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YOUR PRIVACY CHOICES We and our partners store and access non-sensitive information from your device, like cookies, and process personal data, like IP addresses and unique identifiers to personalize content and ads, measure performance, and analyze audiences. By clicking Accept, you consent to this data collection and processing by us and our 200 partners. You can select Reject to continue with only strictly necessary cookies or Customize to manage your preferences. Some processing of your personal data may not require your consent, but you have a right to object to such processing. You can withdraw your consent at any time from the consent preferences link in the footer of any ResearchGate page. For more information, see our Privacy Policy. We and our partners process data for the following purposesPersonalised advertising and content, advertising and content measurement, audience research and services development , Precise geolocation data, and identification through device scanning, Store and/or access information on a device CustomizeRejectAccept * Home * Medicine * Addiction Medicine * Tobacco Cessation ArticlePDF Available INTRODUCING TOBACCO CESSATION IN DEVELOPING COUNTRIES: AN OVERVIEW OF PROJECT QUIT TOBACCO INTERNATIONAL * July 2006 * Tobacco Control 15 Suppl 1(suppl_1):i12-7 DOI:10.1136/tc.2005.014704 * Source * PubMed Authors: Mimi Nichter * The University of Arizona Download full-text PDFRead full-text Download full-text PDF Read full-text Download citation Copy link Link copied -------------------------------------------------------------------------------- Read full-text Download citation Copy link Link copied Citations (76) References (27) Figures (2) ABSTRACT AND FIGURES Project Quit Tobacco International is a pioneering attempt to develop culturally appropriate approaches to tobacco cessation within the health sectors of India and Indonesia. An overview of the formative research that contributed to intervention development is presented followed by a discussion of the research design adopted to evaluate the introduction of tobacco cessation in medical schools and clinics chosen for pilot testing. Four stages of research and implementation are described as a means of providing colleagues in developing countries with a prototype for future tobacco cessation research and training efforts. Project Quit Tobacco International phases of research … ssues for formative research related to cessation … Figures - uploaded by Mimi Nichter Author content All figure content in this area was uploaded by Mimi Nichter Content may be subject to copyright. Discover the world's research * 25+ million members * 160+ million publication pages * 2.3+ billion citations Join for free Public Full-text 1 Content uploaded by Mimi Nichter Author content All content in this area was uploaded by Mimi Nichter Content may be subject to copyright. RESEARCH PAPER Introducing tobacco cessation in developing countries: an overview of Project Quit Tobacco International M Nichter, for the Project Quit Tobacco International Group ............................................................................................................................... See end of article for authors’ affiliations ....................... Correspondence to: Mark Nichter, PhD, MPH, Department of Anthropology, University of Arizona, Emil Haury Building, Tucson, Arizona, USA; mnichter@u.arizona. edu ....................... Tobacco Control 2006;15(Suppl I):i12–i17. doi: 10.1136/tc.2005.014704 Project Quit Tobacco International is a pioneering attempt to develop culturally appropriate approaches to tobacco cessation within the health sectors of India and Indonesia. An overview of the formative research that contributed to intervention development is presented followed by a discussion of the research design adopted to evaluate the introduction of tobacco cessation in medical schools and clinics chosen for pilot testing. Four stages of research and implementation are described as a means of providing colleagues in developing countries with a prototype for future tobacco cessation research and training efforts. T he need for tobacco cessation in developing countries is clear, particularly in countries where tobacco consump- tion is commonplace and increasing. In 2002, Project Quit Tobacco International was initiated by United States, Indian, and Indonesian researchers as a pioneering attempt to develop culturally appropriate approaches to tobacco cessation within the health sectors of India and Indonesia. It was envisioned that this project would build tobacco research and training capacity within these two countries as well as provide a prototype for research in other developing countries. 1 Kerala State, India and Jogjakarta, Indonesia were chosen as sites for capacity building in tobacco cessation research for four reasons. First, both countries have high prevalence rates of tobacco use across all social classes with 47% of men over 15 years of age in India either smokers or users of smokeless tobacco, 23 while in Indonesia, 58% of men are smokers. 4 India and Indonesia are two countries in which tobacco consumption is increasing. Second, both countries have a wide array of indigenous and imported tobacco products. In Indonesia, locally manu- factured clove cigarettes (kretek) are the most popular type, and cigarette marketing is among the most aggressive and innovative in the world. In India, both machine rolled and hand rolled cigarettes (beedi) are popular, as are smokeless tobacco products. 5 Third, smoking cessation is not presently being addressed as a public health priority in either country, and pharmaceutical aids for cessation are not readily available in the market. Fourth, centres of medical and public health education committed to multidisciplinary research and interested in developing a tobacco research programme were identified in each country. In India, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) was selected to be a collaborating centre. Located in Kerala State, SCTIMST is a national level medical research and training institute and home to India’s first Masters in Public Health (MPH) programme recognised by the World Health Organization (WHO) and the Medical Council of India. SCTIMST is located adjacent to a regional cancer centre and state medical college. The India research team includes a senior faculty member who is a public health physician specialising in chronic disease and health services research, two MPH-trained physicians, and an anthropologist with experience in community-based research. In Indonesia, the Gadjah Mada University School of Medicine located in Jogjakarta was chosen as a collaborating institution because of its well established multidisciplinary research track record and participation in the International Network of Clinical Epidemiology. The Indonesian research team is composed of a health psychologist who has conducted research on tobacco prevention among youth, a medical anthropologist with considerable experience in international health, and a physician completing his PhD in the surveillance of chronic disease risk factors in developing countries. Members of the Indian and Indonesian research teams are working closely with a multidisciplinary team of US tobacco researchers including three psychologists, two medical anthropologists having long term research experience in Asia, and a physician specialising in nicotine addiction. They bring expertise to the project in clinical and community- based tobacco cessation programmes, pharmacologic treat- ment of tobacco dependence, international health, and research methodology. Five premises and assumptions guiding Project Quit Tobacco International Five premises and assumptions based on the global literature and the researchers’ experience informed the project from its inception. First, the potential to save lives globally through aggressive cessation initiatives is well documented. It has been estimated that if adult consumption were to decrease by 50% by the year 2020, approximately 180 million tobacco- related deaths could be avoided. 6 Not only is tobacco cessation important in its own right, but it also contributes to tobacco prevention in countries where tobacco use is normative. 7 Cessation initiatives draw attention to the ill effects and addictive nature of tobacco use, and user’s desirability to quit. A second premise is that in order for a downward shift in tobacco use to occur, health care providers must be at the forefront of tobacco cessation efforts. 8 To do so, they need to both quit using tobacco themselves and ask patients about tobacco use as a routine part of medical assessment. 