Liz Nims
- Department of Nursing, Lourdes University, Sylvania, OH, USA
| | - Timothy R. Jordan
- Department of Public Health, The School of Population Health, The University of Toledo, Toledo, OH, USA
| | - James H. Price
- Department of Health Education, The School of Population Health, The University of Toledo, Toledo, OH, USA
| | - Joseph A. Dake
- Department of Public Health, The School of Population Health, The University of Toledo, Toledo, OH, USA
| | - Jagdish Khubchandani
- Department of Health Science, College of Health, Ball State University, Muncie, IN, USA
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Bhad R. Utilization of "Screening Brief Intervention and Referral to Treatment" Approach for Tobacco Addiction in Day-to-Day Clinical Practice in India: The Need of the Hour. J Neurosci Rural Pract 2019; 10:8-9. [PMID: 30765963 PMCID: PMC6337983 DOI: 10.4103/jnrp.jnrp_271_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Roshan Bhad
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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PATI S, CHAUHAN A, MAHAPATRA S, SINHA R, PATI S. Practicing health promotion in primary care -a reflective enquiry. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2017; 58:E288-E293. [PMID: 29707659 PMCID: PMC5912790 DOI: 10.15167/2421-4248/jpmh2017.58.4.749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 10/04/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Health promotion is an integral part of routine clinical practice. The physicians' role in improving the health status of the general population, through effective understanding and delivery of health promotion practice, is evident throughout the international literature. Data from India suggest that physicians have limited skills in delivering specific health promotion services. However, the data available on this is scarce. This study was planned to document the current health promotion knowledge, perception and practices of local primary care physicians in Odisha. METHODS An exploratory study was planned between the months of January - February 2013 in Odisha among primary care physicians working in government set up. This exploratory study was conducted, using a two-step self-administered questionnaire, thirty physicians practicing under government health system were asked to map their ideal and current health promotion practice, and potential health promotion elements to be worked upon to enhance the practice. RESULTS The study recorded a significant difference between the mean of current and ideal health promotion practices. The study reported that physicians want to increase their practice on health education. CONCLUSION We concluded that inclusion of health promotion practices in routine care is imperative for a strong healthcare system. It should be incorporated as a structured health promotion module in medical curriculum as well.
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Affiliation(s)
- S. PATI
- Department of Health and Family Welfare, Government of Odisha, Odisha, India
| | - A.S. CHAUHAN
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - S. MAHAPATRA
- Indian Institute of Public Health, Bhubaneswar, Bhubaneshwar, Odisha, India
| | - R. SINHA
- Independent Researcher, New Delhi, India
| | - S. PATI
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha, India
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Fagunwa IO, Loughrey MB, Coleman HG. Alcohol, smoking and the risk of premalignant and malignant colorectal neoplasms. Best Pract Res Clin Gastroenterol 2017; 31:561-568. [PMID: 29195676 DOI: 10.1016/j.bpg.2017.09.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/31/2017] [Accepted: 09/16/2017] [Indexed: 01/31/2023]
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide and has a complex aetiology consisting of environmental and genetic factors. In this review, we evaluate the roles of alcohol and tobacco smoking in colorectal neoplasia. Alcohol intake and tobacco smoking are associated with modest, but significantly, increased risks of CRC, adenomatous and serrated polyps. There is consistent evidence of dose-response relationships for both alcohol and smoking, and risk of these neoplasms. Alcohol and smoking appear to be more strongly associated with colorectal polyp than CRC development, suggesting roles in the initiation of neoplastic growths. These lifestyle factors also seem more strongly related to adenomas and sessile serrated lesions than hyperplastic polyps, but further confirmation is required. The gastroenterology community has an important, yet currently underexploited, role to play addressing the modifiable factors associated with CRC and polyps. These behaviours include, but are not limited to, alcohol and smoking.
