Skip to content Skip to navigation

Scaling up clinic-based tobacco cessation in India

The smoke-free policies in India were enforced since 2 October 2008 and different states are at varying levels of its implementation, yet the tobacco cessation services are still limited to very few clinics in India.

A lead article published in The Economist (7-13 March 2009) says: "tobacco is more addictive than virtually all of them [narcotic drugs]."

With tobacco being highly addictive, it is clear that for a successful implementation of the smoke-free policies, the scaling up of high-quality and reliable tobacco cessation services can no longer be ignored.

"Large areas in central and north-east India have more than 65 per cent tobacco use" said Dr Pratima Murthy, who is the Professor of Psychiatry and Chief, De-addiction centre, National Institute of Mental Health and Neuro-Sciences, Bangalore, Karnataka, India. She was speaking at the 14th World Conference on Tobacco or Health (WCTOH) which recently concluded in Mumbai (India). About 57 per cent men and 19 per cent women in rural areas use tobacco, both these figures are far more than the percentage of men and women who use tobacco in urban areas. Incidentally, most of the tobacco cessation services in India, are confined to urban areas. It is vital to expand tobacco cessation services in rural areas as well.

With support from the World Health Organization (WHO) and Ministry of Health and Family Welfare, Government of India, in the year 2002, thirteen tobacco cessation clinics (TCC) were established across the country in primarily cancer, psychiatry, surgical, cardiology and some non-governmental organization settings. These include the TCCs at the Chhatrapati Shahuji Maharaj Medical University (upgraded King George's Medical College) in Lucknow, Tata Memorial Hospital in Mumbai, and such premier healthcare institutes in India. Five more TCCs were added in the year 2005 at each of the regional cancer centres in India. Apart from delivering high quality and reliable tobacco cessation services, these TCCs were also mandated to develop intervention model for tobacco cessation for both smoking and smokeless tobacco users.

Each of these TCCs was well equipped with regular and uninterrupted drug supply, equipments like the CO monitor, and a well-trained staff in tobacco cessation. Over the past years, step-wise effective strategies for tobacco cessation evolved in these TCCs apart from providing tips to quit, behavioural counseling and pharmacotherapy.

The main sources of referral were other doctors and media. Since the year 2002, 34,741 cases were registered across the eighteen TCCs in India, and baseline details were available for 23,320, said Dr Murthy. 92 per cent of those registered in the TCCs were men, and 8 per cent were women. 65 per cent of those registered used smokeless forms, and 35 per cent used smoking forms or both (smoking and smokeless forms of tobacco). The mean age of those seeking tobacco cessation services was 37 years. About 50 per cent of those registered for seeking tobacco cessation services at the TCCs in India, had the average monthly income of about Rs 3000 per month (about USD 60).

Majority of those seeking help to quit tobacco didn't receive drugs - rather behavioural therapies, education, tips to quit, motivation to change and relapse prevention counseling were deemed most appropriate for 69 per cent tobacco quitters. About 31.1 per cent of those who registered for quitting tobacco, had successfully get rid of the deadly addiction. About 49.5 per cent of them had significantly improved by reducing the tobacco intake by over 50 per cent (compared to their baseline data). Only 8.7 per cent of those registered reported no change of tobacco cessation therapies on their addiction.

Improvement was significantly associated with being male, younger, using smokeless tobacco and receiving combined behavioural counseling and pharmacotherapy, said Dr Murthy. "Women – don't do badly but are unable to come for follow up" further explained Dr Murthy.

Dr Murthy outlines some limitations of the tobacco cessation programme in India. She says, very small number of population is covered by these TCCs in India. Most of these clinics are predominantly urban based and follow-up is variable in different TCCs. She also highlights another limitation that the use of tobacco quitting services is very limited among young people who are in varying stages of initiation.

The learnings are clear: tobacco cessation services need to be provided from a range of diverse clinical settings. The tobacco cessation service model needs to be extended in the community. There is also an urgent need for trained human resources to provide cessation services. Dr Murthy also emphasizes on the need to retain the people who want to quit tobacco use by improving follow-up.