9 A third premise is that the best way to interest clinicians in tobacco cessation is to draw their attention to the impact of tobacco use on the incidence and management Abbreviations: MPH, Masters in Public Health; PHC, primary health centre; SCTIMST, Sree Chitra Tirunal Institute for Medical Sciences and Technology; TB, tuberculosis i12 www.tobaccocontrol.com of specific diseases, 10 and teach them practical ways of discouraging tobacco use among their patients. A fourth assumption driving the project was that sub- stantial formative research would be needed to: (1) develop culturally appropriate tobacco cessation approaches and educational materials, (2) design pilot cessation interven- tions for clinical settings, and (3) integrate tobacco education modules within medical school curricula. In addition to investigating local perceptions of tobacco products and patterns of tobacco use and exchange, we would need to consider carefully the feasibility of conducting cessation interventions in busy clinics, and the willingness of medical faculty and practising physicians to engage in tobacco cessation efforts. A fifth assumption was that given the time frame of the project, and the population’s low level of interest in tobacco cessation, we would need to consider precursors of tobacco cessation (for example, interest in and motivation to quit, willingness to engage in cessation counselling) in addition to tobacco abstinence as potential outcome measures for pilot interventions. We will return to this issue shortly when discussing our evaluation procedures for pilot interventions. FOUR PHASES OF THE PROJECT Research activities which were proposed for the five year research project are presented in table 1. Activities are grouped under four broad phases of formative research 11 12 undertaken to enable intervention development. Table 2 summarises the types of pilot interventions presently taking place in each country. What follows is an overview of some of the research that contributed to intervention development, and a brief discussion of what we have chosen to evaluate as a measure of success. Approval for all research was obtained from the institutional review board at each of the sites. Phase I We were unable to find a standardised survey instrument on tobacco-related issues which was suitable for use with clinicians. Therefore, we developed and pre-tested an instru- ment to assess (1) the prevalence of physician and medical student tobacco use, (2) their perceptions of tobacco harm, (3) self-reported practices related to asking patients about tobacco use and advising them to quit, and (4) perceptions of the physician’s role in tobacco cessation. Formative research with clinicians (that is, one-on-one interviews) was con- ducted and findings were analysed. Research findings guided instrument development. For example, in interviews we found that in both countries many doctors did not view smoking 5–10 cigarettes per day as harmful to health. We therefore included a survey item exploring the minimum number of cigarettes perceived as harmful to health. Before use, the survey was pre-tested and modifications were made to ensure the cultural appropriateness of the questions and response items. Results from the survey revealed that approximately 55% of male medical students in Indonesia and 29% in India ever smoked and 18% in Indonesia and 14% in India currently smoked. 13 Smoking among practitioners varied by practice setting with 67% of male doctors in Indonesia and 48% in India ever smoking, and 22% in Indonesia and 14% in India currently smoking. In India, the mean number of cigarettes (and beedi) doctors thought relatively safe to smoke a day was 5–6, while in Indonesia the mean number was 10. In both countries, the majority of physicians reported routinely asking patients about tobacco use and advising them to quit. This did not match observations made during formative research. Patient exit interviews were conducted to compare patients’ perceptions with providers’ self reports of cessation advice. Exit interview data suggested that far fewer patients were being asked about their tobacco use than physicians reported. In the government clinics, only 32% of Indian patients and 10% of Indonesian patients reported being asked about tobacco use. Phase II Development of culturally appropriate tobacco education materials was essential for all patient-centred interventions we wished to pilot. Project teams first set out to determine through structured interviews and focus groups what type of global and national level tobacco facts were of interest to local populations. This required us to not only look at the content of facts but the way they were presented and interpreted. For example, how was risk understood and best conveyed? 14 15 Did the lower to middle class populations in urban and peri-urban India and Indonesia respond well to statistics, and if so what were the most relevant points of reference and frames of comparison? We found that lay people responded poorly to global statistics, were lukewarm to national statistics, but responded far better to state level statistics and extrapolations. Lack of response to statistics such as ‘‘lifetime economic expenditure on tobacco use’’ led us to omit this topic from educational materials where space was at a premium. We followed a similar research process to identify the most evocative visual images of tobacco-related pathology affecting various part of the human body. For instance, we queried whether local populations would respond positively or Table 1 Project Quit Tobacco International phases of research Phase I: Year 1 Goal: Baseline data collection 1. Researchers become familiar with tobacco education and cessation approaches used in other countries 2. Tobacco research methods training begins. Researchers build a repository of tobacco-related materials in each country 3. Researchers conduct formative research toward the development of baseline instruments and data collection procedures 4. Researchers collect baseline data in medical schools and the health sector of each country Phase II: Years 2 and 3 Goals: Create culturally appropriate educational materials and situational assessments of medical schools and clinical settings 1. Formative research is undertaken toward the development of culturally sensitive tobacco education materials; pre-testing of materials is undertaken 2. Formative research is conducted on cultural perceptions of tobacco and the link between tobacco and particular diseases 3. A situational assessment of medical school curriculum is conducted in preparation for introducing tobacco education and cessation training 4. A situational assessment of clinical settings is conducted in preparation for pilot cessation intervention planning (e.g. when, where, and how long for interventions) Phase III: Years 3 and 4 Goal: Intervention development and trial 1. Formative research is conducted to develop culturally appropriate cessation approaches. Cessation approaches tried elsewhere are reviewed and what does and does not work is determined 2. Pilot interventions are designed, implemented and evaluated in clinical settings 3. Tobacco education lectures and materials for use in medical school settings are designed, introduced, and evaluated. Phase IV: Years 3–5 Goals: Outreach and dissemination 1. A launch event is held in each country highlighting tobacco cessation as a core issue for health care providers 2. Outreach training in tobacco and tobacco cessation is delivered to health care providers and tobacco cessation materials are disseminated 3. A regional conference is held in both countries to showcase tobacco cessation efforts Tobacco cessation in India and Indonesia i13 www.tobaccocontrol.com negatively to gruesome images of diabetes-related gangrene exacerbated by tobacco use. Structured interviews and focus groups explored responses to tobacco facts and images among literate lower and middle class samples, aged 20–50 years. The same procedure was employed when pre-testing material for question and answer booklets addressing local misconceptions and questions about tobacco. For example, formative research in India documented the misperception that harm related to tobacco could be minimised by eating particular foods or drinking large quantities of water. In Indonesia, our research documented beliefs that if a person smokes a brand of cigarettes that is ‘‘suitable’’ (cocok) for his body, smoking will not harm the body and that certain brands of clove (kretek) cigarettes are believed to be beneficial for those with respiratory illness. Alternative ways of addressing such misconceptions and answering common questions were pre-tested. Responses selected for use in educational booklets were those found to be popular among most respondents, as well as least misunderstood by even a minority of respondents (that is, those having the best balance of specificity and sensitivity). One lesson learned early in both field sites was that local populations wanted more specific information on how tobacco caused specific health problems, beyond general information about harm. They did not simply want to know that tobacco was particularly harmful for people with diabetes, but they wanted to gain an understanding of how tobacco consump- tion affected blood flow and how poor blood circulation was related to foot ulcers. A demand for specifics explained in simple terms and easy to grasp analogies and images 16 influenced the development of our tobacco education materials. A situational analysis of medical education and clinical settings was also undertaken to provide the team with a sense of when interventions could take place, where, and for how long. Interviews with faculty and a baseline survey of medical students were carried out to document what kind of tobacco education was currently in the curriculum, lecturer’s willingness to integrate short tobacco messages in courses, and when cessation training might best be introduced. Preparation for our clinic-based pilot interventions required a detailed understanding of practice logistics obtained through observation of patient flows through clinical settings and identifying opportunities for brief counselling. Phase III The US research team provided the Indian and Indonesian research teams with training in various aspects of tobacco cessation, including training in the brief patient-centred approach to tobacco cessation being developed by Project Reach in Arizona. 