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Quitting: in male vs. female users of different types of tobacco at eight months post intervention in a community setting
Dr. Srabana Misra Bhagabaty: Assistant Professor cum In-Charge, Department of Preventive Oncology, Dr. B. Borooah Cancer Institute
Guwahati-16
(Scietific session: oral presentation in 3rd North East Zonal conference of IAPSM and IPHA on 22nd-23rd October 2016)
Dr. Srabana M Bhagabaty
Objectives of this study
Dr. Srabana M Bhagabaty
To analyze if there is any difference in quit rates depending on the different type of tobacco use at eight months post intervention
To speculate the if the quit rate in female tobacco users of varying patterns tally with their male counterparts
To consider specific intervention procedures towards better quit rate depending on the type of use and user
Methodology
Dr. Srabana M Bhagabaty
• Community based intervention study
• Study sample : 800
• Duration of the study : one year
• Study period: 2009-2010
Dr. Srabana M Bhagabaty
Methodology…
• Study area: Assam : It was carried out in South, East, West and Central urban blocks of Guwahati Metro.
• Tool of data collection : Predesigned pretested proforma
• Data entry and analysis: SPSS
Dr. Srabana M Bhagabaty
Methodology…
The inclusion criteria for the study
Tobacco users of both sex, aged >15 years and permanent residents of study areas willing to take part in the study.
The exclusion criteria were Non users of tobacco, past users of tobacco, tobacco users
of age less than 15 years, not willing to get tobacco cessation intervention, not permanent residents of the study areas.
Dr. Srabana M Bhagabaty
Methodology…
Staff recruitment – training – survey subject registration
Four Medical social workers (MSWs) wererecruited and trained up
They conducted door to door survey in the study area and registered the study subjects ( 200 study subjects per MSW)
Dr. Srabana M Bhagabaty
Methodology…
During registration :
Information communication and education materials on tobacco hazards were offeredto the study subjects
A date and time for counseling was fixedaccording to the convenience of thesubjects a keeping in mind time frame ofthe study . Dr. Srabana M
Bhagabaty
Methodology…
Community intervention
:Mode : Tobacco cessation counseling
:BY: The MSW (200 each)
:At : The community setting ,homes of the study
subjects. Dr. Srabana M
Bhagabaty
Methodology…
Follow up
By : Direct contact
Intervals and duration :
0-2 weeks, 2- 4 weeks, 4-6 weeks, 6weeks-2months, 2-3months, 3-4 months, 4- 6 months, 6-8 months.
When contacted for follow up the study subjects ,needed re-counseling was given to them whereneeded
Dr. Srabana M Bhagabaty
Methodology…
RESULTS
AND
DISCUSSIONS
Dr. Srabana M Bhagabaty
• The survey covered 750 households
• 87% of these households with a nuclear family
• Persons in the age group >15years and permanent residents of these areas were 2100 out of which 860 were current tobacco users
• 60 of these 860 could not meet the inclusion criteria
Results and discussions….
Dr. Srabana M Bhagabaty
GENDER DISTRIBUTIONStudy sample showed 4.2: 1, male: female ration
81%
19%
MALE
FEMALE649 were male users and 151 were female users of tobacco
Dr. Srabana M Bhagabaty
literacy status of the study subjects
Dr. Srabana M Bhagabaty
42%
33%
14%
4%4%3% CollegeHigher secondaryHigh schoolMiddle schoolprimary schoolIlliterate
Males
Results ….
32%
28%
24%
6%5%5%
CollegeHigher secondaryHigh schoolMiddle schoolprimary schoolIlliterate
Females
PATTERN OF TOBACCO USE: MALES
Smokeless 25.4%
Both form 42%
Smoking 33%
Dr. Srabana M Bhagabaty
• 94.6% female users used of smokeless forms of tobacco
• Only 8 females out of 151 were smokers • No women used both forms
Males are known smokers and females are chewersmale female ratio of smoking form of tobacco use is around 27:1.
