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Understanding the ovjectives of tobacco cessation programs — Transcript

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0:18[Music]
0:21A very warm welcome to all the learners.
0:24I Dr. Niha Agraal, professor of public
0:27health dentistry, Dr. Zaudin Ahmed
0:30Dental College, a legal Muslim
0:32University welcomes you all for today's
0:35discussion on understanding the
0:38objective of tobacco association
0:41program. So tobacco use is responsible
0:44for the death of one adult per 10 adults
0:48all around the world with one tobacco
0:51user dying in every 6.5 seconds. If we
0:56talk about India, 8 lakh people they die
1:00because of the tobacco related illnesses
1:04annually and this death rate exceeds the
1:08death which are caused by malaria,
1:11tuberculosis and AIDS in the combined
1:14form. Therefore, the use of tobacco is
1:18considered as the most preventable cause
1:21of the death and disability around the
1:24world.
1:27So millions still they struggle with the
1:30tobacco addiction even though they know
1:33about the harmful effect of the tobacco.
1:36Why it occurs? Because they have already
1:38fell into the addiction cycle of the
1:41tobacco. Along with that there are
1:44several factors like psychological
1:46factor, the social factor which are
1:49ingraining in them which are making them
1:52to use the tobacco.
1:56So the tobacco sization program they are
1:58very crucial to help the people quit the
2:01use of tobacco. So in this presentation
2:05today we'll be discussing the aims and
2:08objectives of the tobacco sessation
2:10program which will be focusing on how we
2:14can help the individual who are using
2:16tobacco to quit how to prevent the new
2:20user and how to make a healthier
2:23smoke-free future for our
2:28generations. So with this introduction I
2:31start my presentation. So these are the
2:34contents of my
2:35presentation. We will be starting with
2:37understanding the tobacco problem all
2:40around the world. Then the tobacco
2:42sization fundamental. What is the
2:45definition and importance? Then we'll be
2:48dealing with the intervention
2:51approaches, the psychological
2:53approaches, the pharmacological
2:55approaches, behavioral approaches and so
2:57on. then policy and the educational
3:01framework. Then we'll be seeing the
3:04evolution and the future directions
3:08where we will be discussing about
3:10monitoring evaluation and the challenges
3:13and the call for the action at the
3:18end. So let's discuss the tobacco
3:21sization program. So these are a
3:24critical public health strategy to deal
3:27the global tobacco epidemic. It aims to
3:30reduce the tobacco use through
3:32multifaceted approach that addresses
3:35through the use of prevention, education
3:38and the community
3:40support by targeting individuals at the
3:43various stage of tobacco use. These
3:46programs seeks to create the lasting
3:49behavioral change and improve the
3:52overall quality of life of an
3:55individual. So these program they are
3:57instrumental in creating a healthier
4:00smoke-free future for the communities
4:04worldwide. Now coming to the global
4:08tobacco epidemic. So let's discuss what
4:11is the worldwide impact of the tobacco
4:14use. So tobacco affects 1.3 billion
4:19people globally killing more than 8
4:22million people annually. Developing
4:25country they bear the 80% of the burden
4:29with the economical losses exceeding
4:32dollar 1.4 trillion yearly. Even the
4:37secondhand smoke it leads to the killing
4:40of 1.2 2 million people globally even
4:44without using any form of the tobacco.
4:48So tobacco users they feel 10 years
4:51older and even they die 10 years earlier
4:55than the
4:56non-smokers. This create an urgent need
4:59for effective cessation programs that
5:02can reduce the preventable cause of
5:05mortality.
5:07But the irony is the 60% of whom who
5:11want to quit the tobacco they face
5:13significant
5:14barriers around 70% of the tobacco users
5:18have no access to the comprehensive
5:21cessation services due to the challenges
5:24including limited human and financial
5:27resources limited capacity of the health
5:31care professionals to deliver effective
5:34cessation
5:37services. Now let's start with the
5:40Indian tobacco epidemic. So India faces
5:43a unique challenge with the dual use of
5:46the tobacco product that is the
5:48smokeless and the smoking form
5:50particularly in underprivileged area,
5:53the rural area and the farreached areas.