17 Taking the US National Cancer Institute’s 5 A’s for brief tobacco interventions (Ask, Assess, Advise, Assist, Arrange) as a starting place for exploratory research into the relative utility of cessation intervention strategies developed in the USA, team members began investigating issues which had been identified in many global contexts as germane to the quitting process (table 3). Formative research was next conducted on the ways in which concerns about and barriers to quitting could be addressed in a culturally appropriate manner. Research was conducted on how best to refuse a cigarette in a social setting, how to deal with particular withdrawal symptoms, or how best to convey to smokers that such symptoms would abate over time. Over the course of the next year, team members experimented with different ways of conducting cessation counselling sessions in government health clinics. In India, a primary health centre (PHC), a tuberculosis (TB) clinic, a diabetes clinic and a cardiology clinic were initially selected for exploratory research, while in Indonesia a PHC and lung clinic were initial research sites. These health centres charge very nominal fees and are widely accessible to the public. Illness-specific materials were developed, pre-tested, and then revised based on clinic experience. Once the team developed confidence in their ability to engage smokers in the early stages of tobacco cessation, pilot interventions were designed. Several ways of introducing smoking cessation to patients in clinical settings were considered, including: (1) testing a physician-based intervention in the clinic setting; (2) testing culturally-tailored interventions delivered by tobacco cessa- tion counsellors; and (3) testing the effectiveness of culturally-tailored patient educational materials to motivate patients to think about quitting. Testing a physician-based intervention was judged to be premature as physicians receive little training in tobacco counselling. Conducting a pilot cessation clinical trial with abstinence as a primary outcome was deemed premature and logistically difficult given that the research team had encountered few smokers already motivated to quit. Poor patient knowledge about the disease specific harmful effects of tobacco predicated the need to increase patients’ awareness of harm as a means to increase their desire to quit tobacco. Since formative research suggested that physician’s advice to quit was a strong motivator for patients to quit, we decided to compare the additive effect of patient education materials (general and illness-specific tobacco facts, question and answer and how to quit guides) on patients willingness to receive further cessation counselling, zeroing in on personal motivations and barriers for quitting. When designing the pilot study, our primary goals were to test the feasibility of cessation interventions in clinical settings, provide team members with experience conducting tobacco cessation studies, and generate pilot feasibility data for future clinical trials. In India, clinics serving cardiology and diabetes patients were selected for pilot studies, as cardiology is a specialty of Sree Chitra and Kerala has the highest number of diabetic patients in India. 18–21 In Indonesia, Table 2 Project pilot interventions Intervention India Indonesia Medical education Trivandrum Medical College Gadjah Mada School of Medicine Educational outreach Physicians and health educators from primary health centres Physicians and health educators from primary health centre and lung clinic Clinical settings TB clinic Lung clinic Diabetes clinic (public hospital) Primary health centres Cardiology clinic (SCTIMST, private hospital) Community-based Interventions Community-based lay DOTS provider training Community-based lay DOTS provider training DOTS, Directly Observed Tuberculosis Treatment; SCTIMST, Sree Chitra Tirunal Institute for Medical Sciences and Technology; TB, tuberculosis. i14 Nichter www.tobaccocontrol.com clinics treating high numbers of lung and TB patients were selected as both TB and lung diseases are seen as top priorities in public health centres in the country. Recent research has linked smoking as both a risk factor for TB and for TB relapse after treatment. 22–24 The basic design for the pilot studies was a two-arm randomised pilot study designed to test whether use of patient educational materials tailored to specific diseases increased the proportion of patients who agreed to receive smoking cessation counselling. The methodology adopted has been commonly used in clinical pilot studies. 25 The primary end point of the study was the proportion of patients agreeing to enter counselling in each study arm. Our target sample size in each country was 100 patients, 50 patients in each treatment condition. Although it is typically recom- mended to have at least 30 participants to estimate statistical parameters, we decided upon a larger sample size because of the ease of obtaining participants. 25 All patients entered into the study completed a baseline and post-intervention assessment. Questionnaires were developed specifically for this study drawing upon standard questions and measures used for cessation studies in the West. Instructions and assessment items were written in the native language of the patients and pre-tested for compre- hension. A baseline questionnaire assessed patient demo- graphics, smoking history, attitudes toward tobacco use, and smoking cessation. A post-intervention questionnaire re- assessed attitudes toward tobacco and smoking cessation in addition to interest/disinterest in counselling. Pilot studies are currently in progress. Medical education Our approach to introducing tobacco cessation into medical education is multifaceted, and seeks to integrate tobacco education within all years of preclinical and clinical training. Tobacco’s effects on health are far-reaching, and relevant to virtually all subjects in the medical curriculum (for example, physiology, pharmacology, internal medicine, paediatrics, behavioural science, etc). Integration of tobacco education in particular courses is being accomplished by providing medical faculty with mini-modules of instructional materials (learning objectives, slides with speaker’s notes and citations, review articles and examination questions) focused on a particular aspect of tobacco use (for example, impact of smoking on TB). At Trivandrum Medical School, a block of time is being reserved in preventive and social medicine (year 4) to review data on tobacco epidemiology and for basic training in tobacco cessation. Gadjah Mada University School of Medicine employs a problem-based learning curriculum and the team is identifying blocks in which tobacco education can be integrated. An elective on lifestyle-related diseases is also being developed in which training in tobacco cessation counselling will be offered. To make cessation training more attractive, the team is exploring the possibility of certifica- tion, an incentive used in community-based training in the USA. 26 Our most basic goal is to train every medical student to ask patients routinely about their tobacco use and to convey to patients the message that quitting is one of the most important things that they can do for their own health and that of their family. To evaluate the impact of our curriculum intervention, we conducted a baseline survey of medical students’ perceptions of the tobacco-related education they had received and undertook a document review of medical curriculum related to tobacco. Semi-structured interviews were conducted with medical school faculty to explore their baseline interest and