Half of the tobacco users in the country try to quit but fall off the wagon in a month. Now, dentists will play a lead role in helping people quit tobacco, as the Union health ministry announced plans for Tobacco Cessation Centres (TCC) in the 310 dental colleges of the country.
The ministry announced the operational guidelines for the centres on Wednesday, while launching the full report of the Global Adult Tobacco Survey 2016-17 (GATS-2), a year after it made the results public.
The use of tobacco, and the kind of tobacco varies hugely across India, GATS-2 has shown. Tripura had a prevalence of 64.5 percent while Goa had 9.7 percent.
The government has been vocal about its interest in pushing cessation, or how to get people to quit tobacco. The prevalence of tobacco has decreased in the country by 17.3 percent, thanks, in part, to larger graphic warnings on tobacco packs. More needs to be done, however, for the 38.5 percent, or two out of five, users who are attempting to quit, and the 54.5 percent who are interested in quitting.
Earlier this year, the Director General of the Indian Council Of Medical Research (ICMR), Dr Balram Bhargava said that, ideally, all medical colleges should have such centres; pulmonologist, cardiologist, psychologists and oral medicine specialists would work together to not only get tobacco users to quit but also closely monitor their health and habits.
GATS-2 revealed that a majority of users consume tobacco within the first 30 minutes of them waking up. Additionally, 47.4 percent of cigarette users and 48.7 of bidi smokers who tried to quit in the last 12 months, only lasted a month without tobacco. The same applied to 49.5 percent of smokeless tobacco users.
Such centres will now function in all dental colleges, said the ministry’s guidelines. Since dental colleges are affiliated to either medical colleges or hospitals, other departments — pulmonology, cardiology, community medicine, psychiatry — will be tapped into. These other departments will also serve as referral points, sending people to the TCCs as and when required.
Along with a dental surgeon, a medical social worker’s presence is necessary in these centres, while that of a psychologist is optional.
India, as GATS-2 mentions, is the second largest consumer of tobacco, with 28.6 percent or 266 million, of its adults using, and the third largest grower. Its consumption lies not just in cigarettes but largely in smokeless tobacco — 11 percent adults use khaini, 6.8 percent use gutkha. Some 7.7 percent of adults smoke bidis, which doctors present at the launch said is mistakenly seen less harmful than cigarettes by some.
Oral health becomes the linchpin for cessation because of the how tobacco is changing the nature of oral disease, with rising cases of “oral muscular lesions and oral cancer”, said the guidelines. This despite the decrease in daily tobacco use by 4.2 percentage points and in occasional use by 1.7 percentage points.
Still, the mean number of cigarettes smoked in a day by a daily smoker was 6.8 and bidis by a bidi smoker was 15.1. Smoking seemed more prevalent in rural areas — 1.9 percent prevalence as opposed to 8.3 percent in urban areas.
AIIMS cardiologist Dr Ambuj Roy pointed out at the launch that cancer is the obvious fallout. The highest number of tobacco related deaths were from heart conditions, the second from respiratory failures and the third from cancers. Tobacco also increased a person’s chance of getting diabetes, or tuberculosis by “more than two-and-a-half times”, said GATS-2.
The burden of tobacco GATS-2 confirmed lies largely on men, with 42.4 percent of them using tobacco as opposed to 14.2 percent women. However, at least the initiation age for users went up by a year — users started from the age of 18.9 years instead of 17.9 as seen in GATS-1 of 2009-19 — pointing to an impact on adolescent awareness. Despite this, 33.1 percent of all smokers started before the age of 18. While 10 percent of smokers between the ages of 20 and 34 started before they were 15.
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