Presentation by Jagdish Kaur, MBBS, Union Health Ministry, India, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.

1. CHALLENGES faced in
expanding the role of healthcare
providers and delivering
treatment - India
Dr Jagdish kaur

2. Tobacco Use in India - GATS
84% tobacco
users use it
every day
Smokers 14% Smokeless tobacco users 26%

3. Burden of tobacco use
 Second largest consumer of tobacco
in the world
 275 million adults are tobacco users
 Prevalence in rural areas 38%, urban
areas 25%
 Multiple smoking and SLT products in
use

4. Burden…
 Prevalence of overall tobacco use
among males – 48%
 Among females – 20%
 Prevalence of smoking among males
– 24%
 Among females 3%
 Prevalence of SLT use among males
is 33%
 Among females 18%

5. GYTS India 2009
 13-15 years school students
 14.6% use tobacco (boys 19%, girls,
8.3%)
 4.4% smoke (boys 5.8%, girls 2.4%)
 21.9% live in the homes where other
smoke in their presence

6. Multiple tobacco products in use

7. Smoking products
Bidis Hukka (Hubble Bubble)

8. Smokeless Tobacco products
Gutkha Mawa
Khaini
Mishri
(masheri)
Qiwam Creamy Pan masala
snuff (betel quid)

9. Smokeless Tobacco products
Red
Tooth
Powder
Snus
(snuff)) Zarda
Other smokeless forms of tobacco products are:
Gudhaku (tobacco paste)
Tuibur (Tobacco water)

10. Quit attempts among Smokers
GATS India 2010-
 Among smokers, 38% made an
attempt to quit tobacco use in the
past 12 months.
 38% males, 39% females
 39% urban, 38% rural
 Highest proportion of smokers who
made an attempt to quit – 15-24 age
group (47%)
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11. Quit attempts among SLT users
 35% current and former users made
an attempt to quit tobacco use in the
past 12 months.
 39% males, 29% females
 37% urban, 35% rural
 Highest proportion of SLT users who
made an attempt to quit – 15-24 age
group (44%)
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12. Role of HCPs
 53% of smokers who visited a HCP in
the past 12 months were asked about
the smoking habits and 46% were
advised to stop smoking.
 64% of smokers age 65 and above
were asked about smoking habits and
58% were advised to quit, as
compared to only 31% in the age
group 15-24 years who were asked
about smoking and 26% were advise
to quit.
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13. Role of HCPs
 35% of SLT users who visited a HCP
were asked about the habit of SLT
use and 27% were advised to quit.
 Males, urban residents and older
persons were more likely to be asked
about SLT use and advised about
quitting.
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14. Methods of Quitting
For Smoking For SLT
Counseling 9.2% Counseling 7.6%
Pharmacotherapy 4.1%
Others (traditional medicines, switching Others (traditional medicines, other
to SLT, cold turkey) 26% products, cold turkey ) 26%
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15. Interest in quitting
 47% of current smokers planned to
quit smoking eventually (either within
12 months or after 12 months). 53%
had no plans to quit.
 Younger smokers (15-24 yrs) and
smokers with higher education were
relatively more inclined to quit.
 A comparatively higher proportion of
students planned to quit smoking
either within a month or within a
year. 1

16. Interest in quitting
 46% of users of SLT wanted to quit
eventually. 55% had no plans to quit.
 48% males and 39% females were
interested in quitting.
 The proportion of SLT users
interested in quitting decreased with
age and increased with the level of
education.
 A comparatively higher proportion of
students planned to quit SLT use
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17. Training in Tobacco cessation
 UG medical, dental, nursing and
pharmacy curriculum does not
cover tobacco dependence
treatment adequately.
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18. Available treatment methods
 Counseling
 NRT – gum
 Bupropion
 Varenicline
 Cost/affordability is a factor
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19. infrastructure for tobacco cessation
 A network of Tobacco cessation
clinics established in collaboration
with WHO
 Cessation facilities at the district
hospital level under NTCP
 General hospitals and TB hospitals
 Private hospitals and clinics
 Tobacco cessation Intervention
Initiative by IDA
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20. India is the
second
country in
SEAR to have
national
guidelines on
tobacco
dependence
treatment
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21. Manual for
training of
primary
health care
doctors was
developed for
training in
tobacco
control
including
cessation
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22. A Guide to train
health workers
in tobacco
control including
‘brief advice’
was developed
to build capacity.
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23. TB Tobacco Integration Project
 Highest burden for TB in the world,
accounting for one fifth of the global
incidence – 2 million cases annually.
 TB-Tobacco association is proven.
 Revised National Tuberculosis Programme
under implementation all over the country.
 Doctors and health workers were trained to
provide ‘brief advice’ to TB patients who
were smokers/tobacco users.
 Encouraging preliminary results.
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24. Opportunities
 Interest in quitting tobacco use is
high, especially among youth.
 Integration of tobacco cessation with
on going national health programmes.
 80% health care in private sector-
involve private practitioners by
training in tobacco dependence
treatment.
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25. Main challenges
 Large proportion of population using
tobacco
 Multiple tobacco products in use
 Limited infrastructure and capacity of
health care delivery system for
tobacco cessation
 Curriculum of health professionals
lack training in tobacco dependence
treatment (although covers alcohol
and substance use).
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26. Way forward
 Develop and implement cost effective
strategies for tobacco dependence
treatment.
 Build capacity of health care delivery
system to deal with high demand for
quitting tobacco use.
 Integrate tobacco cessation in youth
health programmes.
 Quitline
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27. Thank You
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