willingness to incorporate more tobacco education into the curriculum. The medical school intervention will be evaluated by follow-up surveys that examine the amount and quality of tobacco education received, changes in tobacco-related perceptions (for example, level of smoking that is harmful), and attitudes toward teaching about tobacco and the doctors’ role in cessation. Phase IV One way to introduce tobacco cessation into the health services of both countries is through a series of outreach activities. To this end, a highly publicised and well attended launch event was held in each country. At these events, public support for tobacco cessation was garnered from state health officials, prominent professors of medicine, and local health activists. US members of the project team provided overview lectures on tobacco epidemiology, drawing atten- tion to global and regional trends of tobacco-related mortality and morbidity. They emphasised the importance of introdu- cing tobacco cessation in medical education and clinical Table 3 Issues for formative research related to cessation Issues Kerala Jogjakarata Common motivators to quit smoking Having an illness Having an illness Family pressure Getting old/after age 60, interest in smoking declines Family health as motivator to quit Children yes, wife less so Same Common social barriers to quitting, when one has the intention to do so Visual and auditory cues in the environment Same Pressure of friends especially among low SES groups and the young Impolite to refuse items offered in social settings Cigarettes helpful for thinking and working, and managing negative emotions Is setting a quit date culturally appropriate? If yes, are particular occasions good candidates for use? Setting a date may not be popular as birthdays and anniversaries are not culturally relevant Same Ramadan is a possibility worth exploring Announcing one’s intent to quit attempt to family/ friend It is not appropriate to tell friends; family members should be told to support the quit attempt Same Withdrawal symptoms evoking concern Digestive problems Bitterness of mouth Constipation, gaseousness Feeling too lazy to work Dullness (lethargy) Fatigue Throbbing head Headache and dizziness Short tempered SES, Socioeconomic status. Tobacco cessation in India and Indonesia i15 www.tobaccocontrol.com settings. Local team members brought the problem of tobacco use home by presenting results from project baseline surveys. They highlighted medical student/health care provider tobacco habits, and current practices of assessing the tobacco use of patients. In Indonesia, the launch event served as the occasion for the Dean of the Gadjah Mada University School of Medicine to announce that the medical campus was to become smoke-free, a pioneering effort in a country where tobacco control efforts are in their infancy. In year 4, outreach training for groups of clinicians is being planned beginning with staff from pilot intervention sites and moving on to other groups of interested health practitioners. Drawing on US based experience with com- munity-based training of non-medical tobacco intervention- ists, 27 we are also planning to pilot test the training of lay providers of directly observed TB treatment (DOTS) to deliver basic smoking cessation. DOTS providers will be trained to offer sustained tobacco cessation messages to TB patients not only during six months of drug therapy, but also afterwards as a means of preventing smoking relapse. TB patients often quit smoking during the intensive phase of medication treatment, but resume smoking later when their symptoms abate. TB was selected because of its high prevalence in India and Indonesia. Another important contribution of this project has been institutional capacity building in tobacco research. Staff in both institutes are routinely called upon to provide tobacco- related lectures to health professionals in their state and to assist graduate students with tobacco-related research. In both India and Indonesia, tobacco is now a topic routinely covered in MPH course modules and MPH students attending both institutions have completed theses related to tobacco. Two final activities are being planned in year 5 of the project. National conferences in each country will be held to showcase the results of tobacco cessation research and to encourage colleagues in the public, private, and NGO sectors to get involved in cessation activities. It is hoped that dissemination of information and materials will make such involvement more feasible and will stimulate health profes- sionals and their professional associations to become advocates for tobacco control policy at the national level (for example, adoption of the Framework Convention on Tobacco Control). The centres of tobacco research established in Kerala and Jogjakarta will support these efforts in all ways possible. Finally, we have plans to build capacity in cessation research by making our methods and instruments available for use and modification in other countries. Toward this end, we will place our materials and process notes on a Quit Tobacco International website that we hope to establish and grow in the future. CONCLUSION In this paper, we have described a process for developing culturally appropriate cessation programmes. The need for cessation in India and Indonesia was evident given the high prevalence of smoking among men. At present, cessation projects are underway in one region in each country. It is important to note, however, that India and Indonesia are culturally diverse countries and cultural approaches designed for regions of Kerala, India and Java, Indonesia may not be appropriate for other parts of the country. For this reason, in Project Quit Tobacco International, we have placed emphasis on outlining the steps that groups in other regions could follow to develop, test, and evaluate their own cessation materials and approaches. Outreach and trainings planned for the future should facilitate the process of widespread dissemination. ACKNOWLEDGEMENTS The authors would like to gratefully acknowledge support from the Fogarty International Center of the National Institutes of Health for a research grant to conduct this research and intervention work in India and Indonesia (RO1 TW005969). Project Quit Tobacco International is composed of three teams (Indian, Indonesian, and USA). The Indian team members are K.R. Thankappan, A.S. Pradeep Kumar, Sailesh Mohan, and C.U. Thresia from the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India. The Indonesian team members are Yayi Suryo Prabandari, R Siwi Padmawati, and Nawi Ng, from the Department of Public Health, School of Medicine, Gadjah Mada University, Jogjakarta, Indonesia and the Centre for Bioethics and Medical Humanities, School of Medicine, Gadjah Mada University, Jogjakarta, Indonesia. The US team members are Mark Nichter, Mimi Nichter, Myra Muramoto (Department of Anthropology and Department of Family and Community Medicine, University of Arizona, Tucson, AZ), C Keith Haddock, W Carlos Poston, Felix Okah, and Kevin Hoffman, from the Department of Psychology, College of Arts & Sciences, University of Missouri – Kansas City, Kansas City, Missouri and Harry Lando, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN, USA. 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Society for Research on Nicotine and Tobacco, 11 th Annual Meeting held jointly with the 7 th Annual SRNT European Conference. March 20–23, 2005 Prague, Czech Republic. Tobacco cessation in India and Indonesia i17 www.tobaccocontrol.com CITATIONS (76) REFERENCES (27) ... Although most smokers have the desire to quit, they may fail up to 30 times before quitting successfully, and only 3-5% quit without an external aid [10][11][12]. Quit rates are lower in LMICs where resources and infrastructure are lacking to combat tobacco use [13,14]. In such contexts, health professionals, given their credibility and influence on the community, can significantly contribute to smoking cessation efforts as advocates, leaders, and role models [10,15]. ... Smoking Cessation Counseling: Practices, Determinants, and Barriers in a Sample of Iranian Primary Care Dentists Article Full-text available * Sep 2024 * Mohammad Reza Khami * Parvin Bastani * Shabnam Varmazyari Objectives: Despite the successful tobacco smoking cessation counseling (TSCC) efforts of dental professionals, Iranian primary care dentists have not fully utilized their potential for TSCC provision. Thus, this study assessed the TSCC practices and their associations with socio-professional attributes, knowledge, and attitude, and explored the TSCC barriers and their socio-professional determinants in a sample of Iranian primary care dentists. Materials and Methods: This cross-sectional study was conducted at Comprehensive Healthcare Centers (CHCs) in Tehran Province, Iran from March to June 2019. All dentists practicing in these centers (n=190) completed self-administered questionnaires regarding TSCC-related knowledge, attitude, practice, and barriers. Simple and multiple linear regression and multiple logistic regression tests were used for statistical analyses. Results: The respondents (n=180, response rate=93%) were predominantly females (81.6%), recent graduates (69.6%), and non-cigarette smokers (90.2%), with a mean age of 34±9.98 years. Most performed 'Ask' (90.6%) and 'Advise' (69.1%), while a few were engaged in 'Assess' (33.7%) and fewer in 'Assist,' with 21.3% making physician referrals and 31.5% making psychologist referrals. Non-smokers (B=0.80, 95% CI: 0.19 to 1.40; P=0.01), and those with a more positive attitude (B=0.06, 95% CI: 0.04 to 0.08; P< 0.001) were more likely to provide TSCC. The main identified barriers included “absence of educational resources for patients”, “time constraints”, and “lack of patient cooperation. Conclusion: Although the selected sample of Iranian primary care dentists performed “Ask” and “Advise” more frequently than their peers, their TSCC practice required further improvement through simplified guidelines, customized pathways, training, team work, and resource advocacy. View Show abstract ... 