High Demand Outweighs Resources for Tobacco Dependence Treatment in India

India is the second largest consumer of tobacco in the world.

According to the Global Adult Tobacco Survey India (GATS), in 2010 more than one third (35%) of adults (persons age 15 years and above) used tobacco in some form or another.

Among the adults, 21% use only smokeless tobacco, 9 % only smoke and 5 % smoke as well as use smokeless tobacco.

Hence, India has 275 million users of tobacco.

Prevalence of overall tobacco use among males is 48% and among females is 20%.

Nearly two in five (38%) adults in rural areas and one in four (25%) in urban areas use tobacco.

Prevalence of smoking among males is 24% whereas the prevalence among females is 3 %.

The extent of use of smokeless tobacco products among males is 33% and among females is 18%.

Demand for Quitting Tobacco Use

According to GATS India, nearly two in five smokers (38%) and users of smokeless tobacco (35%) made an attempt to quit respective tobacco use in the 12 month period prior to the survey.

Among smokers, males and females equally reported (38% males and 39% females) that they made a quit attempt.

Among smokeless tobacco users, fewer females (29%) made a quit attempt compared to males (39%).

Tobacco Control Policies

India has a comprehensive law [Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003] for tobacco products regulation.

India ratified WHO FCTC in 2004.

The National Tobacco Control Programme (NTCP) is under implementation since 2007-08.

In collaboration with WHO, the Government of India initiated setting up Tobacco Cessation Clinics (TCC) back in in2001-2002.

Under this initiative, 19 TCC s were set up in different health care settings such as cancer hospitals, mental health institutes, general hospitals and NGOs.

The NTCP provides for tobacco cessation facilities at the district level where a counsellor is provided.

However, it is limited to only 42 districts (out of 642) at present.

There are many scattered individual examples of establishing TCCs in medical colleges, general hospitals and tuberculosis hospitals in public and private sectors throughout  the country.

The Indian Dental Association (IDA) has recently started a Tobacco Intervention Initiative (TII) to train dental surgeons in tobacco dependence treatment.

The Government of India released National Guidelines on Tobacco Dependence Treatment in 2011.

The assistance in the tobacco cessation facilities or TCCs is based on providing “brief advice” to tobacco users.

The NRT available in the market is mainly in the gum form (4 mg with prescription and 2 mg OTC), which is not affordable by the low socio-economic class which uses smokeless tobacco products.

Buproprion is used mainly by psychiatrists and not general practitioners for treatment of tobacco dependence.

Varenicline is used mainly by private hospitals as cost is a factor.

One major limitation in providing tobacco dependence treatment is inadequate knowledge and skills of physicians and health care providers in tobacco dependence treatment.

The curriculum of undergraduate medical, dental, and nursing courses are deficient in tobacco dependence treatment, and as a result these professionals are not well equipped to handle tobacco dependence treatment.

There is huge gap in the training of medical and paramedical professionals in tobacco dependence treatment.

In view of high demand for quitting tobacco use, as revealed by GATS India, the resources and infrastructure to fulfill this demand are no match when one takes into account the enormity of the problem.