Tobacco Harm Reduction Approach in Clinical Practice: A Qualitative Study among Multi-Specialty Healthcare Professionals in an Indian Metropolitan City

Authors

  • Sree T Sucharitha Tagore Medical College Hospital, Chennai
  • Aravind Manoharan Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam
  • Pradeep Rangasamy Madha Medical College, Chennai
  • Balaji SM Thanjavur Medical College, Thanjavur
  • Hari M Krishnan Tagore Dental College, Chennai
  • Jeevanandam Subramanian Tagore Medical College Hospital, Chennai

DOI:

https://doi.org/10.55489/njcm.1332022391

Keywords:

Healthcare professionals, tobacco harm reduction, cessation relapse, tobacco clients, personal interviews, Indian metropolitan city

Abstract

Background:Tobacco harm reduction when advocated by care providers as continuum of care towards the goal of tobacco cessation might result in long-term abstinence than it is currently seen. This study aimed to qualitatively explore the healthcare professionals approach and self-reported practices related to tobacco harm reduction and smoking cessation.

Methods: A purposive sample (N=36) of multi-specialty healthcare professionals providing tobacco related cessation services at six private medical teaching institutes were engaged in semi-structured qualitative interviews between July 2020 and October 2020 in Chennai.

Results: The results indicated that majority of the healthcare professional’s lack conceptual understanding about tobacco harm reduction. Harm reduction was practised and nicotine replacement therapy was prescribed by psychiatrists in this study. Majority of the healthcare professionals were found to have misconceptions that promoting harm reducing practices instead of cessation might result in continued addiction to nicotine products among the clientele.

Conclusions: The findings reveal that tobacco harm reduction remains an under-utilized clinical practise in Indian setting due to knowledge and awareness gaps among multi-specialty healthcare professionals. Improved sensitization through continuous medical education updates is needed to inform effective clinician-affirmative tobacco harm reduction practices.

References

WHO report on the global tobacco epidemic, 2017, monitoring tobacco use and prevention policies. Geneva, Switzerland: WHO; 2017 [cited 31 January 2021]. Available from: https://www.who.int/tobacco/global_report/2017/en/

Ncdirindia.org. 2021 [cited 31 January 2021]. Available from: https://www.ncdirindia.org/NCRP/ALL_NCRP_REPORTS/HBCR_REPORT_2007_2011/ALL_CONTENT/ALL_PDF/Preliminary_Pages.pdf

WHO report on the global tobacco epidemic, 2013 enforcing bans on tobacco advertising, promotion and sponsorship. Geneva, Switzerland: WHO; 2013 [cited 3 March 2021]. Available from: https://www.who.int/tobacco/global_report/2013/en/

Jha P, Ramasundarahettige C, Landsman V. 21st-Century Hazards of Smoking and Benefits of Cessation in the United States. Journal of Vascular Surgery. 2013;57(5):1448. DOI: 10.1056/NEJMsa1211128. https://doi.org/10.1056/NEJMsa1211128

Apps.who.int. 2021 [cited 3 March 2021]. Available from: https://apps.who.int/iris/bitstream/handle/10665/272672/wntd_2018_india_fs.pdf?sequence=1

The Lancet. Adding harm reduction to tobacco control. The Lancet. 2007;370(9594):1189. DOI: 10.1016/s0140-6736(07)61519-0 https://doi.org/10.1016/S0140-6736(07)61519-0

Dubois G. Smoking cessation should have more emphasis within Tobacco Control? The case against. Health Policy. 2009;91:S26-S30. doi: 10.1016/S0168-8510(09)70006-5. https://doi.org/10.1016/S0168-8510(09)70006-5

Meier B, Shelley D. The Fourth Pillar of the Framework Convention on Tobacco Control: Harm Reduction and the International Human Right to Health. Public Health Reports. 2006;121(5):494-500. doi: 10.1177/003335490612100503 https://doi.org/10.1177/003335490612100503

Warner K. Tobacco harm reduction: Promise and perils. Nicotine & Tobacco Research. 2002;4(4):61-71. doi: 10.1080/1462220021000032825. https://doi.org/10.1080/1462220021000032825

Optimising the use of nicotine replacement therapy. Inpharma Weekly. 1996;&NA;(1057):16. https://doi.org/10.2165/00128413-199610570-00028

Shiffman S, Ferguson S, Rohay J, Gitchell J. Perceived safety and efficacy of nicotine replacement therapies among US smokers and ex-smokers: relationship with use and compliance. Addiction. 2008;103(8):1371-1378. Available from: . https://doi.org/10.1111/j.1360-0443.2008.02268.x https://doi.org/10.1111/j.1360-0443.2008.02268.x