5:56So health impact. So tobacco causes over
5:591.4 million deaths in India annually.
6:04Coming to the economic burden. So annual
6:07cost of tobacco related disease it comes
6:10around
6:1227.5 billion that is
6:161.04% of the GDP of
6:20India. So let's see the types of tobacco
6:23which are prevalent in India. So they
6:25are the smoking form and the smokeless
6:28forms. So the smoked form like
6:31cigarette, biri, cigal, chillum, chuta,
6:34kitex etc. Coming to the smokeless form
6:38like zarda, keny, gutka, guru, mava,
6:43mishri, gul etc. So each product
6:47represent multiple health risks and
6:50sization
6:52challenges. Now coming to the health
6:55consequences of tobacco in India. So
6:58tobacco as we have seen kill more than
7:011.4 million people in India annually. So
7:06the diseases is caused by it is cancer
7:10which may be oral esophasial lung
7:12cancer, pancreatic cancer, bladder
7:15cancer. Then the heart diseases like
7:17coronary heart diseases, strokes,
7:20peripheral vascular diseases. than
7:23respiratory problems ranging from
7:25emphyma, chronic bronchitis, various
7:28respiratory infections, chronic
7:31obstructive pulmonary diseases etc. Even
7:34they affect the oral health causing
7:37periodontitis, loss of the tooth,
7:40various premalignant disorder and
7:43ultimately the oral cancer. So India has
7:46the world's highest rate of oral cancer
7:50due to the use of tobacco and 40 out of
7:54100 cancer cases in India they are
7:57tobacco related and if we talk about
8:00specifically the oral cancer the 95% of
8:04the oral cancer are related to the use
8:07of the
8:09tobacco. So what is tobacco sensation?
8:12Tobacco sization. It's a comprehensive
8:15public health strategy targeting all
8:18forms of the tobacco consumption. So it
8:20is the process of completely stopping
8:24all forms of the tobacco consumption and
8:27breaking the nicotine addiction.
8:31coming to its scope. So it includes the
8:34behavioral therapy, the pharmacological
8:36therapy, various kinds of supporting
8:38groups and the digital tools to help the
8:41person quit the
8:43tobacco. Then coming to the benefits. So
8:46it improves the health. It reduces
8:48various diseases risk. It enhances the
8:51quality of the life and saves money.
8:55even the benefits they extend beyond the
8:58individual health to the broader
9:00societal
9:02well-being. Coming to the primary
9:05objectives of the tobacco sensation
9:08program that is reducing the tobacco
9:10consumption. So first is reducing the
9:13prevalence that means reducing the
9:16percentage of the people who are using
9:19tobacco. So it is through the
9:21comprehensive public health strategies,
9:23community education and targeted
9:26intervention
9:27programs. The second one is reduce the
9:31quantity. That means reducing the
9:34quantity of the tobacco being used by
9:36the person and at the next step stopping
9:40or sizes the habit of tobacco
9:43consumption. So it's by providing
9:45personalized physician support, nicotine
9:48replacement therapy and behavioral
9:51therapies. Then comes prevention of the
9:54relapse. So helping the former user
9:57remain tobaccof free for the long time.
10:01So it is through the continuous support
10:03that mental health resources and robust
10:07followup. Followup is very essential for
10:10maintaining the abstinence of the
10:13tobacco use. So it should be carried out
10:16first at the weekly interval then at the
10:18monthly interval and then at the bianual
10:22interval. Then improving the public
10:24health outcome. So tobacco sization
10:28habit it leads to decrease in the rate
10:30of various diseases. So reducing chronic
10:34infectious diseases through the
10:36prevention and the early detection. So
10:39this leads to extended lifespan that is
10:43helping the individual to live longer
10:46and healthier and smokefree. So this in
10:49turn will improve the quality of the
10:51life of a person and will lead to the
10:54better well-being that is it supports
10:57the physical, social and mental health
11:01holistically.
