Smoking Cessation Intervention in Rural Kerala, India: Findings of a Randomised Controlled Trial

  • Published : 2013.11.30


Background: Prevalence of tobacco use is higher in the rural than urban areas of India. Unlike tobacco cessation clinics located in urban areas, community-based smoking cessation intervention has the potential to reach a wider section of the community to assist in smoking cessation in the rural setting. The present study aimed to assess the effectiveness of a cessation intervention in rural Kerala state, India. Materials and Methods: Current daily smoking resident males in the age group 18-60 years from four community development blocks in rural Kerala were randomly allocated to intervention and control groups. The intervention group received multiple approaches in which priority was given to face-to-face interviews and telephone counselling. Initially educational materials on tobacco hazards were distributed. Further, four rounds of counselling sessions were conducted which included a group counselling with a medical camp as well as individual counselling by trained medical social workers. The control group received general awareness training on tobacco hazards along with an anti-tobacco leaflet. Self-reported smoking status was assessed after 6 and 12 months. Factors associated with tobacco cessation were estimated using binomial regression method. Results: Overall prevalence of smoking abstinence was 14.7% in the intervention and 6.8% in the control group (Relative risk: 1.85, 95% CI: 1.05, 3.25). A total of 41.3% subjects in the intervention area and 13.6% in the control area had reduced smoking by 50% or more at the end of 12 months. Lower number of cigarettes/ bidi used, low nicotine dependence and consultation with a doctor for a medical ailment were the statistically significant predictors for smoking cessation. Conclusions: Rigorous approaches for smoking cessation programmes can enhance quit rates in smoking in rural areas of India.


Community approach;intervention;smoking cessation;rural Kerala;India


  1. Aveyard P, Raw M (2012). Improving smoking cessation approaches at the individual level. Tob Control, 21, 252-7.
  2. Ferguson JA, Patten CA, Schroeder DR, et al (2003). Predictors of 6-month tobacco abstinence among 1224 cigarette smokers treated for nicotine dependence. Addict Behav, 28, 1203-18.
  3. Ferlay J, Shin HR, Bray F, et al (2010) GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10.Lyon, France: International Agency for Research on Cancer; 2010.
  4. Fiore MC, Jaen CR, Baker BT, et al (2008). Treating tobacco use and dependence: 2008 update Clinical Practice Guideline. Rockville. MD: US Dept of Health and Human Services; 2008.
  5. Hyland A, Li Q, Bauer JE, et al (2004). Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine Tob Res, 6, 363-9.
  6. Hymowitz N, Cummings KM, Hyland A, et al (1997). Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tob Control, 6, 57-2.
  7. International Institute for Population Sciences (2010). Global Adult Tobacco Survey India (GATS India), 2009-10. Ministry of Health and Family Welfare, Government of India, 1-7.
  8. Jayakrishnan R, Mathew A, Uutela A, et al (2011). A community based smoking cessation intervention trial for rural Kerala, India-preliminary results. Asian Pac J Cancer Prev, 12, 3191-5.
  9. Jayakrishnan R, Mathew A, Kamala L, et al (2012). Assessment of nicotine dependence among smokers in a selected rural population in Kerala, India. Asian Pac J Cancer Prev, 13, 2663-7.
  10. Jayakrishnan R, Mathew A, Uutela A, et al (2013). Multiple approaches and participation rate for a community based smoking cessation intervention trial in Rural Kerala, India. Asian Pac J Cancer Prev, 14, 2891-6.
  11. Jha P (2009). Avoidable global cancer deaths and total deaths from smoking. Nat Rev Cancer, 9, 655-64.
  12. Kumar MS, Sarma PS, Thankappan KR (2012) Community-based group intervention for tobacco cessation in rural Tamil Nadu, India: a cluster randomized trial. J Subst Abuse Treat, 43, 53-60.
  13. Lancaster T, Stead LF (2005) Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev, 2, 1292.
  14. Mackay J, Eriksen M (2002). The tobacco atlas. Geneva: World Health Organization.
  15. Mackay J, Eriksen M, Shafey O (2006). The Tobacco Atlas 2nd edition. Atlanta: American Cancer Society, 1106-7.
  16. Ministry of Health and Family Welfare, Government of India. The Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003.
  17. Mooney ME, Johnson EO, Breslau N, et al (2011). Cigarette smoking reduction and changes in nicotine dependence. Nicotine Tob Res, 13, 426-30.
  18. Murthy P, Sadicha S (2010). Tobacco cessation services in India. Recent developments and the need for expansion. Indian J Cancer, 47, 69-74.
  19. Noronha V, Dikshit R, Raut N, et al (2012). Epidemiology of lung cancer in India: Focus on the differences between non-smokers and smokers: a single-centre experience. Indian J Cancer, 49,74-81.
  20. Pimple S, Pednekar M, Mazumdar P, et al (2012). Predictors of quitting tobacco-results of a worksite tobacco cessation service program among factory workers in Mumbai, India. Asian Pac J Cancer Prev, 13, 533-8.
  21. Richter KP, McCool RM, Okuyemi KS, et al (2002). Patients' views on smoking cessation and tobacco harm reduction during drug treatment. Nicotine Tob Res, 4, 175-82.
  22. Sinha DN, Dobe M (2004). Effectiveness of tobacco cessation intervention programmes. Indian J Public Health, 48, 138-43.
  23. Thankappan KR, Mini GK, Daivadanam M et al (2013). Smoking cessation among diabetes patients: results of a pilot randomized controlled trial in Kerala, India. BMC Public Health, 13, 47.
  24. Thun MJ, DeLancey JO, Center MM, et al (2010). The global burden of cancer: priorities for prevention. Carcinogenesis, 31, 100-10.
  25. Tobacco Smoke and Involuntary Smoking (2004). Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. IARC, 83, 1452.

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