Ferguson S, Gitchell J, Shiffman S, Sembower M, Rohay J, Allen J. Providing accurate safety information may increase a smoker's willingness to use nicotine replacement therapy as part of a quit attempt. Addictive Behaviors. 2011;36(7):713-716. DOI: 10.1016/j.addbeh.2011.02.002 https://doi.org/10.1016/j.addbeh.2011.02.002

Yingst J, Veldheer S, Hrabovsky S, Sciamanna C, Foulds J. Reasons for non-adherence to nicotine patch therapy during the first month of a quit attempt. International Journal of Clinical Practice. 2015;69(8):883-888. doi: 10.1111/ijcp.12644. https://doi.org/10.1111/ijcp.12644

Hughes J. Use of Nicotine Replacement After a Smoking Lapse. Nicotine & Tobacco Research. 2011;14(6):751-754. doi: 10.1093/ntr/ntr208. https://doi.org/10.1093/ntr/ntr208

Stratton K. Clearing the smoke: the science base for tobacco harm reduction---executive summary. Tobacco Control. 2001;10(2):189-195. https://www.ncbi.nlm.nih.gov/books/NBK222375/ doi: 10.17226/10029 https://doi.org/10.17226/10029

Jhanjee S. Putting tobacco harm reduction in perspective: is it a viable alternative?. Indian Journal of Medical Research. 2016;143(1):25. doi: 10.4103/0971-5916.178583 https://doi.org/10.4103/0971-5916.178583

Toolkit for delivering the 5A's and 5R's brief tobacco interventions in primary care [Internet]. World Health Organization. 2021 [cited 3 Febraury 2021]. Available from: https://www.who.int/tobacco/publications/smoking_cessation/9789241506953/en/

Balmford J, Borland R, Burney S. The influence of having a quit date on prediction of smoking cessation outcome. Health Education Research. 2010;25(4):698-706. doi: 10.1093/her/cyq013. https://doi.org/10.1093/her/cyq013

Brady B, Nair U, Gerald J, Yuan N, Krupskie L, Thomson C. Higher quality quit-date goal setting enhances quit attempts among quitline callers. Tobacco Prevention & Cessation. 2019;5:20. doi: 10.18332/tpc/109537. https://doi.org/10.18332/tpc/109537

Selvamary A, Aswath Narayanan M, Doss J, Ramesh Kumar S. Effectiveness of cognitive behavior therapy in tobacco cessation at a dental setting: A hospital-based randomized controlled trial. Journal of Indian Association of Public Health Dentistry. 2016;14(4):370. DOI:10.4103/2319-5932.195845 https://doi.org/10.4103/2319-5932.195845

Holliday R, Hong B, McColl E, Livingstone-Banks J, Preshaw P. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database of Systematic Reviews. 2021;2(2) doi: 10.1002/14651858. CD005084.pub4. https://doi.org/10.1002/14651858

Stead L, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K et al. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews. 2012; 11:CD000146. doi: 10.1002/14651858.CD000146.pub4. https://doi.org/10.1002/14651858.CD000146.pub4

Fagerstrom K, Jimenez-Ruiz C. Pharmacological treatments for tobacco dependence. European Respiratory Review. 2008;17(110):192-198. doi: 10.1155/2013/278392 https://doi.org/10.1155/2013/278392

Ferrara P, Shantikumar S, Cabral Veríssimo V, Ruiz-Montero R, Masuet-Aumatell C, Ramon-Torrell J. Knowledge about E-Cigarettes and Tobacco Harm Reduction among Public Health Residents in Europe. International Journal of Environmental Research and Public Health. 2019;16(12):2071. doi: 10.3390/ijerph16122071 https://doi.org/10.3390/ijerph16122071

WHO. ICD-10 : international statistical classification of diseases and related health problems : tenth revision. Apps.who.int. 2021 [cited 21 Febraury 2021]. Available from: https://apps.who.int/iris/handle/10665/42980

Who.int. 2021 [cited 23 Febraury 2021]. Available from: https://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_FactSheet.pdf?ua=1

Jha P, Ranson M, Nguyen S, Yach D. Estimates of Global and Regional Smoking Prevalence in 1995, by Age and Sex. American Journal of Public Health. 2002;92(6):1002-1006. doi: 10.2105/ajph.92.6.1002 https://doi.org/10.2105/AJPH.92.6.1002