11:02So each component of these cycle they
11:05reinforces and support each other. So
11:08comprehensive public health strategies
11:11they are essential for the sustainable
11:14improvement among the
11:17people. Now coming to preventing the
11:20initiation of tobacco use especially
11:23among the youth. So comprehensive
11:26strategies are required to prevent the
11:28youth from the tobacco use. So it
11:31includes the education the program that
11:34highlights what are the health risks of
11:37the tobacco and what are the
11:39consequences of using the
11:41tobacco. Then awareness can be generated
11:45through various community camps outreach
11:48programs again regarding the harmful
11:51effect of the tobacco and its effect on
11:54all the aspects of a person's life. than
11:57coming to the prevention through
11:59strategic intervention to discourage the
12:02youth from the tobacco use.
12:06So implementing strict marketing
12:09restrictions targeting youth through
12:11education, awareness and the prevention
12:14we can empower the youth to make the
12:17informed decision
12:19and leave the tobacco habits in
12:22protecting the future generations from
12:25addiction and creating a healthier
12:29society. Now coming to the secondhand
12:32smoke that is the hidden danger. So what
12:35is the secondhand smoke? It is the smoke
12:37which comes out from someone else be or
12:40the cigarette. That means the person
12:42himself doesn't use any form of the
12:44tobacco but it contains as same toxins
12:49as the smoke of cigarette and tobacco
12:52have. It has more than 70 compounds
12:55which are carcinogenic. Then who is
12:58affected? So all are affected. adults,
13:01non-smokers, young children, babies,
13:03pregnant women, elderly, etc. As such,
13:07no label of exposure of the second hand
13:11smoke is considered safe. Even the brief
13:15exposure will lead to the diseases.
13:19So coming to the health impacts so it
13:21leads to various heart diseases, lung
13:24diseases, then respiratory disorders,
13:26infections and even various types of
13:30cancers than protecting measure. So
13:32creating smokefree environment is the
13:35only measure through which we can
13:37prevent the person to come in contact
13:40with the secondhand smoke. So that is
13:44why the smoke free policies are so much
13:47crucial for the tobacco control
13:50efforts. Now coming to enhancing the
13:53quit rates and long-term abstinence
13:56which is very much essential. So first
13:59is assessment. So we will be evaluating
14:02what is the level of addiction
14:04motivation and barriers among the
14:07tobacco users so that a personalization
14:11can be done a treatment plan can be
14:14planned for specific use and specific
14:18triggers and the barriers against the
14:21tobacco use based on the individual
14:24needs. So this will help to build up the
14:27intervention that is the pharmacological
14:30therapy, behavioral therapy and
14:32individual support along with the
14:35community support but it requires a long
14:39followup that is providing ongoing
14:42support to the individual so that he
14:45remain abstances of the tobacco use in
14:48the long run.
14:51Now coming to providing accessible
14:54cessation services. So removing barrier
14:57to the sization services is very much
14:59important and will increase the
15:02utilization of the services. So how we
15:05can do that? Through the point of care
15:07services, integration of tobacco
15:10susation services with the primary
15:12health care with the hospitals with the
15:15dentist clinics and with the dental
15:17hospitals for the increased access to
15:21the services for the vulnerable
15:23population.
15:24than community outreach program through
15:27the various mobile clinics and even
15:30various community outreach programs that
15:33bringing services to the underserved
15:36underprivileged rural areas that the
15:39teley health
15:41options. So where the access of services
15:44is not available the teley um health can
15:48be used to provide the uh tobacco
15:51sization services. So remote counseling
15:54and support the reducing geographical
15:57and mobility barriers for the
16:01population. Then the financial support
16:04subsidized medicine and even free
16:07tobacco sensation services will help in
16:10uh sating the habit among the
16:12individuals. So systematic integration
16:15of the smoking services across the
16:18health care settings creates the
16:21multiple intervention touch points. Thus
16:25increasing the rate of tobacco susation
16:28among the people and getting the help of
16:32professional becomes very
16:35easy. Now coming to the benefits of
16:38getting tobacco. So the body begins
16:41healing immediately after quitting the
16:45habit of smoking with its benefit
16:48continues for the long period of the
16:50time till the ears. So if we talk within
16:5324 hours the blood pressure normalizes
16:55even carbon mono oxide levels they drop.