She recommends that tobacco cessation training should be a part of the undergraduate training of medical professionals. Also there is a need to focus on basic training of all health professionals. She suggests a community based model to strengthen tobacco cessation services in India.



Bobby Ramakant
Citizen News Service (CNS)


(The author is a World Health Organization (WHO) Director General’s WNTD Awardee (2008) and can be contacted at: bobbyramakant@yahoo.com)

Add new comment

Random Stories

Fourth anniversary of Assam Bhawan Mumbai

24 May 2008 - 4:52pm | editor
The officers and staff of Assam Bhawan Mumbai cordially invite you to Sampritir Godhuli: An evening of togetherness to mark the Fourth Anniversary of Assam Bhawan on the 31st of May 2008.Eminent...

NRC: APW moves fresh plea

13 Jul 2015 - 1:34pm | AT News
Amid an escalating controversy over NRC, the Assam Public Works on Monday moved yet another affidavit before the supreme court alleging that the ongoing process is not satisfactory.In the affidavit...

All Assam Students' Union (AASU) celebrated 91th Birth Anniversary of Dr Bhupen Hazarika at Dighalipukhuri Guwahati onFriday. Photo by UB Photos

Jajabar music fest on Nov 5

9 Sep 2017 - 9:46am | Raktim Baruah
Dr. Bhupen Hazarika Foundation [DBHF]will launch its firstannualBhupen Hazarika Jajabor* Music Festival on November 5 in Guwahati.  Organizers say it aims at stimulating interest in the various...

Poaching rerun in Kaziranga

3 Oct 2015 - 8:31am | AT News
After a brief lull, poachers have struck again in Kaziranga leaving a full grown rhino killed in the world heritage site. The incident took place in Burhapahar range where the poachers have killed...