Dr. Srabana M Bhagabaty
• Maximum no of female chewers gave history of use of betel quid
• Out of male users of smokeless tobacco and majority used it in khaini form
Dr. Srabana M Bhagabaty
• Nearly half (47%) of current smokers and smokeless tobacco users (46%) want to quit tobacco and 38 percent made an attempt to quit tobacco.
Dr. Srabana M Bhagabaty
Quitting according to type of use irrespective of gender
Habits Users Quitters % Quit
Smoking Habit Only 221 103 46.6
Smokeless Tobacco Habit Only 308 162 52Smoking &
Smokeless Habit 271 110 40.59
Dr. Srabana M Bhagabaty
Chi square test for the difference of type of use and quitting tobacco (irrespective of gender) showed Chi square=3.036, degree of freedom was 2 with P value 0.2191.
INSIGNIFICANT
Dr. Srabana M Bhagabaty
Quitting according to type of use: Males
• Habits• Users• Quitters• % Quit• Smoking Habit Only• 221• 103• 46.6• Smokeless Tobacco Habit Only• 308• 162• 52• Smoking & Smokeless Habit• 271• 110• 40.59
Habits Users Quitters % Quit
Smoking Habit Only
213 103 48.36
Smokeless Tobacco Habit
Only
165 85 51.52
Smoking & Smokeless
Habit
271 110 40.59
The association between different tobacco use pattern and quit rate amongst males gave chi square=2.123, degree of freedom 2, P>0.05, INSIGNIFICANT Dr. Srabana M
Bhagabaty
Distribution of female quitters with different tobacco use habit
Habits Users Quitters % Quit
Smoking Habit Only
8 0 0Smokeless
Tobacco Habit Only
142 78 54.9
Smoking & Smokeless
Habit
0 0 0
Dr. Srabana M Bhagabaty
• On comparing between different use type and quit rate it was found as statistically significant with value of Chi-square statistic 4.311, at degree of freedom 2 and P value was .0379
Dr. Srabana M Bhagabaty
The difference in quit rates between female smokeless tobacco users and female
smokers was found significant.
• Quit rate was zero for female smokers
• But 54.9% female chewers quitted successfully
Dr. Srabana M Bhagabaty
No female smokers quitted tobacco where as 46.6 percent male smokers quitted the habit
Dr. Srabana M Bhagabaty
Conclusions
Dr. Srabana M Bhagabaty
> Males were found to use both smoking and smokeless forms of tobacco predominantly > Females were predominant users of smokeless forms > Quit rates as such did not differ significantly based upon the type of tobacco use irrespective of sex of the user
Dr. Srabana M Bhagabaty Dr. Srabana M Bhagabaty
Conclusions• No such quit rate difference had been observed in
intra group comparison between male users of different types of tobacco
• In case of female, quit rate for smokers was zero and the difference of quit rates amongst smokers and smokeless tobacco users was.
statistically found to be significant
• Not only female smokers quit less than female chewers in our research significantly but also female smokers alarmingly shoulder high quitting challenges for the cessation service provider than the male smoker counterpart.
Conclusions
RecommendationQuitting behavior difference and disparity
between males and female counterpart needs more research.
Counseling for cessation at both clinic based and community settings should be added by liberal use of NRT and chemo interventions for more challenging patterns of tobacco use for example those who uses both, i.e. smoking and smokeless forms and female smokers.
Dr. Srabana M Bhagabaty
Recommendation
Capacity development of the tobacco cessation service providers, towards use of Nicotine replacement therapy(NRT) or antidepressants should be given more emphasis on.
Dr. Srabana M Bhagabaty
> Dr. Amal Chandra Kataki, Director Dr. B.Borooah Cancer Institute > Dr. Sekhar Shalkar , National organisation for Tobacco Eradication India, GOA
> Manoj Kalita,Population based Cancer Registry, Dr. B.Borooah Cancer Institut
Acknowledgement
Dr. Srabana M Bhagabaty
Dr. Srabana M Bhagabaty
THANK YOU
Dr. Srabana M Bhagabaty