Jha P, Jacob B, Gajalakshmi V, Gupta P, Dhingra N, Kumar R et al. A Nationally Representative Case-Control Study of Smoking and Death in India. New England Journal of Medicine. 2008;358(11):1137-1147. DOI: 10.1056/NEJMsa0707719 https://doi.org/10.1056/NEJMsa0707719

Tobacco. Who.int. 2021 [cited 23 Febraury 2021]. Available from: https://www.who.int/news-room/fact-sheets/detail/tobacco

Casella G, Caponnetto P, Polosa R. Therapeutic advances in the treatment of nicotine addiction: present and future. Therapeutic Advances in Chronic Disease. 2010;1(3):95-106 doi: 10.1177/2040622310374896 https://doi.org/10.1177/2040622310374896

Girvalaki C, Papadakis S, Vardavas C, Pipe A, Lionis C. Effectiveness of the TITAN-CRETE intervention on rates of tobacco treatment delivery in primary care. Tobacco Prevention & Cessation. 2017;3(May Supplement). DOI:10.18332/tpc/70823 https://doi.org/10.18332/tpc/70823

Luck C, Tirukkovalluri S, Makesh R, Akhshaya P, Radhakrishnan A, Karthick R et al. Workplace based potentially malignant oral lesions screening among tobacco consuming migrant construction site workers in Chennai, South India: A pilot study. Journal of Family Medicine and Primary Care. 2020;9(9):5004. doi: 10.4103/jfmpc.jfmpc_687_20 https://doi.org/10.4103/jfmpc.jfmpc_687_20

Mohan S, Pradeepkumar A, Thresia C, Thankappan K, Poston W, Haddock C et al. Tobacco use among medical professionals in Kerala, India: The need for enhanced tobacco cessation and control efforts. Addictive Behaviors. 2006;31(12):2313-2318. doi: 10.1016/j.addbeh.2006.02.013. https://doi.org/10.1016/j.addbeh.2006.02.013

Tobacco Control in India. [cited 3 March 2021]. Available from: https://www.who.int/fctc/reporting/Annex6_Report_on_Tobacco_Control_in_India_2004.pdf

Beard E, McNeill A, Aveyard P, Fidler J, Michie S, West R. Association between use of nicotine replacement therapy for harm reduction and smoking cessation: a prospective study of English smokers. Tobacco Control. 2011;22(2):118-122. Available from: http://www.jstor.org/stable/43289316. https://doi.org/10.1136/tobaccocontrol-2011-050007

Mohan S, Pradeepkumar A, Thresia C, Thankappan K, Poston W, Haddock C et al. Tobacco use among medical professionals in Kerala, India: The need for enhanced tobacco cessation and control efforts. Addictive Behaviors. 2006;31(12):2313-2318. DOI: 10.1016/j.addbeh.2006.02.013 https://doi.org/10.1016/j.addbeh.2006.02.013

Saddichha S et al. Knowledge, Attitude and Practices of Indian Dental Surgeons Towards Tobacco Control: Advances towards Prevention. Asian Pac J Cancer Prev. 2010;11(4):939-42. Available from: https://pubmed.ncbi.nlm.nih.gov/21133605/

Kokane AM, Mitra A. Preparedness of primary health care providers for tobacco cessation - Experiences from a non-communicable disease training program. Indian J Cancer. 2020 [cited 3 March 2021];57:443-50. Available from: https://www.indianjcancer.com/text.asp?2020/57/4/443/297030

Agboola S, McNeill A, Coleman T, Leonardi Bee J. A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Addiction. 2010;105(8):1362-1380. doi: 10.1111/j.1360-0443.2010.02996.x. https://doi.org/10.1111/j.1360-0443.2010.02996.x

Murthy P, Sahoo S. Tobacco cessation services in India: Recent developments and the need for expansion. Indian Journal of Cancer. 2010;47(5):69. DOI:10.4103/0019-509X.63873 https://doi.org/10.4103/0019-509X.63873

Downloads

Published

2022-03-31

How to Cite

1.
Sucharitha ST, Manoharan A, Rangasamy P, Balaji SM, Krishnan HM, Subramanian J. Tobacco Harm Reduction Approach in Clinical Practice: A Qualitative Study among Multi-Specialty Healthcare Professionals in an Indian Metropolitan City. Natl J Community Med [Internet]. 2022 Mar. 31 [cited 2024 Nov. 21];13(03):151-7. Available from: https://njcmindia.com/index.php/file/article/view/391

Issue

Section

Original Research Articles