17:00Then 2 to 12 weeks improved circulation
17:03and improved function of the
17:06lungs. Then one to five years it leads
17:09to heart attack risk become half and the
17:13stroke risk also
17:15reduces and about 10 years lung cancer
17:19risk halves and the heart risk it
17:22becomes
17:24normalized. Now coming to addressing the
17:27nicotine addiction a core challenge. So
17:30when discussing the nicotine addiction
17:33it is crucial to understand its
17:36multiaceted nature. So physical
17:39dependence nicotine it triggers the
17:42release of dopamine and which activates
17:46the powerful reward mechanism in the
17:49brain which makes the person feel good
17:52and this is the reason for the repeated
17:55use of tobacco in them. Then
17:58psychological dependence. So smoking
18:00become linked to various daily routines
18:03and even the emotions like people use it
18:07as the coping mechanism for the
18:09stressful situation, anxiety, social
18:12isolation, boredom etc. Even smoking
18:16integrates with the personal and social
18:19context like it's been linked with some
18:21daily routines like after just waking
18:24up, after having the meal, after meeting
18:27the friend who is just smoking and
18:29during the social
18:33gatherings. So coming to the behavior
18:36intervention how we can treat or uh
18:40combat with all of these triggers that
18:43uh lead the person to use the tobacco.
18:46So behavioral interventions they
18:49represent the holistic multifaceted
18:51approach to the tobacco sensation that
18:54addresses both the psychological and the
18:57emotional factors. So coming to it first
19:00we have individual counseling that
19:02onetoone counseling it addresses the
19:05personal triggers and develop the
19:08customized plan for the individual based
19:11on his own needs. than group therapy. So
19:15collaborative environment where people
19:18can share their triggers, how they
19:21overcome that motivation and even the
19:24path they have chosen to overcome the
19:27craving or other kinds of barriers. So
19:30this will improve the quitting attempt
19:32of the other persons and help them in
19:35their quitting journey. Then coming to
19:38the ongoing support that is the
19:40follow-up appointments which are very
19:42much crucial for long-term abstinence of
19:46the
19:47tobacco. So coming to the nicotine
19:50replacement therapy. So nicotine
19:52replacement therapy provides a
19:54controlled method to manage nicotine
19:57withdrawal symptoms during the sessation
20:00process. These products they help to
20:03reduce the craving by providing the
20:06metered dose of nicotine. So let's see
20:09them one by one. The first is patches.
20:12So it delivers the static nicotine
20:15through the skin absorption and it
20:18provide consistent relief throughout the
20:20day. Then comes the gums. These are the
20:23ones which are chewed and then park
20:25inside the oral cavity. So they provide
20:29immediate relief from the craving and
20:31allowing user to self-regulate the
20:35doses. Then comes the lozenes. They
20:38dissolve in the mouth slowly and provide
20:41again quick onset relief from the
20:45craving. So they are used for acute
20:48smoking
20:50urges but they should be used under the
20:53medical supervision. than the
20:55prescription medicines for the tobacco
20:57sensation. So we have buproprion and
21:00vanisline which are FDA approved
21:03prescription medicines for the tobacco
21:06sensation. So propriion it's an
21:08anti-depressant and it reduces the
21:11withdrawal symptoms by affecting the
21:14brain
21:15chemistry. Then comes the vaniceline. It
21:18blocks the nicotine receptors. This
21:21reduces the pleasurable feeling after
21:24the use of
21:26tobacco. Then comes the combination
21:28therapy where the combined therapy have
21:31been found to be the best method to deal
21:34with the tobacco addiction. So these
21:36prescription medications they work
21:38through the different mechanisms to
21:40reduce the craving and support the
21:43long-term tobacco sessation.
21:47Coming to the tailored program to the
21:50specific
21:51population. While developing the
21:53intervention program, it is crucial to
21:56recognize that one approach is
21:58ineffective for all. So cultural
22:01sensitivity, it ensures the respectful
22:04and appropriate communication across
22:07various
22:08cultures. Then age specific strategies.
