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Sequeira M, Naughton F, Velleman R, Murthy P, D'souza J, Pacheco MG, Kamat AK, Gadiyar A, Sanjeevan V, Jain L, Nadkarni A. Perspectives of smokers, smokeless tobacco users and cessation practitioners in India: A qualitative study. Arch Psychiatr Nurs 2024; 51:194-200. [PMID: 39034078 DOI: 10.1016/j.apnu.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/05/2023] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION India is the second largest consumer of tobacco in the world and accounts for 70% of global deaths due to smokeless tobacco (SLT) use. AIM The aim of this study is to understand the perspectives of tobacco users (smokers and SLT users) and practitioners in India to inform cessation interventions. METHOD Semi-structured in-depth interviews with tobacco users (smoked and smokeless; n=23), and healthcare practitioners (n=13). Perspectives were triangulated using thematic analysis to examine convergence, divergence and complementarity of findings. RESULTS We present the results in a socio-ecological framework to highlight reasons for initiation and continuation of tobacco and motives to quit at the individual, interpersonal, occupational, societal and policy levels. SLT is seen as culturally acceptable compared to smoked forms of tobacco. Emotionally framed messages highlighting negative effects of tobacco on loved ones were perceived to be a better motivator than other types of cessation messages. DISCUSSION Nuanced differences exist between smokers and SLT user perspectives which have implications for cessation programs. Our findings supplement similar studies with other South Asian populations. IMPLICATIONS FOR PRACTICE Our study provides useful insights to tailor cessation interventions to the type of tobacco consumed in order to enhance their acceptability and effectiveness.
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Affiliation(s)
- Miriam Sequeira
- Addictions and Related Research Group, Sangath, Porvorim, Goa, India
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Richard Velleman
- Addictions and Related Research Group, Sangath, Porvorim, Goa, India; Department of Psychology, University of Bath, Bath, England, UK
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Joseline D'souza
- Addictions and Related Research Group, Sangath, Porvorim, Goa, India
| | | | - Amita Kenkre Kamat
- Department of Public Health Dentistry, Goa Dental College and Hospital, Bambolim, India
| | - Akshatha Gadiyar
- Department of Public Health Dentistry, Goa Dental College and Hospital, Bambolim, India
| | - Vinita Sanjeevan
- Department of Public Health Dentistry, Goa Dental College and Hospital, Bambolim, India
| | - Latika Jain
- Addictions and Related Research Group, Sangath, Porvorim, Goa, India
| | - Abhijit Nadkarni
- Addictions and Related Research Group, Sangath, Porvorim, Goa, India; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Campopiano von Klimo M, Nolan L, Corbin M, Farinelli L, Pytell JD, Simon C, Weiss ST, Compton WM. Physician Reluctance to Intervene in Addiction: A Systematic Review. JAMA Netw Open 2024; 7:e2420837. [PMID: 39018077 PMCID: PMC11255913 DOI: 10.1001/jamanetworkopen.2024.20837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/07/2024] [Indexed: 07/18/2024] Open
Abstract
Importance The overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low. Objective To describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions. Data Sources A literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021. Study Selection Publications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included. Data Extraction and Synthesis Two reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons. Main Outcomes and Measures The primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria. Results A total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug. Conclusions and Relevance In this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.
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Affiliation(s)
| | - Laura Nolan
- JBS International, Inc, North Bethesda, Maryland
| | - Michelle Corbin
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Lisa Farinelli
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Jarratt D. Pytell
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Caty Simon
- National Survivors Union, Greensboro, North Carolina
- NC Survivors Union, Greensboro, North Carolina
- Whose Corner Is It Anyway, Holyoke, Massachusetts
| | - Stephanie T. Weiss
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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Panda R, Persai D, Mahapatra S, Mohanty I. Does behavioral intervention affect intention to quit? : A quasi-experimental study from primary healthcare settings in India. Tob Prev Cessat 2021; 7:56. [PMID: 34395953 PMCID: PMC8330841 DOI: 10.18332/tpc/138951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/30/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tobacco is the leading cause of death and disease in India. This study examines the effect of training intervention in behavioral counseling on intention to quit tobacco in primary healthcare settings in India. The intervention included training to improve behavioral counseling practices of primary care physicians (PCPs) based on the 5As approach to increase patients' motivation to quit tobacco. METHODS A quasi-experimental design was used for the study. The intervention consists of training of primary care physicians in the behavioral intervention in tobacco cessation. The intervention was conducted in twelve districts of two states in India (Rajasthan and Odisha) in 2016-2017. Four districts were randomly sampled for the study. A total of 1314 participants (intervention and control) were recruited for the study in the baseline and end-line surveys, respectively. Intention to quit in 30 days was the primary outcome measure. Difference-in-difference (DiD) logistic regression models were used separately for smokers and smokeless tobacco users to estimate the odds of intention to quit. Analysis was done in STATA Version 14. RESULTS The intervention and time variable had a significantly positive influence on the intention to quit tobacco among smokers. Smokers in the intervention districts had higher odds of intention to quit (OR=9.82; 95% CI: 1.67-57.72) compared to smokers in the control districts. Smokeless tobacco (SLT) users had higher odds of intention to quit (OR=3.06; 95% CI: 1.35-6.98) in the end-line survey compared to baseline survey. CONCLUSIONS Our findings indicate that building capacity in behavioral intervention in primary care settings can help increase the intention to quit among smokers. The observed difference in intention to quit between smokers and SLT users suggests the need of tailored counseling interventions for SLT users. There is a need for further research to design and evaluate training and behavioral interventions for SLT and dual (smoking and SLT) users in primary care settings in low- and middle-income countries.
