Objectives

To determine current tobacco use in 2018-19, quit attempts made and to explore the enablers and barriers in quitting tobacco among tobacco users identified in the Tamil Nadu Tobacco Survey (TNTS) in 2015-16.

Setting

TNTS was conducted in 2015-16 throughout the state of TN in India covering 111363 individuals. Tobacco prevalence was found to be 5.2% (n=5208)

Participants

All tobacco users in eleven districts of TN identified by TNTS (n=2909) were tracked after three years by telephone. In-depth interviews (n=26) were conducted in a sub-sample to understand the enablers and barriers in quitting.

Primary and Secondary Outcomes

Current tobacco use status, any quit attempt and successful quit rate were the primary outcomes, while barriers and enablers in quitting were considered as secondary outcomes.

Results

Among the 2909 tobacco users identified in TNTS 2015-16, only 724 (24.9%) could be contacted by telephone, of which 555 (76.7%) consented.  Of those who consented, 210 (37.8%) were currently not using tobacco (i.e. successfully quit) and 337 (60.7%) continued to use any form of tobacco. Of current tobacco users, 115 (34.1%) never made any quit attempt and 193 (57.3.8%) have made any attempt to quit. Those using smoking form of tobacco products (aRR=1.2, 95% CI: 1.1-1.4) and exposure to smoke at home (aRR=1.2, 95% CI: 1.1-1.3) were found to be positively associated with continued tobacco use (failed or no quit attempt). Support from family and perceived health benefits are key enablers, while peer influence, high dependence and lack of professional help are some of the barriers to quitting.

Conclusion

Two-thirds of the tobacco users continue to use tobacco in the last 3 years. While tobacco users are well aware of the ill-effects of tobacco, various intrinsic and extrinsic factors play a major role as a facilitator and lack of the same act as a barrier to quit.

Data were collected from two sources: a) TNTS database (already collected in 2015-16) and b) Telephonic survey (conducted in 2018-19). A structured questionnaire was used to collect information by telephone survey with the respondents of the original TNTS survey, with the items broadly covering areas such as current tobacco usage (both smoking and/or smokeless), quit attempt(s) and their duration and their intention to quit. In addition, socio-demographic and tobacco use related variables were extracted from the TNTS. Reported tobacco users of TNTS (N=2909) in 11 districts of TN were contacted through telephone by a team of trained project staff at the Cancer Institute, Chennai. A Standard Operating Procedure (SOP) was prepared and followed for telephone survey. Each study participant was contacted a maximum of three times at an interval of 30 minutes in a day. After two calls, a standardized text message was sent stating the details of the caller and the purpose of the call. Subsequently, the tobacco user was called 30 minutes after the text message. This process was repeated again after 7 days (if no contact was made in the previous attempt) before labeling it as an unsuccessful contact. Response to each call was recorded by the project staff using a separate sheet as: no response, disconnected the call, number not reachable, number invalid, refused to share information, busy schedule, responded to the call and so on. Respondents who were contacted and verbally consented to participate were briefed about the purpose of the call. The questions were administered over telephone and the responses were recorded on a structured questionnaire.