22:12It addresses the developmental and the
22:15generational differences in the health
22:19perspectives. Then the gender
22:21considerations like their biological
22:23differences, their health experience
22:26differences and the social context
22:29behind the use of the tobacco. So
22:31customized intervention by addressing
22:34the unique needs of the different
22:37population ensures that our program is
22:40inclusive and
22:43effective. Coming to the role of health
22:46care professionals in the tobacco
22:48susation. So health care professional
22:51they play a crucial role in the tobacco
22:54susation process. The advice given by
22:58them carries significant weightage.
23:00among the patient and can become a
23:03powerful motivating factor for leaving
23:06the habit. By integrating tobacco
23:09susation interventions into various
23:12routine care, health care providers can
23:15reach to the large number of population
23:18and significantly impact the tobacco use
23:21prevalence. So medical doctors like
23:24physicians they can identify the tobacco
23:27users by assessing the tobacco use. They
23:30can advise them to quit the tobacco.
23:33They can assess what is the motivation
23:35level, what is the dependence and based
23:38on that they can assist them, how they
23:41can deal with the triggers and various
23:44kinds of cravings and thus helping them
23:47in the long go so that they can remain
23:50tobaccof free throughout their life.
23:54Then dental professionals like dentists
23:56and dental hygienist they can have a
23:59look at the oral cavity identify the
24:02premalignant lesions and the early stage
24:05and counel the patient and check and
24:08monitor the course of action during the
24:11long time. Then pharmacist they can
24:14provide the information on various
24:16sization medicines. What is the proper
24:20method of using them? what are the side
24:22effects and what are the drug
24:25interactions. The nurses and community
24:28health workers these people they can be
24:31trained and after training they can
24:34provide the education awareness and
24:37support for the people so that they can
24:40approach and they can make forward moves
24:43for quitting the tobacco.
24:47Coming to the policy intervention, the
24:49smokefree laws and the tobacco
24:52taxes. So coming to the smokefree laws
24:55that is creating smokefree environment
24:58in the public spaces to protect the
25:02non-smokers coming in contact and again
25:05reducing the social acceptability of the
25:09smoking. Then tobacco taxes. Increasing
25:12the tobacco taxes increases the cost
25:15thus reducing the demand and reducing
25:18its use among the youth and the low
25:21soioeconomic
25:23population. Then comprehensive
25:26regulations. So combined regulations
25:29measures like education economics
25:32incentives to reduce the tobacco
25:34sization. So evidence shows that the
25:37comprehensive policy intervention they
25:40can significantly reduce the rate of
25:43tobacco use among the
25:46people. Then coming to the legal
25:48framework of tobacco sization in India.
25:53The legal framework of tobacco sization
25:55in India provides the foundation for the
25:58tobacco sization procedures.
26:01It creates an environment that
26:03discourages the tobacco users and raises
26:06the awareness about the harmful effects
26:09of tobacco. Healthcare providers they
26:13should be well aware about all these
26:15laws to support their implementations
26:18and to educate the people about their
26:21right to protection against the tobacco
26:24exposure. So we have cigarette and other
26:28tobacco product act that is code part
26:312003. It is the comprehensive
26:34legislation that has various section
26:36like prohibition of smoking in the
26:39public places to protect the people from
26:43the secondhand smoke. Then ban on
26:46tobacco advertising both in the direct
26:49and indirect ways. Then protection of
26:53the miners prohibiting the sale of
26:56tobacco to the people who are younger to
26:5818 years and 100 yards around the
27:02educational institutes. Then health
27:05warnings then it is compulsory mandatory
27:08to have health warnings either in the
27:11form of pictorial warnings on the
27:14packets of the tobacco to make people
27:17aware about its harmful effects.
27:20Then coming to the mass media campaign
27:23which involves various traditional
27:25medias like radio, TV, newspaper and the
27:30billboards. So these reach the broad
27:32audience with their compelling
27:35messages. Then the digital campaign use
27:39of various social medias than digital
27:41platforms, websites, mobile platform.
27:45They engages the young audience
27:47interactively.