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Affiliation(s)
| | - Divya Persai
- Public Health Foundation of India, Gurugram, India
| | | | - Itismita Mohanty
- Health Research Institute, University of Canberra, Canberra, Australia
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Persai D, Karan A, Panda R. Incremental Benefits of Multiple Tobacco Control Interventions: A Factorial Randomized Control Trial. Asian Pac J Cancer Prev 2020; 21:1905-1911. [PMID: 32711414 PMCID: PMC7573427 DOI: 10.31557/apjcp.2020.21.7.1905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 11/29/2022] Open
Abstract
Tobacco control requires a comprehensive approach. The present study aims to examine the incremental effectiveness of health systems intervention when combined with other interventions in enhancing knowledge and practices of physicians in tobacco cessation.
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Affiliation(s)
- Divya Persai
- Indian Institute of Public Health, Public Health Foundation of India, Delhi NCR, India
| | - Anup Karan
- Indian Institute of Public Health, Public Health Foundation of India, Delhi NCR, India
| | - Rajmohan Panda
- Indian Institute of Public Health, Public Health Foundation of India, Delhi NCR, India
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Mughal F, Rashid A, Jawad M. Tobacco and electronic cigarette products: awareness, cessation attitudes, and behaviours among general practitioners. Prim Health Care Res Dev 2018; 19:605-609. [PMID: 29880076 PMCID: PMC6692824 DOI: 10.1017/s1463423618000166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/30/2018] [Accepted: 05/28/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Little is known around how general practitioners (GP) approach tobacco products beyond traditional cigarettes.AimTo examine GP perceptions of tobacco and electronic cigarette (EC) products, and their attitudes and behaviours towards product cessation. METHOD A 13-item self-completed anonymous questionnaire measured awareness of waterpipe tobacco smoking (WTS) and smokeless tobacco (ST). Cessation advice provision, referral to cessation services, and the harm perception of these products were asked using five-point Likert scales that were dichotomised on analysis. Correlates of cessation advice were analysed using regression models.FindingsWe analysed 312 responses, of whom 63% were aware of WTS and between 5-32% were aware of ST products. WTS and ST were considered less harmful than cigarettes by 82 and 68% of GPs, respectively. WTS, ST, and EC users were less advised (P<0.001) and referred (P<0.001) to cessation services compared to cigarette users. Ethnic minority and senior GPs were more likely to provide cessation advice for WTS and ST users compared to younger white GPs. GPs who were recent tobacco users were less likely to give cessation advice to cigarette users (adjusted odds ratios 0.17, 95% confidence interval 0.03-0.99, P<0.049).Conclusions (implications for practice and research)GPs had lower harm perception, gave less cessation advice, and made less referrals for WTS and ST users compared to cigarettes. Our findings highlight the need for targeted tobacco education in general practice. More research is needed to explore GP perceptions in depth as well as patient perspectives.
