Objective="Create public awareness on the harmful effects of tobacco."
Details for Reform Option "Tobacco Cessation Centre, Dr. B. Barooah Cancer Institute, Assam"
Tobacco problem in the North-East is more complex than probably any other state in India, with a large burden of tobacco related diseases and death. In the North Eastern States tobacco is smoked in cigarettes, bidis and pipes. Tobacco is also chewed in the form of paan or betel nut with tobacco and slaked lime. In Assam, a fermented form of areca nut known as tamol or bura tamol is chewed extensively. Bura tamol is often infected with fungus. Tobacco water (known as tuibur in Mizoram and hidakphu in Manipur) is also used by passing tobacco smoke through water. A very common feature in the North East is the use of gutkhas and pan masalas.
Tobacco related cancer alone accounts for over 40% of the cancer and as much as 35-50% are due to food and the contaminating materials in the food. Tobacco related cancers account for half of all the cancers in males and 1/4th of all cancers in females.
The National Family Health Survey (NFHS-2) survey conducted in 1998-99 among the individuals aged above 15 years revealed that the consumption of tobacco use in Mizoram is very high compared with other states of the North East. Meghalaya also has high consumption of tobacco.
In the state of Assam according to the data available it was found that about 34.9% of the male population smoke tobacco while a high rate of 48.2% chew tobacco. But still, the figures are very high compared to the national figures.
The NFHS2 (1998-99), revealed that the percentage of tobacco consumption was higher in case of illiterates than educated individuals. Similarly the percentage of tobacco users was twice as high in the case of population with low standard of living as those whose standard of living was high.
A survey done between 2000-2004 (Global Youth Tobacco Survey) supported by World Health Organisation (WHO) in 26 major states of the country revealed that in North Eastern States tobacco users who first used tobacco before the age of 10 years were more than 65%. In Nagaland, exposure to tobacco is as high as 60% among children in the age group of 11-13 years.
To mitigate the problem, the Department of Preventive Oncology, in Dr. B. Barooah Cancer Institute, started a “Health Education Programme on Cancer and Tobacco”. The programme was started in 2003 in various schools and colleges where the students were educated and made aware of the harmful effects of tobacco on health as a whole. Similar activities were conducted in the state of Meghalaya, Nagaland and Arunachal Pradesh.
In addition, cancer screening camps and public awareness on tobacco related cancer for community was organized from time to time. Regular awareness for female population on common cancer among females was conducted in rural and urban areas.
A ‘Tobacco Cessation Centre’ (TCC) has also been started with support from WHO and Government of India where the people who want to quit the habit of tobacco consumption are counseled and motivated.
The center is manned by a clinical psychologist who counsels the people on quitting and also provides them with Nicotine replacement therapy available in chemist shop in the form of chewing gums. The center has a social worker who generates awareness amongst the people on tobacco and its related problems. The center was inaugurated on 20 April 2005. Following are the aims and objectives of the center :
i) Help people to quit tobacco
ii) Forming anti tobacco network
iii) Awareness in rural and urban areas
iv) Setting up satellite clinics
* New patients in the center : 222
* Patients reviewed : 207
* No. of satellite clinics : 04
* No. of training programme : 04 (45 volunteers trained)
* Number of Schools/Colleges/Institutes covered : 26
* Number of students & teachers made aware : 2200 & 80
* Number of awareness programmes in communities : 21 places (1600 people made aware)
* Number of street plays : 05 (attended by over 500 people)
* Exhibitions held : 2 (over 450 people participated)
* Number of TV and ratio spots : 07
The budget for Tobacco Cessation Centre for the year 2005-06 was INR 21, 5000 and the budget for the year 2006-07 is INR 2,64000. This fund is for staff salary, awareness programme and IEC materials
Setting up of a Satellite Tobacco Cessation Centre does not require any extra fund. All that is required is a committed person with counselling skills and some space for seating.
Dr. B. Barooah Cancer Institute, Guwahati, Assam
Time to set up this facility is relatively less. What is needed is about a few weeks’ training programme (for Counsellors), some space and basic infrastructure.
The Health Education Programme on Cancer and Tobacco started in 2003.
Phase I of the programme was from Jan. 2005 to April 2006.
Phase II was from May 2006 to 2007.
Strategic Location: Being in the Regional Cancer Institute, where the tobacco consumption is one of the major reasons for cancer helps the TCC to create awareness amongst people who come from different areas and communities.
Cost Effective: By disseminating information through street plays, exhibitions, satellite centres and counselling centres, costs are kept low and greater numbers of people are reached.
Improper network: Forming anti-tobacco networks remains a challenge
Lack of Commitment: Lack of commitment of NGOs to work on a sustainable basis in cooperation with the TCC.
* Dedicated team of counsellors.
* Space for holding counselling sessions.
* IEC for awareness creation.
Who needs to be consulted
Office of the WHO Representative Tobacco Free Initiative
534 A Wing
Maulana Azad Road
Tel: 011 23018955
TCC at Dr. Borooah Cancer Institute will continue till WHO continues funding and after that it will be taken up by the Institute. The Programme does not require huge funds so it is easily sustainable.
Chances of Replication
After the positive response from 12 TCCs, 5 more new centres at Guwahai, Mizoram, Hyderabad, Kolkata and Trivandrum have beenset up.
Prabha Sati, Research Consultant, ECTA and Dhrub Kumar Singh, Research Consultant, Central Bureau of Health Intelligence, New Delhi, October 2006.