27:49Then we have various community outreach
27:52programs like the local events, various
27:54kind of awareness generation camp,
27:57educational camp that can again provide
28:00the education about the harmful effects
28:02of
28:05tobacco. Then coming to the monitoring
28:07and evaluation of the tobacco use
28:10cessation program. effective monitoring
28:14and evaluation is an essential component
28:17of the tobacco sessation program. The
28:20key indicators are the prevalence of the
28:23tobacco use, the quit attempts being
28:26made by the individual, the successful
28:29quits rate, then the rate of provider
28:33who are advising to quit tobacco and the
28:37use of cessation services by the people.
28:41So regular assessment of these
28:42indicators help us to track our
28:45progress. Then identify the areas where
28:48we can improve and demonstrate the
28:51impact of cessation
28:54interventions. Now coming to the
28:57challenges that comes in the tobacco
28:59cessation journey. So tobacco sization
29:02faces several challenges. Dealing them
29:05is very crucial. So first is the relapse
29:09rate.
29:10So high relapse rate it reflects the
29:13nicotine's strong neurological and
29:16psychological grip with the most
29:18individuals they require multiple
29:21quitting attempts and many fail attempts
29:24to finally quit the tobacco.
29:27than accessibility. So limited access to
29:30the sization resource specifically in
29:33the
29:33underprivileged far-reached and rural
29:36area it creates the significant health
29:40disparity. Bank funding insufficient
29:43funding constraints our ability to have
29:46researches on various newer
29:49evidence-based strategies for the effect
29:51of tobacco sization. So addressing these
29:55challenges it requires the holistic
29:58interdisciplinary approach that
30:00recognizes the complex nature of the
30:03tobacco
30:05addiction. Now coming to reaching the
30:08underserved community. So there are
30:11various barrier to access specifically
30:14geographical isolation remote areas the
30:17financial constraint specifically in
30:19middle and the lowincome countries
30:22language differences which affects the
30:25communication and understanding of the
30:27resource materials cultural factors
30:30which are very prevalent in India
30:32because of the geographical distribution
30:35and limited healthcare service
30:38availability.
30:39So how can we overcome these? Through
30:42the mobile health units. Then through
30:45the community health worker which have
30:47been trained and they can work as the
30:50support system. than through culturally
30:53adapted material so that it increase the
30:56understanding and even the pro people
30:59they become more involved in the process
31:02than teley health services to reach the
31:05farreach areas and partnership with the
31:08trusted local organization which will
31:11potentiate the effect of tobacco
31:13sization interventions. So equity in the
31:16sation services requires intentional
31:19strategies to overcome all the
31:23barriers. Just saying the global best
31:26practices. So in the United Kingdom
31:30national stop smoking uh network has
31:33resulted in 15 or 14% reduction in the
31:37prevalence of the tobacco.
31:40than in Brazil. Integrating into primary
31:43health care services had led to 50%
31:46reduction in the smoking rates. Then in
31:50Thailand, the taxf funded quit line and
31:53the resources has resulted in
31:56substantial decrease in the male
31:59smoking. So these success stories they
32:01provide valuable inputs and models for
32:05the tobacco susation programs worldwide.
32:10Coming to the call for action that is
32:13the healthcare provider. So integrating
32:16cessation intervention into daily
32:19routine practices will increase the
32:22number of contact between the health
32:24care provider and the person using
32:27tobacco. So leading to the
32:29identification of more number of tobacco
32:32smokers and giving the opportunity to
32:36counel them. than health care system. So
32:39implementing supportive policies and
32:42removing barriers than having the
32:44sessation centers at various hospitals,
32:48clinics and even at the primary health
32:50center which will improve the
32:53accessibility of the services. Then
32:56policy makers strengthen the policies
32:59and even the implementation of the
33:02policies regarding the tobacco sization
33:06and providing funding for the research
33:08in this regard. Then the communities
33:11they should come up with their support
33:13to the tobacco free societies and the
33:17sization efforts. So together we can
33:20significantly reduce the tobacco use and
33:23its devastating consequences on the
33:26community and make our generation
33:29healthier, brighter and tobaccof
33:33free. Thank you.
33:38[Music]

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