Why is CERTAIN needed

Tobacco use is a major public health issue that contributes to significant health problems that need to be mitigated. It is one of the leading cause of morbidity and mortality in India. About, 35-50% of Indian primary care attenders are tobacco users.

The percentage of smokeless tobacco users in Odisha is 42.9% which is double that of the national average. 57.6% of men, 33.6% of women and 45.6% of all adults either smoke tobacco and/ or use smokeless tobacco. The prevalence of any tobacco use has decreased marginally but not significantly, from 46.2% in Global Adult Tobacco Survey 1 (GATS 1) to 45.6 in Global Adult Tobacco Survey (GATS 2). Khaini and tobacco for oral application are the two most commonly used tobacco products in Odisha; 16.9% of adults use khaini and 14.9% of adults use tobacco for oral application.

Tobacco cessation counselling by health care providers has been identified as an important intervention to help people quit tobacco use. However, the overburdened health providers in the out-patient-clinics have limited time for counselling tobacco users. Mobile phone interventions, widely used for healthcare delivery in the developed world and increase the chance of quitting tobacco by 25-50%. Yet, even though the WHO has advocated the use of such interventions in low and middle income countries (LMIC), to date there have been no trials or evaluations of its effectiveness. There is hence, an urgent need to test the use of mobile phone calls and messages for tobacco cessation in Indian primary care. India with 970 million mobile phone users has the second-largest user base in the world which presents a good opportunity for this intervention.

Combining a brief intervention offered by the Indian primary care physician with a face to face and low cost phone mobile counselling could deliver a high quality complex cessation intervention to tobacco users. The results will provide valuable insights into bridging the gap between need and services received for a customized tobacco cessation intervention in primary care in India. Positive outcome will help provide evidence about cost effective tobacco cessation through digital health (m-heath initiatives which are customized for patients in primary care). This will help the National Tobacco Control Program to strengthen their current initiatives in reaching out to patients and offering low cost customized tobacco cessation interventions.