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Affiliation(s)
- Faraz Mughal
- GP & Honorary Research Fellow, Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
- NIHR In-Practice Fellow, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Ahmed Rashid
- UCL Medical School, Royal Free Hospital, Hampstead, London, UK
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, Hammersmith, UK
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Abstract
Background Globally, over 300 million people consume diverse smokeless tobacco (ST) products. They are addictive, cause cancer, increased cardiovascular mortality risks and poor pregnancy outcomes. Purpose of Review To identify gaps in implementing key ST demand-reduction measures, focused literature reviews were conducted and findings synthesized according to relevant WHO Framework Convention on Tobacco Control (FCTC) Articles. Recent Findings The literature supports implementation of ST demand-reduction measures. For taxation, labelling and packaging, most administrations have weaker policies for ST than cigarettes. Capacity to regulate ST contents and offer cessation support is lacking. There is poor compliance with bans on ST advertising, promotion and sponsorship. Summary The literature on implementation of WHO FCTC for ST is limited. Although strengths of ST demand-control activities are currently identifiable from available literature, full implementation of FCTC is lacking. A wider evidence-based response to WHO FCTC is proposed, particularly for countries facing the greatest disease burdens.
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Sinha DN, Rizwan SA, Aryal KK, Karki KB, Zaman MM, Gupta PC. Trends of Smokeless Tobacco use among Adults (Aged 15-49 Years) in Bangladesh, India and Nepal. Asian Pac J Cancer Prev 2016; 16:6561-8. [PMID: 26434875 DOI: 10.7314/apjcp.2015.16.15.6561] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smokeless tobacco (SLT) has long been realized as an important component of the fight for global tobacco control. It still remains a major problem in countries like India, Bangladesh and Nepal. The objective of this study was to estimate the trends of SLT use in three countries of the SEARO WHO office. MATERIALS AND METHODS We used data from national surveys in three countries (Bangladesh, India and Nepal) to estimate trends in prevalence of current SLT use. All available nationally representative data sources were used. Estimates were weighted, age standardized and given along with 95% confidence intervals. Significance of linear trend in prevalence over time was tested using the Cochrane-Armitage test for trend. A p value of less than 0.05 was considered statistically significant. RESULTS We identified three surveys for Bangladesh, three for India and four for Nepal that met the selection criteria (such as Demographic and Health Surveys, WHO-STEPwise approach to Surveillance and Global Adult Tobacco Surveys). A significantly increasing trend was noticed in the prevalence of current SLT use among Bangladeshi men (20.2% to 23%, p=0.03). In India, a similar significantly increasing trend was seen among men (27.1% to 33.4%, p<0.001) and women (10.1% to 15.7%, p<0.001). In Nepal, there was a no significant trend among both men (39.1% to 31.6%, p=0.11) and women (5.6% to 4.7%, p=0.49). CONCLUSIONS In the study countries SLT use has remained at alarmingly high levels. Usage trends do not show any signs of decline in spite of control efforts. Tobacco control measures should focus more on controlling SLT use.
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Affiliation(s)
- Dhirendra N Sinha
- Regional Adviser, Surveillance, (Tobacco Control), Tobacco Free Initiative Unit, Regional Office for South-East Asia, World Health Organization, New Delhi, India E-mail :
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Duman E, Yildirim M, Kaya V, Ozturk D, Inal A, Akarsu Z, Gunduz S, Yildiz M. Effects of Definitive Chemoradiotherapy on Respiratory Function Tests and Quality of Life Scores During Treatment of Lung Cancer. Asian Pac J Cancer Prev 2016; 16:6779-82. [PMID: 26434911 DOI: 10.7314/apjcp.2015.16.15.6779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemoradiotherapy is an important treatment modality for lung cancers. The aim of this study was to investigate alterations in, as well as the interrelationship between, lung function and quality of life of patients receiving chemoradiotherapy due to locally advanced non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) limited to the thorax. MATERIALS AND METHODS The study included patients receiving definitive chemoradiotherapy for lung carcinoma. The respiratory function of the patients was assessed by measuring forced expiratory volume in 1 s per unit (FEV1) and forced expiratory volume in 1s per unit of vital capacity (FEV1/VC) before, in the middle of and after treatment. During the study, EORTC QLQ C30 and LC13 questionnaires developed by the Committee of the European Organization for Research and Treatment of Cancer (EORTC) were employed to evaluate the quality of life on the same day as respiratory function tests (RFT). FINDINGS The study included 23 patients in total: 19 (82.6%) diagnosed with NSCLC and 4 (17.4%) with SCLC. The average percentage FEV1 was 55.6±21.8% in the pre-treatment period, 56.2±19.2% in the middle of treatment and 60.4±22% at the end of treatment. The improvement in functional scores, symptom scores and general health scores during treatment was not statistically significant (P=0.568, P=0.734, P=0.680, P=0.757 respectively). CONCLUSIONS Although this study showed an improvement in respiratory function and quality of life of patients during treatment with thoracic chemoradiotherapy, no statistically significant results were obtained. While evaluating the effectiveness of treatments for lung carcinoma, the effects of treatment on respiratory function and quality of life should be considered.
