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The next big healthcare question: Tobacco cessation

By Bobby Ramakant
April 14, 2007 03:13 IST
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The decision of Kerala's leading traders' association not to sell cigarettes from April 16 has opened the debate about an important smoking related issue -- tobacco cessation.

There is already a ban on smoking in public places in India, but it has not been strictly enforced.

Even otherwise, the main issue in combating smoking is quality tobacco cessation and counseling services. Without these, there is no way to effectively enforce these bans.

These tobacco control policies came into being after mountainous healthcare and non-smokers' rights' advocacy initiatives and are indeed vital. If this is to be of any relevance at all, we also have to develop a fairly strong understanding of how tobacco corporations have duped young people with deceptive advertising and tobacco promotion and initiated them into tobacco use. So the 'blame' is not entirely on the tobacco users.

Tobacco cessation has emerged as a specialty of its own, and various disciplines from clinical management of nicotine dependence to faith based healings have conclusively proven to be effective in different settings.

Experts say that there is a complex and circular relationship between depression, smoking and medical illness that complicates smoking cessation in those who have a history of depression. Depression-history smokers require a multimodal approach to assist with mood regulation and nicotine withdrawal. Nicotine dependence is associated with increased rates of depression prior to and after taking up smoking as well as increased rates of suicidal ideation.

While nicotine replacement and counselling are effective for smoking cessation, standard smoking cessation strategies may not pay sufficient attention to the needs of smokers with a depression history. Psychological and lifestyle strategies, such as motivational interviewing, relaxation exercises and mood charts, assist in mood regulation over and above the standard smoking cessation treatments for smokers with a depression history, who require more attention to relapse of depression and smoking after quitting.

The World Health Organisation had taken a leadership with Ministry of Health and Family Welfare to establish state-of-the-art Tobacco Cessation Clinics in mainstream hospitals across India about 5 years back. But the number of these clinics is far too low for a population of more than a billion people. Moreover, documented studies showing higher tobacco use incidence in medical students than in general population.

Effective tobacco control doesn't seem to be a reality unless public health and corporate accountability initiatives unite in tandem. As we control tobacco corporations and enforce legislations to regulate tobacco and its promotion, we also must not neglect a vital key to the whole puzzle -- tobacco cessation.

With India struggling to even deliver basic healthcare services to a majority of underserved communities, in terms of affordability, accessibility and availability -- it is not going to be easy to integrate tobacco cessation services in existing healthcare service network.

It is clear that there is a lot to learn from other healthcare service-delivery initiatives before we go forward rapidly expanding tobacco cessation services in India.

And there is no place for complacency. Rather a sense of urgency has to drive us further.

The author is a senior health and development journalist. He is a member of the Network for Accountability of Tobacco Transnationals. He can be reached at:

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Bobby Ramakant