30 However, several other factors could also have influenced the outcomes, including lack of perceived harm of smoking, or the perception that tobacco use at low doses is relatively safe. 24,31,32 Smoking is a cultural and social activity among Indonesian men, and cigarettes are commonly given out at events, including weddings, funerals, religious ceremonies, and community meetings. The pressure to accept the offer might have made it difficult for current smokers to stop despite illness. ... The Dynamic of Smoking Behavior through the Course of Tuberculosis Illness: A Hospital-Based Study in Medan, Indonesia Article Full-text available * May 2024 * Nanda Safira * Wit Wichaidit * Virasakdi Chongsuvivatwong Smoking is associated with the prognosis of tuberculosis (TB). The diagnosis of TB in patients who smoke or recently quit smoking can be a pivotal moment that motivates them to continue quitting smoking. However, there is a paucity of information on changes in smoking status among TB patients through the course of the disease. This study presented self-report smoking status during the pre-symptomatic, post-symptomatic, intensive treatment, and continuation treatment phases among TB patients receiving treatment. This was a cross-sectional study conducted at four hospitals in Medan, Indonesia, from December 2019 to February 2020. For at least one month, healthcare workers invited TB patients who had received treatment at the hospitals’ TB-Directly Observed Treatment Shortcourse (DOTS) clinics to participate in this study. Trained enumerators collected the data through face-to-face interviews, in which the patients self-reported information on their smoking status at various phases. Of 285 patients who met the inclusion criteria, 277 gave their consent (97% participation), of whom 146 never smoked in their lifetime. Among 131 ever smokers, 88 (67%) had quit smoking before or during the pre-diagnosis phase, 65 (51.6%) of whom remained quitters throughout the course of the disease. Thirty-eightpatients continued to smoke after symptom onset, and more than half of them had stopped smoking by the continuation phase of treatment. Smoking cessation was relatively common after the appearance of TB symptoms and after diagnosis. However, some patients subsequently relapsed,while others were unable to quit smoking. Social desirability could have influenced the responses and should be considered in interpreting the study findings. View Show abstract ... Health-risks of smoking are not well-recognized in Indonesia (Ng et al. 2007), and the population has false beliefs such as that using a suitable brand of tobacco and smoking 5-10 cigarettes per-day would not be harmful to health. (Nichter 2006;Mark Nichter et al. 2009) Tobacco smoking is an addictive behavior, while being diagnosed with TB can function as a teachable moment for smoking cessation. (Shin et al. 2012) In addition, North Sumatera province especially Medan City has the second TB prevalent rate cases with 531/ 100,000 in 2019 as well as the number of smokers. ... Prevalence of receiving smoking cessation intervention from healthcare providers among tuberculosis patients: a hospital-based cross-sectional study in Medan, Indonesia Conference Paper * Sep 2021 * Nanda Safira * Virasakdi Chongsuvivatwong * Wit Wichaidit The worldwide public health community has generally recognized the necessity of adopting smoking cessation interventions among tuberculosis (TB) patients. However, the extent that healthcare worker provided such intervention according to guidelines has rarely been investigated. The objective of this study was to document the prevalence of TB patients receiving smoking cessation interventions in Indonesia according to the ABC (A-Ask, B-Brief advise, C-Cessation support) method as suggested by the International Union Against Tuberculosis and Lung Disease. A hospital-based cross-sectional study was conducted from December 2019 to February 2020 in Medan City, Indonesia. TB patients with at least one month treatment were interviewed using a structured questionnaire. Of 277 TB patients, 223 reported for being asked (80.5%) by their healthcare provider about their smoking status and were considered to have received at least one component of ABC. Patients who were ever smokers commonly reported that they received brief advice on smoking cessation (the B component of ABC), but only 2 patients reported that they received cessation support (the C component of ABC) from their healthcare providers. The ABC smoking cessation approach was not properly delivered healthcare providers to our study population, with the most commonly missing component being cessation support. Interventions targeting appropriate implementation of this strategy are key for improving TB and tobacco control in Indonesia. View Show abstract ... The content for this intervention was designed based on the formative research done by the quit tobacco international project with some basic modifications. [6,7] Follow-up-effect on tobacco intervention outcome was studied at 6 months and 1 year after the first intervention and immediately (1 month) after the second intervention. ... Community-based Interventional Study for Tobacco Cessation in Urban Slums of Ahmedabad City: A Cluster-Randomized Trial Article Full-text available * Oct 2021 * Anjali Mall * Sheetal Vyas Background: Tobacco is one of the most important preventable causes of death and a leading public health problem all over the world. The present study was conducted to determine the effect of community-based intervention for tobacco cessation in urban slums of Ahmedabad city. Materials and methods: A total of 20 slums (10 slums each) in the intervention and control group were randomly selected through the process of randomization. A total of 200 participants each in the intervention and control group were studied through a cluster-randomized trial. Results: The outcome of the community-based tobacco intervention measured after 6 months depicted that the odds ratio (OR) of the prevalence of tobacco abstinence, quit rate, and reduction of more than 50% of tobacco use was significantly higher (30.37 times, 2.84 times, and 2.19 times respectively more) in the intervention as compared to the control group. However, after 1 year of the first and immediately after the second intervention, the OR of tobacco point prevalence abstinence, quit rate, and reduction of more than 50% was more pronounced (5.11 times, 3.52 times, and 4.31 times, respectively, more) in the intervention group than the control group. Post intervention, it was also observed that there was a significant increase in the average quit attempt. Conclusion: The community-based intervention was very effective in reducing the consumption of tobacco in urban slums in any form. As per the study findings, there is a wide possibility for the integration of tobacco cessation activity into the health program. View Show abstract Feasibility of tobacco cessation intervention at non-communicable diseases clinics: A qualitative study from a North Indian State Article Full-text available * May 2023 * PLOS ONE * Garima Bhatt * Sonu Goel * Sandeep Grover * Gurmandeep Singh Background One of the ’best buys’ for preventing Non-Communicable Diseases (NCDs) is to reduce tobacco use. The synergy scenario of NCDs with tobacco use necessitates converging interventions under two vertical programs to address co-morbidities and other collateral benefits. The current study was undertaken with an objective to ascertain the feasibility of integrating a tobacco cessation package into NCD clinics, especially from the perspective of healthcare providers, along with potential drivers and barriers impacting its implementation. Methods A disease-specific, patient-centric, and