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Affiliation(s)
- Ifewumi O Fagunwa
- Cancer Epidemiology Research Group, Centre for Public Health, Queen's University Belfast, Northern Ireland, United Kingdom.
| | - Maurice B Loughrey
- Department of Histopathology, Belfast Health and Social Care Trust, Northern Ireland, United Kingdom; Centre for Cancer Research and Cell Biology, Queen's University Belfast, Northern Ireland, United Kingdom.
| | - Helen G Coleman
- Cancer Epidemiology Research Group, Centre for Public Health, Queen's University Belfast, Northern Ireland, United Kingdom; Centre for Cancer Research and Cell Biology, Queen's University Belfast, Northern Ireland, United Kingdom.
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Panda R, Mahapatra S, Gaurav K, Pati S, Mathur MR. A quasi-experimental intervention to assess the effectiveness of a physician-delivered tobacco cessation intervention in India: A detailed study protocol. SAGE Open Med 2017; 5:2050312117697173. [PMID: 28540045 PMCID: PMC5433661 DOI: 10.1177/2050312117697173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/31/2017] [Indexed: 01/08/2023] Open
Abstract
Introduction: Tobacco cessation is the most important, cost-effective preventive maintenance that clinicians can offer study participants who use tobacco. There is lack of preparedness among primary care physicians in delivering cessation interventions. There are also limited studies which record the effectiveness of cessation interventions in the Indian context. This study is designed to evaluate the effectiveness of brief and intensive tobacco cessation interventions delivered by trained primary care providers in two states of India. Methods and Analysis: A quasi-experimental study design has been adopted for the study with around 20 primary care practices, selected from four districts of two states in India (Odisha and Rajasthan). Brief (3A) and Intensive tobacco (5A) cessation intervention services will be provided to two groups of tobacco users, respectively. Both groups will be followed up for 6 months to determine the effectiveness of the cessation interventions. The cost-effectiveness of the services will also be documented at the end of the study. The entire study will be completed in 24 months, of which the final 6 months will be reserved for study participant follow-up and quit rate evaluation. When comparing the two groups, differences between proportions will be assessed by chi-square test and differences between means with t-test. The conventional significance level of 0.05 will be used in all analyses in order to reject the null hypothesis of no difference between groups. We will use difference-in-differences methods to assess the impact of the interventions on physicians’ behavior to deliver tobacco cessation in their clinical practice. Conclusion: The study is in participant recruitment phase.
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Affiliation(s)
| | | | - Kumar Gaurav
- Public Health Foundation of India, Gurgaon, India
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Ruhil R. Sociodemographic characteristics of tobacco users as determinants of tobacco use screening done by healthcare providers: Global Adult Tobacco Survey India 2009-2010. J Family Med Prim Care 2016; 5:82-8. [PMID: 27453849 PMCID: PMC4943156 DOI: 10.4103/2249-4863.184629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION World Health Organization and Indian Public Health Standards recommend provision of tobacco use screening and cessation help at primary care settings. Evidence shows that brief advice by healthcare provider helps tobacco user quit. It starts with asking the patient about his tobacco use status. The rate of tobacco use screening done by healthcare providers is very low and also depends on sociodemographic characteristics of patients along with several other factors. OBJECTIVES This paper intends to study how sociodemographic characteristics (age, gender, residence [rural/urban], education, and occupation) of tobacco users influence the tobacco use screening done by healthcare providers. MATERIALS AND METHODS The study was a secondary data analysis of the Global Adult Tobacco Survey India 2009-2010. There were 4958 smokers and 7255 smokeless tobacco users included in the study who visited healthcare provider in the past 12 months prior to the survey. RESULTS AND DISCUSSION The results showed that male smokers were more likely to be screened for smoking by healthcare providers as compared to female smokers. Furthermore, tobacco users in younger age groups were less likely to be screened for tobacco use by healthcare providers as compared to tobacco users in older age groups. Urban smokeless tobacco users were more likely to be screened for tobacco use by healthcare provider as compared to rural smokeless tobacco users. CONCLUSION Healthcare providers were being biased in tobacco use screening of their patients based on demographic characteristics of patients, i.e., their age, gender, and rural/urban residence. However, the evidence shows that it is very imperative to screen each and every patient for tobacco use habit.
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Affiliation(s)
- Rohini Ruhil
- Centre for Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
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