Other Contents by Author

The 'We reject Indo US Nuclear Deal' campaign was launched today in Lucknow by Dr Sandeep Pandey, Ramon Magsaysay Awardee (2002) and convener of National Alliance of People's Movements (NAPM). Dr Pandey was speaking on Indo US Nuclear Deal at Rao's IAS coaching centre on Faizabad road."The dream to provide electricity across the country by signing the Indo US Nuclear Deal is not true" said Dr Pandey. "Nuclear power is not a safe, affordable or better option for producing electricity. Rather nuclear power is a very dangerous and expensive option. The Indo US Nuclear Deal is actually a political and military deal" said Dr Pandey.There is a deliberate misinformation being...
Last week the bollywood heartthrob film-star Aamir Khan was found smoking after the launch of the latest blockbuster movie 'jaane tu … ya jaane na'. Earlier in June 2008, he was reported saying that he is back to smoking due to 'stress' related to the forthcoming release of 'jaane tu … ya jaane na' film and he will quit smoking right after the film-release. Although the film has been successfully released and is doing well at box office, the cigarettes are hard to leave… and Aamir continues to smoke. Tobacco is addictive, and some researchers feel nicotine is as addictive as heroin. It is not impossible to quit, but not easy too, because tobacco is so...
Despite of the India's legally-binding Cigarette and Other tobacco products Act (2003) and repeated appeals of India's Health and Family Welfare Minister Dr Anbumani Ramadoss to bollywood film-stars to refrain from on-screen smoking, there seems to be less compliance in the guise of 'creative liberty'.On 30 June 2008, the Goa Bench of Mumbai High Court issued notice to megastar 'Big B' - Amitabh Bachchan - and others for allegedly violating the Anti-Tobacco Act. Goa-based anti-tobacco organisation, National Organisation for Tobacco Eradication (NOTE), had filed the case against Bachchan and others after billboards showing the megastar smoking a cigar were raised on the Goa highway. Indian...
NAPM demands immediate closure of the Counter-Insurgency and Jungle Warfare School at Vairengte in Mizoram Amidst protests against price rises of essential items throughout the country, the Prime Minister Manmohan Singh has again started harping on the issue of the Indo-US Nuclear Deal. Activists of National Alliance of People's Movements (NAPM) - the largest network of people's struggles in India - opposed the deal. "The Deal has been pushed forward in India in an anti-democratic manner without approval of the Parliament - in fact in the teeth of opposition by a large majority of parliamentarians" said Dr Sandeep Pandey, who is a Ramon Magsaysay Awardee (2002) and a convener of...
A 10-days fast (16 - 25 June 2008) demanding the release of Dr Binayak Sen began today in India, Pakistan, Thailand, US and UK. More than 100 organizations have endorsed this fast and campaign demanding justice for Dr Sen worldwide.Twenty-two Nobel laureates from around the world had earlier appealed to the Indian government to allow Dr Binayak Sen to receive the 2008 Jonathan Mann Award for Global Health and Human Rights in person at the end of May 2008. But Indian government denied the permission and Dr Sen's wife received the coveted award on his behalf.Dr Binayak Sen of Raipur, Chhattisgarh, India, who has helped establish a hospital serving poor mine workers in the region, founded a...
This posting is based on The Times of India news published on 8 June 2008, to read the news, click here The ITC's license to purchase 500,000 metric tonnes of wheat directly from the farmers in Uttar Pradesh (UP) state was suspended till 30 June 2008 by UP state government. Despite of a UP government's cabinet order not to purchase wheat till 30 June 2008 during the 'Rabi' crop harvesting season, and another state government's order on 25 May 2008 which fixes stock limit for traders, ITC could manage to get a license issued from Agriculture department of UP government on 30 May 2008 to purchase 500,000 metric tonnes of wheat directly from the farmers. When the leading English newspaper...
On June 9, for the first-time government, public health and business leaders, heads of UN agencies and advocates are coming together at United Nations (UN) Headquarters to acknowledge HIV/TB as an urgent priority. This first HIV/TB Global Leaders' Forum, convened by Dr Jorge Sampaio, the UN Secretary-General's Special Envoy to Stop TB, seeks to galvanize leadership at all levels. The 2008 Anti-Tuberculosis Drug Resistance in the World report and the 2008 Global Tuberculosis Epidemic report of World Health Organization (WHO) clearly mandates much heightened urgency in responding to TB-HIV co-infection.India continues to have the highest TB burden in the world. TB is the leading cause of...
Land-mafia in Kanpur in connivance with officials of Kanpur Development Authority (KDA) have slapped false fabricated charges against an Right-to-Information (RTI) campaign leader - Roby Sharma.Roby has been spearheading the RTI campaign in Kanpur since past two years now, exposing corruption and championing people's causes across the city.Roby had filed a RTI application seeking the information from the KDA and Fire Department officials on how many multi-storey buildings are following the fire-safety norms setup by them, and how many of these buildings have obtained a no-objection certificate from the fire department.Roby had further asked under the RTI Act that under which government...
A human rights activist was arrested in Manipur for discussing a state government's decision in a public forum. Sapam Kangleipal Meitei, 27 years, was discussing the impact of arming the civilians with weapons on the conditions prevalent in Manipur state. The state government had decided to give 500 gun licenses to natives of two villages in Manipur state. State government decided to hand over 500 gun licenses to civilians because armed cadres of People Revolutionary Party of Kangleipak (PREPAK), an armed opposition group in Manipur, had reportedly shot-dead two girls and a boy while seriously injuring the eyes of another girl on 24 March 2008. So the civilians of these villages were...
More than 300 million people around the world have asthma, and the disease imposes a heavy burden on individuals, families, and societies.The Global Burden of Asthma Report, indicates that asthma control often falls short and there are many barriers to asthma control around the world. Proper long-term management of asthma will permit most patients to achieve good control of their disease. Yet in many regions around the world, this goal is often not met.Poor asthma control is also seen in the lifestyle limitations experienced by some people with asthma. For example, in some regions, up to one in four children with asthma is unable to attend school regularly because of poor asthma control....