culturally-sensitive tobacco cessation intervention package was developed (published elsewhere) for the Health Care Providers (HCPs) and patients attending the NCD clinics of Punjab, India. The HCPs received training on how to deliver the package. Between January to April 2020, we conducted a total of 45 in-depth interviews [medical officers (n = 12), counselors (n = 13), program officers (n = 10), and nurses (n = 10)] within the trained cohort across various districts of Punjab until no new information emerged. The interview data wereanalyzed deductively based on six focus areas concerning feasibility studies (acceptability, demand, adaptation, practicality, implementation, and integration) using the 7- step Framework method of qualitative analysis and put under preset themes. Results The respondent’s Mean ± SD age was 39.2± 9.2 years, and years of service in the current position were 5.5 ± 3.7 years. The study participants emphasized the role of HCPs in cessation support (theme: appropriateness and suitability), use of motivational interviewing, 5A’s & 5R’s protocol learned during the training & tailoring the cessation advice (theme: actual use of intervention activities); preferred face-to-face counseling using regional images, metaphors, language, case vignettes in package (theme: the extent of delivery to intended participants). Besides, they also highlighted various roadblocks and facilitators during implementation at four levels, viz. HCP, facility, patient, and community (theme: barriers and favorable factors); suggested various adaptations to keep the HCPs motivated along with the development of integrated standard operating procedures (SOPs), digitalization of the intervention package, involvement of grassroots level workers (theme: modifications required); the establishment of an inter-programmatic referral system, and a strong politico-administrative commitment (theme: integrational perspectives). Conclusion The findings suggest that implementing a tobacco cessation intervention package through the existing NCD clinics is feasible, and it forges synergies to obtain mutual benefits. Therefore, an integrated approach at the primary & secondary levels needs to be adopted to strengthen the existing healthcare systems. View Show abstract Non-Monetary Incentives for Tobacco Prevention Among Youth in Indonesia Article * Apr 2022 * J HEALTH ECON * Margaret Triyana * Justin S. White We provide evidence on the effectiveness of a school-based program that uses a non-monetary penalty and regular monitoring to prevent risky behavior among adolescents in Indonesia. The field experiment invited students to sign a pledge to abstain from tobacco use and a similar pledge for parents to monitor their children. To test group incentives, a subset of treated schools also competed against each other for the highest tobacco abstinence rates. We find that the individual pledge increases biochemically verified tobacco abstinence by 5 percentage points. This effect is sustained 3 months after the program ended. School competition has no additional impact on tobacco abstinence. Our findings highlight the effectiveness of non-monetary incentives to curb risky behaviors among adolescents who face limited self-control and peer pressure. View Show abstract Cancers' Multiplicities: Anthropologies of Interventions and Care Chapter * Mar 2022 * Lenore Manderson This chapter aims to write of cancers as multiple conditions, and contextualize this in relation to anthropological work on differences in social structures and health systems as much as in differences in etiology, diagnosis, and prognosis. It focuses on cancer, supplementing the reviews especially by H. F. Mathews and N. J. Burke and J. McMullin, and considers how anthropological research contributes to our understanding of these different conditions, interventions, and outcomes. Luzviminda's experience resounds with that of other women with breast cancer and with other symptoms. Cancers develop, however, because infections are often an outcome of constraints in people's everyday lives, and the material conditions in which they live. Cancers bring together individuals, households, communities, and public health, depending on the pathogen and the methods of prevention. The Human Papilloma Virus was identified as causing cervical cancer only in the late 1990s, and the first vaccine was available in 2006. View Show abstract Clinical and Functional Outcomes of Patients Receiving Cerebral Reperfusion Therapy: A Stroke Databank Study in Brazil Article Full-text available * Feb 2022 * Natalia Eduarda Furlan * Gustavo José Luvizutto * Pedro Tadao Hamamoto Filho * Rodrigo Bazan Objectives Cerebral reperfusion therapy is recommended for the treatment of acute ischemic stroke. However, the outcomes of patients receiving this therapy in middle- and low-income countries should be better defined. This study aimed to evaluate the clinical and functional outcomes of cerebral reperfusion therapy in patients with ischemic stroke.Materials and Methods This retrospective study included patients with ischemic stroke treated with cerebral reperfusion therapy, including intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and IVT with MT. The primary outcomes were death and disability, assessed using the modified Rankin scale (mRS), and stroke severity, assessed using the National Institutes of Health Stroke Scale (NIHSS), after intervention and 90 days after ictus. The association between the type of treatment and the primary outcome was assessed using binary logistic regression after adjusting for confounding variables. Furthermore, receiver operating characteristic (ROC) curves were generated to identify the cutoff point of the NIHSS score that could best discriminate the mRS score in all types of treatments.ResultsPatients (n = 291) underwent IVT only (n = 241), MT (n = 21), or IVT with MT (n = 29). In the IVT with MT group, the incidence of death within 90 days increased by five times (OR, 5.192; 95% CI, 2.069–13.027; p = 0.000), prevalence of disability increased by three times (OR, 3.530; 95% CI, 1.376–9.055; p = 0.009) and NIHSS score increased after IVT (from 14.4 ± 6.85 to 17.8 ± 6.36; p = 0.045). There was no significant difference between the initial NIHSS score and that after MT (p = 0.989). Patients' NIHSS score that increased or decreased by 2.5 points had a sensitivity of 0.74 and specificity of 0.65, indicating severe disability or death in these patients.Conclusion Altogether, a 2.5-point variation in NIHSS score after reperfusion is an indicator of worse outcomes. In our particular context, patients receiving the combination of IVT and MT had inferior results, which probably reflects challenges to optimize MT in LMIC. View Show abstract Pembelajaran Penyakit Terkait Perilaku, Merokok, dan Edukasi untuk Berhenti Merokok di Pendidikan Dokter Fakultas Kedokteran UGM Article Full-text available * Mar 2014 * Yayi Prabandari Background: As the third big populous smoker country in the world, smoking-related diseases have become a major cause of death in Indonesia. Physician should play role in preventing tobacco epidemic. Therefore, the medical curriculum should prepare graduates who will be competent to explain the health effects of smoking behavior and help patients quit smoking. This study proposed to describe how far tobacco and smoking topic were thought in the medical school curriculum and assess student attitudes toward the necessity of physicians to routinely asked on smoking behavior, advice patients to stop smoking as well as the important of physician to receive smoking related diseases education in medical school.Method: The study was based on five separate cross sectional surveys carried out in 200, 2007, 2009, 2010 and 2011. Participants were 1696 students (733 males and 963 females) of Faculty of Medicine, Universitas Gadjah Mada (FM UGM). They were the Non- Problem Based Learning Curriculum (N-PBLC), the PBL Curriculum (PBL-C) and the Competency Based Curriculum (CBC) batches. Data was collected through a self-administered questionnaire. Descriptive analysis was used to present the data.Results: Cigarettes smoking topic had been delivered in FM UGM by several lectures (N-PBLC students) and blocks (the PBL-C and the CBC students). The amount of 40,6 % to 83,5 % students in 5 years surveys reported that they had been trained on subjects that discussed the cigarette smoking topic. Topics on how to help quit smoking reported lower (12,3%-50%) than topic of tobacco related diseases or tobacco and public health. The majority of students mentioned that doctors should ask and give advice or patient’ education (96,7 % - 99,8 %). More than 95 % of students stated that the teaching that addresses cigarette smoking related diseases is important to be taught and trained in medical school.Conclusion: Teaching and learning on the subject of cigarette smoking related diseases have been given, but needs to be