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Affiliation(s)
- Evrim Duman
- Department of Radiation Oncology, Antalya Education and Research Hospital, Antalya, Turkey E-mail :
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Kristina SA, Thavorncharoensap M, Pongcharoensuk P, Montakantikul P, Suansanae T, Prabandari YS. Effectiveness of tobacco education for pharmacy students in Indonesia. Asian Pac J Cancer Prev 2015; 15:10783-6. [PMID: 25605176 DOI: 10.7314/apjcp.2014.15.24.10783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking remains the major preventable cause of death worldwide, especially cancer-related death. Evidence clearly indicates that tobacco-related morbidity and mortality is reduced by smoking cessation. Pharmacists are well-positioned to provide tobacco cessation services an involvement of pharmacists in smoking cessation is encouraged by several organizations. While Indonesia's prevalence of smoking is in the first rank in Asian countries, none of the pharmacy schools in Indonesia are currently offering tobacco-related courses in their existing curricula at present. Our study aimed to develop and to evaluate the effectiveness of tobacco education (TE) for pharmacy students in Indonesia. MATERIALS AND METHODS A 6-hour TE was developed and evaluated using pre-test/post-test with control group design. A total of 137 fifth-year pharmacy students at Gadjah Mada University (GMU), Yogyakarta, were chosen as an intervention group while a total of 105 fifth-year students of Islamic University of Indonesia, (UII) served as the control group. Knowledge, perceived-role, self-efficacy, and ability to perform counseling using the 5A's framework were evaluated. RESULTS A significant improvement (P < 0.001) in knowledge, perceived-role, and self-efficacy was found in the intervention group but not in the control group. In addition, we revealed that 89.7% of the intervention group were able to perform counseling using 5A's. CONCLUSIONS The developed TE significantly improved student knowledge, perceived-rolse, self-efficacy, and created an ability to perform cessation counseling. Integration of TE education in curricula of Indonesian pharmacy schools nation-wide should be encouraged.
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Affiliation(s)
- Susi Ari Kristina
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand E-mail :
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Kristina SA, Thavorncharoensap M, Pongcharoensuk P, Prabandari YS. Impact of Smoking Cessation Training for Community Pharmacists in Indonesia. Asian Pac J Cancer Prev 2015; 16:3319-23. [DOI: 10.7314/apjcp.2015.16.8.3319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Persai D, Panda R, Venkatesan S, Arora M, Ahluwalia JS. Does receipt of 5As services have implications for patients' satisfaction in India? BMC FAMILY PRACTICE 2014; 15:209. [PMID: 25515606 PMCID: PMC4287186 DOI: 10.1186/s12875-014-0209-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/12/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The 5As model for behavior change counseling is an evidence-based counseling approach. This study aims to explore the relationship between patient satisfaction with counseling services and 5As interventions in tobacco cessation. We also investigated the impact of satisfaction with counseling services on patients' intention to quit and recommendation of those services to other tobacco users. METHODS Two cross-sectional surveys were administered among patients and physicians working in primary health care facilities in 12 districts of two states in India. Health facilities and patients were recruited by systematic random and simple random sampling respectively. We limited our analyses to only those patients who were asked about their tobacco consumption. We used multivariable logistic regression to investigate associations between individual components of 5As interventions and patients' satisfaction with the counseling services. RESULTS Patients who reported that they were 'advised' to quit (OR: 9.56; 95% CI: 1.89-48.28), 'assessed' for readiness to quit (OR 2.1, 95% CI: 1.07-4.15) and offered cessation 'assistance' (OR 2.2, 95% CI: 1.17-4.29) were more satisfied with the counseling services. Patients who were satisfied with the counseling services were five times more likely to have an intention to quit tobacco (OR: 5.45, 95% CI: 3.59 to 8.27) and four times as likely to recommend counseling to other tobacco users (OR 3.83; 95% CI:2.46 -5.96). CONCLUSIONS Incorporating 5As interventions in the delivery of primary care would likely increase patients' satisfaction with physicians' delivered counseling services. Patients' recommendation of counseling services will aid in demand generation for cessation services in primary care.
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Affiliation(s)
- Divya Persai
- Public Health Foundation of India, New Delhi, India.
| | | | - Sudhir Venkatesan
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India.
| | - Jasjit S Ahluwalia
- Center for Health Equity, University of Minnesota, Minneapolis, MN, USA.
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