HealthcareHealthcare facilities

Dependence on tobacco is a primary medical problem deserving of thoughtful, ongoing attention from every healthcare provider. Any argument to the contrary can be answered with the following facts: 40 out of every 100 cancer cases in India are tobacco-related1. Nearly 95% of all oral cancers occur among tobacco users1. Tobacco usage is estimated to cause about 71% of all deaths due to lung cancer, 42% of all chronic respiratory diseases and nearly 10% of all cardiovascular diseases2. Hospitalisation offers an opportunity to address tobacco-use among patients who may be particularly receptive, especially if they are hospitalised for a tobacco-related illness. Addressing tobacco use among hospitalised patients also takes advantage of patients' interaction with the healthcare system, as they may not have previously interacted with healthcare providers in a setting where tobacco use was discussed.

Life First’s tobacco treatment protocol is based on Tobacco treatment programmes at Mayo Clinic (USA), Massachusetts General Hospital (USA), and National Health Service (UK), and the Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guideline by the U.S. Department of Health and Human Services as well as by our experiences at Prince Aly Khan Hospital, where the programme has been adapted for the Indian context. By partnering with LifeFirst, one can offer tobacco treatment services to the people who need it the most, namely, those who are already at risk. Quitting tobacco results in a host of positive outcomes like improved response to treatment, better rate of survival among cancer patients3, reduced likelihood of developing secondary cancer after treatment4, and reduced mortality after suffering from a heart attack5.

All admitted patients are screened for tobacco use by a trained Tobacco Treatment Specialist (TTS). Further, tobacco users are motivated to make a quit attempt during their hospital stay by giving a brief advice session. Patients willing to join the programme are then provided with face-to-face counselling, behavioural modification, pharmacotherapy (if needed) and follow-up support (in person or over the phone) for six months following their discharge.

Patients are identified through a process of screening by a trained Tobacco Treatment Specialist (TTS) or via a referral system by primary consultants. These patients are then taken through a session wherein they are informed about the ill-effects of tobacco, the benefits of quitting and given information about the LifeFirst TTS service. Patients who agree to join the service are provided with specialised services, according to the LifeFirst protocol.

Nearly 95% of all oral cancers occur among tobacco users1.
Be a LifeFirst Partner

What does LifeFirst offer?

  • Intensive training of the identified hospital staff in tobacco treatment by internationally qualified trainers.
  • Periodic sensitisation of consultants and Resident Medical Officers.
  • Development of Information Education and Communication materials to create awareness.
  • Setting up of an electronic database system for data collation.
  • Technical support for implementation of the service and ongoing monitoring support.

What will be your contribution?

  • Coordinating the implementation of the service and ensuring inclusion in identified departments/areas.
  • Providing space and logistical support to the implementation team.
  • Supporting the execution of activities through feedback and participation in core committee meetings.
  • Supporting the development of a successful model and subsequent scaling up in other departments/areas of the hospital.
  • Supporting any relevant research activity for tobacco treatment.
  • Publicising tobacco treatment services through various hospital communication materials, websites etc.

1Health Workers Guide, National Tobacco Control Programme, Ministry of Health and Family Welfare, Govt. of India, 2010
2Global status report on non-communicable diseases, WHO, 2010
3U.S. Department of Health and Human Services, 2000
4Silverman S, Gorsky M, Greenspan D. Tobacco usage in patients with head and neck carcinomas: a follow-up study on habit changes and second primary oral/oropharyngeal cancers. J Am Dent Assoc. Jan 1983;106(1):33-35.
5Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. Jul 2003;290(1):86-97.

Advice from primary healthcare practitioners greatly increases the tobacco abstinence rate1. Integrating tobacco treatment into primary healthcare makes it possible to reach a large number of tobacco users, since the message is widely delivered using existing entry points and opportunities. In 2011, tobacco killed almost 6 million people. Nearly 80 percent of these deaths occurred in low and middle-income countries. Tobacco causes more premature deaths than tuberculosis, HIV/AIDS and malaria combined2. LifeFirst in collaboration with Navi Mumbai Municipal Cooperation provides tobacco treatment services in urban health post centers in Navi Mumbai.

Nearly 80 percent of these deaths occurred in low and middle-income countries.
Be a LifeFirst Partner

What does LifeFirst offer?

  • Providing tobacco treatment services to patients visiting the Out Patient Department (OPD) for any health concerns and setting up a referral system from other departments.
  • Training outreach staff to create awareness about the ill-effects of tobacco and the availability of tobacco treatment services, as well as referral of tobacco users identified during their daily activities.

1WHO, MPOWER 2008
2The Tobacco Atlas, 4th Edition. Eriksen, Mackay, and Ross (eds). 2012. American Cancer Society.

Tobacco use is a factor which is suspected to be negatively impacting the TB epidemic. In 2007, the World Health Organisation (WHO) and the International Union Against TB and Lung Disease (The Union) have jointly published a monograph emphasizing on the significance of a close coordination between Tobacco Control and the TB Programs in the respective countries.

Passive or active exposure to tobacco smoke is significantly associated with tuberculosis infection and tuberculosis disease. Smoking increases the risk of TB disease by more than two-and-a-half times. The relationship between the use of smokeless tobacco and TB has not yet been studied deeply and hence there are gaps in knowledge about this. However, it has been established that the relative risk of death is higher among TB patients who use smokeless tobacco than TB patients who do not use any kind of tobacco.1

More than 20% of global TB incidence may be attributable to smoking while 40% of the TB burden in India may be attributed to smoking. 50% of deaths among Indian male TB patients are also attributable to smoking.2 The DOTS (Directly Observed Treatment Short course) strategy used by the Revised National TB Control Programme (RNTCP) entails that the patient is in personal contact with the health provider on a regular basis – thrice a week for initial 2-3 months and then once a week for the remaining 4-5 months of treatment.

Aggressive tobacco control has been reported to possibly avert 27 million deaths from TB attributable to smoking by 2050.2

Regular contact with patients during the treatment provides an opportunity for health promotion to influence their tobacco-related behaviour. Consequently, treating tobacco addiction in patients suspected with TB is likely to improve the control of TB and prevent tobacco-related diseases.3 Introducing tobacco cessation services in TB treatment protocols would result in multiple benefits not only to the tobacco user as an individual but to the health of the community at large.

TB care-givers (DOT providers, Lab Technicians, Doctors, Paramedical Staff etc.) can include counseling services for cessation without elaborate or costly training. They can do this within a DOTS programme, and it can become a part of their routine protocols.4

LifeFirst provides tobacco treatment services through the Revised National Tuberculosis Programs DOTS program. At the DOTS centre, patients are provided counselling and follow-up services by trained DOTS providers.

1Tobacco associated mortality in Mumbai (Bombay) India. Results of the Bombay Cohort Study Prakash C Gupta, Mangesh S Pednekar, DM Parkin and R Sankaranarayanan, International Journal of Epidemiology 2005;34:1395–1402
2WHO Factsheet TB and Tobacco, Nov 2009
3 An integrated approach to treat tobacco addiction in countries with high tuberculosis incidence Kamran Siddiqi and Andrew Chee Keng Lee
4Slama K, Chiang C-Y, Enarson DA, Tobacco cessation interventions for tuberculosis patients – A guide for low-income countries. International Union Against TB and Lung Disease (The Union), 2008

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