improved, particularly on skills to help patients quit smoking. View Show abstract An impact of single prevalence rate reduction of tobacco on cancer incidence- A challenge for global policy maker Article * May 2020 * Dr Atanu Bhattacharjee * Subita Pranav Patil * Sanjay Talole * Rajesh Dikshit Worldwide 8.2 million people die from cancer & 2/3rd of them are from LMIC. Tobacco-related cancer (TRCs) accounts a major share. In India, 45% of male's and 20% of female's cancer is due to tobacco use. Nearly half of all cancers in men occur at sites associated with tobacco use( Farhood and et al., 2018 Mar) .11 Objective This attempt to find out impact of tobacco prevalence on incidence rate of Tobacco related cancers across various states of India. This can help policy makers to understand and formulate control measures to curb the increasing trend of TRCs. Methods Age standardised incidence rate of TRCs from Global Burden of Diseases, Injuries, and Risk Factors Study and tobacco prevalence from NFHS-4 data was observed. State-wise data harmonisation towards tobacco prevalence and cancer incidence was performed. Results Reduction of tobacco consumption prevalence only 1% may decline incidence of lip, oral cavity and larynx cancer by 23.56 per 10 lac female populations and incidence of pharynx cancer by 25.31 per 10 lac male populations. Conclusion Tobacco consumption contributes substantial AAR of TRCs among both sexes in most of the Indian states while, other factors need to be considered too. Hence, systematic, multi-sectorial coercive approach to curtail the burden related to TRCs is imperative. View Show abstract Show more Tobacco cessation skills certification in Arizona: Application of a state wide, community based model for diffusion of evidence based practice guidelines Article Full-text available * Jan 2001 * Myra Muramoto * T Connolly * Louise Strayer * Leischow Scott To describe the development and preliminary results from a community based certification model for training in tobacco cessation skills in Arizona. A programme evaluation using both quantitative pre-post measures and qualitative methods. Arizona's comprehensive tobacco control programme of state funded, community based local projects and their community partners providing tobacco treatment services for geographically, socioeconomically, and ethnically diverse communities. A three tiered model of skills based training emphasising Agency for Health Care Policy and Research guidelines, and utilising a training of trainers approach to build community capacity. Certification roles addressed basic tobacco cessation skills, tobacco cessation specialist, and tobacco treatment services manager. Initial target audience was community based local project personnel and their community partners, with later adoption by community organisations unaffiliated with local projects, and the general public. MAIN EVALUATION MEASURES: Process measures: participant satisfaction, knowledge, skills, and self-efficacy. Outcome: participant demographics, community organisations represented, post-training, cessation related activities. During the model's implementation year, 1075 participants attended certification training, 947 participants received basic skills certificates and 82 received specialist certificates. Pre, post, and three month measures of self efficacy showed significant and durable increases. Analysis of participant characteristics demonstrated broad community representation. At post-training follow up, 80.9% of basic skills trainees had performed at least one brief intervention and 74.8% had made a referral to intensive services. Among cessation specialists, 48.8% were delivering intensive services and 69.5% were teaching basic skills classes. Initial experience with Arizona's state wide, community based model for certification of tobacco cessation skills training suggests this model may be a promising method for broad, population based diffusion of evidence based tobacco cessation guidelines. View Show abstract Treating tobacco use and dependence: Clinical practice guideline Article * M C Fiore * William C. Bailey * S.J. Cohen * R. Mecklenburg View Qualitative Research: Contributions to the Study of Drug Use, Drug Abuse,1 and Drug Use(r)Related Interventions Article * Jan 2004 * Mark Nichter * Gilbert Quintero * Mimi Nichter * Sohaila Shakib This article describes how qualitative social science research has and can contribute to the emerging field of drug and alcohol studies. An eight-stage model of formative-reformative research is presented as a heuristic to outline the different ways in which qualitative research may be used to better understand micro and macro dimensions of drug use and distribution; more effectively design, monitor and evaluate drug use(r)-related interventions; and address the politics of drug/drug program representation. Tobacco is used as an exemplar to introduce the reader to the range of research issues that a qualitative researcher may focus upon during the initial stage of formative research. Ethnographic research on alcohol use among Native Americans is highlighted to illustrate the importance of closely examining ethnicity as well as class when investigating patterns of drug use. To familiarize the reader with qualitative research, we describe the range of methods commonly employed and the ways in which qualitative research may complement as well as contribute to quantitative research. In describing the later stages of the formative-reformative process, we consider both the use of qualitative research in the evaluation and critical assessment of drug use(r)-intervention programs, and the role of qualitative research in critically assessing the politics of prevention programs. Finally, we discuss the challenges faced by qualitative researchers when engaging in transdisciplinary research. View Show abstract Qualitative Methods in Public Health: A Field Guide for Applied Research Article * Jul 2005 * Priscilla R. Ulin * Elizabeth T. Robinson * Elizabeth E. Tolley An abstract is unavailable. This article is available as HTML full text and PDF. View Show abstract What is the Evidence That Changing Tobacco Use Reduces the Incidence of Diabetic Complications? Chapter * Apr 2003 * Deborah L Wingard * Elizabeth Barrett-Connor * Nicole M Wedick In addition to the known benefits of smoking cessation for the general population, substantial evidence from patient series, case-control, and cohort studies of adults with diabetes indicates that smoking is associated with both the development and progression of heart disease and nephropathy, and with the development of neuropathy. Evidence of an association with retinopathy is inconsistent. Smoking also increases the risk of overall mortality in individuals with diabetes. There are no randomized controlled trials of smoking cessation among those with diabetes, but evidence from studies of nondiabetic individuals suggests that smoking cessation will be associated with a significant reduction in risk of cardiovascular disease and death. Individuals with diabetes appear to be smoking at the same rate as nondiabetic individuals (or even higher among black males). Development of group-specific approaches to smoking cessation and trials of the effectiveness of such programs among diabetic adults are critically needed. View Show abstract Design and analysis of pilot studies: Recommendations for good practice Article * May 2004 * J EVAL CLIN PRACT * Gillian A Lancaster * Susanna Dodd MSc * Paula Williamson Pilot studies play an important role in health research, but they can be misused, mistreated and misrepresented. In this paper we focus on pilot studies that are used specifically to plan a randomized controlled trial (RCT). Citing examples from the literature, we provide a methodological framework in which to work, and discuss reasons why a pilot study might be undertaken. A well-conducted pilot study, giving a clear list of aims and objectives within a formal framework will encourage methodological rigour, ensure that the work is scientifically valid and publishable, and will lead to higher quality RCTs. It will also safeguard against pilot studies being conducted simply because of small numbers of available patients. View Show abstract When doctors smoke Article * Sep 1993 * R. M. Davis View The Health Benefits of Smoking Cessation. A Report of the US Surgeon General Article * Dec 1990 * Am J Respir Crit Care Med * Jonathan M. Samet View Smoking and diabetes Article * Dec 1999 * DIABETES CARE * Debra Haire-Joshu * Russell Glasgow * Tiffany L. Tibbs The objective of this review is to summarize the literature on diabetes and smoking related to epidemiological risks, efficacy and cost-effectiveness of different cessation approaches, and implications for clinical practice. Over 200 studies were reviewed, with special emphasis placed on publications within the past 10 years. Intervention studies that included patients with diabetes but did not report results separately by disease are included. Diabetes-specific studies are highlighted. There are consistent results from both cross-sectional and prospective studies showing enhanced risk for micro- and macrovascular disease, as well as premature mortality from the combination of smoking and diabetes. The general cessation literature is extensive, generally well-designed, and encouraging regarding the impact of cost-effective practical office-based interventions. In particular, system-based approaches that make smoking a routine part of office contacts and provide multiple prompts, advice, assistance, and follow-up support are effective. Although there is minimal information on the effectiveness of cessation interventions specifically for people with diabetes, there is no reason to assume that cessation intervention would be more or less effective in this population. There is a clear need to increase the frequency of smoking cessation advice and counseling for patients with diabetes given the strong and consistent data on smoking prevalence; combined risks of smoking and diabetes for morbidity, mortality, and several complications; and the proven efficacy and cost-effectiveness of cessation strategies. View Show abstract What Does It Mean to Understand a Risk? Evaluating Risk Comprehension Article * Feb 1999 * Neil D. Weinstein Risk communications are frequently intended to help people understand hazards they face, with the hope that this understanding will help them make better decisions about the need for action or help them choose among alternative actions. To evaluate the success of such communications, a definition of "understanding" is needed. This paper suggests that decisions about personal risks require, at a minimum, information about the nature and likelihood of potential ill effects, information about the risk factors that modify one's susceptibility, and information about the ease or difficulty of avoiding harm. Even if these attributes are accepted as essential criteria for understanding, research on risk perceptions suggests that assessing what people know or believe is sometimes quite difficult. The focus of the paper is on the several dimensions of risk comprehension. Examples of how each can be assessed are drawn from research on public perceptions of the risks from smoking. These examples demonstrate that the public has only a limited understanding of smoking risks. View Show abstract Show more RECOMMENDED PUBLICATIONS Discover more about: Tobacco Cessation Article ASSESSING THE UTILITY OF TARGETED OUTREACH TO INTERVENE WITH 18 TO 24 YEAR OLD NON-TREATMENT SEEKING... August 2010 · Drugs: Education Prevention and Policy * Dave A Zanis * Daniel Derr * Ronald E Hollm * Donna M Coviello Objective: This pilot study assessed the utility of a targeted outreach approach to intervene with non-treatment seeking 18 to 24 year old tobacco users to quit smoking. Methods: A total of 184 tobacco users were recruited from community settings and completed a structured interview assessing tobacco use patterns. Interest in quitting tobacco was measured with an analog scale (1 = none to 10 = ... [Show full abstract] highest). Participants (N = 145) who reported any interest (2 or greater) in quitting were provided a brief tobacco intervention. Results: Overall 78/145 (54%) completed a 6 month follow-up of which 14 (17.9%) reported no tobacco use in the past 30 days. Also, a service utilization assessment found that 19.2% used a Nicotine Replacement Therapy (NRT) and 19.2% enrolled in a tobacco cessation program during the past 6 months. Conclusions: The pilot targeted outreach program is an acceptable public health technique to recruit non-treatment seeking tobacco users and help them to quit smoking and engage in cessation services. Read more Article Full-text available PROJECT QUIT TOBACCO INTERNATIONAL: LAYING THE GROUNDWORK FOR TOBACCO CESSATION IN LOW- AND MIDDLE-I... July 2010 · Asia-Pacific Journal of Public Health * Mark Nichter * Mimi Nichter * Myra Muramoto The 3 aims of Project Quit Tobacco International are to design a tobacco curriculum for medical colleges, develop culturally appropriate approaches to clinic and community-based tobacco cessation, and to build tobacco research and training networks within India and Indonesia as a prototype for other countries. This article describes pilot interventions being launched in 10 medical colleges in ... [Show full abstract] these 2 countries to (a) integrate tobacco into their 4-year training programs, ( b) establish illness-specific cessation clinics, and (c) involve colleges in community outreach efforts to promote smoke-free households. This article reports on lessons learned, challenges faced, and successes realized to date. View full-text Chapter Full-text available ANTHROPOLOGICAL CONTRIBUTIONS TO THE DEVELOPMENT OF CULTURALLY APPROPRIATE TOBACCO CESSATION PROGRAM... July 2009 * Mark Nichter * Mimi Nichter * Siwi Padmawati * Thresia Cu This chapter describes Project QTI, a pioneering attempt to find out what we need to know to successfully carry out tobacco cessation in clinical and community settings. Formative research carried out in India and Indonesia is described. Both countries have high prevalence rates of tobacco use across all social classes, popular indigenous as well as imported tobacco products, few cessation ... [Show full abstract] activities, and no established tobacco curriculum in medical schools. A biopolitical model is presented for encouraging systematic assessment of tobacco dependency at the sites of the body, environment, and state. The tobacco control field recognizes the value of transdisciplinary research. The chapter describes Project QTI's ongoing attempts to build a community of tobacco cessation practice that spans both efforts to encourage individuals to quit tobacco use and communities to establish smoke free households and worksites. View full-text Article Full-text available THE ASSOCIATION BETWEEN SMOKING AND TUBERCULOSIS February 2006 · Salud Pública de México * Kristen Hassmiller Lich To review epidemiological evidence on the association between smoking and tuberculosis. Reviewed articles were identified by searching Pubmed for the terms "smoking" or "tobacco" and "tuberculosis". Additional articles were obtained from the bibliographies of identified papers. Thirty-four studies were reviewed: five investigate the association between smoking and mortality from tuberculosis, 13 ... [Show full abstract] investigate the association between smoking and development of tuberculosis, eight investigate the association between smoking and infection with Mycobacterium tuberculosis, and nine estimate the impact of smoking on characteristics of tuberculosis and disease outcomes. Taken together, evidence suggests that smoking (both current and former) is associated with: risk of being infected with Mycobacterium tuberculosis, risk of developing tuberculosis, development of more severe forms of tuberculosis, and risk of dying of tuberculosis. In many cases, there is a strong dose-response relationship -both in terms of quantity and duration of smoking. These relationships are not explained away by controlling for potentially confounding variables such as age, gender, alcohol consumption, and HIV status. View full-text Article Full-text available ASSOCIATIONS BETWEEN TOBACCO AND TUBERCULOSIS April 2007 · The International Journal of Tuberculosis and Lung Disease * Chen-Yuan Chiang * Kamel Slama * D A Enarson The association between smoking and tuberculosis (TB) has been investigated since 1918. Both passive and active exposure to tobacco smoke have been shown to be associated with tuberculous infection and with the transition from being infected to developing TB disease. The association between smoking and developing TB disease (without separating the risk of transition from being exposed to being ... [Show full abstract] infected and that from being infected to developing TB disease) has been reported substantially. Smoking affects the clinical manifestations of TB. It has been shown that ever smokers are more likely to have cough, dyspnoea, chest radiograph appearances of upper zone involvement, cavity and miliary appearance, and positive sputum culture, but are less likely to have isolated extra-pulmonary involvement than non-smokers. Smoking has been found to be associated with both relapse of TB and TB mortality. There appears to be enough evidence to conclude that smoking is causally associated with TB disease. Patients with TB need and should receive counselling and assistance in stopping smoking. View full-text Last Updated: 22 Oct 2024 Interested in research on Tobacco Cessation? Join ResearchGate to discover and stay up-to-date with the latest research from leading experts in Tobacco Cessation and many other scientific topics. Join for free ResearchGate iOS App Get it from the App Store now. 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