Tobacco Cessation Program among Cab Drivers in Mumbai, India: An Interventional Study.

Background: Tobacco epidemic is one of the biggest public health threats, killing nearly seven million people annually. With implementation of smoke-free public places legislation, cabs in India are smoke free. However, large majority of cab drivers are addicted to tobacco. Aims: The objectives were to measure cab drivers' knowledge, attitude, and practices about tobacco pre and post intervention, educate them regarding hazards of tobacco and need for smoke-free cabs, perform oral cancer screening, and provide assistance to quit tobacco. Subjects and Methods: This interventional study among cab drivers was conducted in Mumbai during 2015-2018. Different cab unions in Mumbai were contacted and 400 cab drivers were enrolled and interviewed. They were offered health education, oral cancer screening, and tobacco cessation assistance at regular intervals for 1 year. Results: About 63.8% of cab drivers used tobacco, mainly in smokeless forms. Almost 94.1% intended to quit, 66.3% had made previous quit attempts, and 69.8% expressed the need of assistance for quitting. One hundred and twelve cab drivers were diagnosed with oral precancers and one with oral carcinoma. About 49.4% of cab drivers quit tobacco and 46.7% reduced tobacco consumption at the end of 1 year. According to multivariate logistic regression analysis, Muslim cab drivers were less likely to quit tobacco as compared to Hindus. Conclusion: Adherence to smoke-free laws plays a significant role in reducing exposure of cab drivers to secondhand smoke. This program demonstrates the successful implementation of tobacco cessation program that could be replicated among other workforces.

Cervical Cancer Screening in Low Resource Settings: Cytology versus HPV Triage for VIA Positive Women.

BACKGROUND: The objective of the study is to comparatively evaluate performance of human papillomavirus (HPV) hybrid capture 2 (HC2) and cytology as triage tests among visual inspection after application of 3-5% acetic acid (VIA) screen positive women, thus aiming to reduce the referral burden. METHODS: The community-based cross sectional cervical cancer screening with VIA was conducted among women aged between 30 and 65, residing in selected low socio-economic areas of Mumbai, India, during October 2010-March 2017. After obtaining informed consent, delivering health education and collecting socio-demographic data, participants were offered VIA screening by trained primary health workers. The VIA screen positive women underwent cytology, HPV HC2 and diagnostic colposcopy at nodal hospital. Women with positive colposcopy underwent cervical biopsies. RESULTS: 231 VIA positive women underwent cytology and HPV HC2 test, followed by colposcopy. Cervical biopsies were obtained in 83 cases. The sensitivity and specificity in detecting ≥ CIN 2 were 77.8 and 92.3 for HC2 and 66.7 and 98.2 for cytology. The false positivity and negativity rates were 7.7 and 22.2 for HC2 and 1.8 and 33.3 for cytology. CONCLUSIONS: HPV HC2 reduces referrals to larger extent and misses fewer cases compared to cytology, thus appearing a better triage test among VIA positive women.

Smokeless tobacco use and oral neoplasia among urban Indian women.

OBJECTIVES: Oral cavity cancers are fourth most common cancers among Indian women. The objectives were to create cancer awareness (CA) and screen tobacco-using women for oral cavity cancers. MATERIALS AND METHODS: A community-based CA and screening programme was conducted among women in Mumbai, India. The tobacco-using women participated in CA and oral cavity screening by oral visual inspection (OVI). All screen-positive women were referred to nodal hospital and assisted for diagnostic confirmation and treatment completion. RESULTS: Twelve slum clusters comprising of 138,383 population and 13,492 tobacco-using women have been covered. Among them, 11,895 (88.2%) participated in CA and 11,768 (87.2%) in OVI. A total of 377 (3.2%) women were screened positive, 275 (72.9%) complied with referral and 207 oral precancers [173 leukoplakia, 9 erythroplakia, 3 erythroleukoplakia and 41 sub-mucus fibrosis (SMF) including 35 women with multiple precancers] and 7 oral cancers were diagnosed. The detection rate of oral precancerous lesions and oral cancers was 17.6 and 0.6 per 1,000 screened women. Thirty-five women had multiple oral precancerous lesions. The results of multivariate analysis indicate dose-response relationship between tobacco use and risk of oral precancers. CONCLUSION: Good participation rates (>85%) for cancer awareness and OVI were seen among urban slum women in India. Many oral precancer and cancer cases were detected and were managed at the nodal hospital.

Evaluation of cytology as secondary triage in visual inspection after application of 4% acetic acid-based cervical cancer screening program.

CONTEXT BACKGROUND: Visual-based screening techniques are low cost and have good sensitivity. Hence, they appear promising for primary screening in low-resource settings. However, to reduce referrals for diagnostic colposcopy, there is need to triage these screen-positive women with test with good specificity. AIMS: The study aims to evaluate the performance of cytology as triage for visual inspection after application of 4% acetic acid (VIA) screen-positive women. SETTINGS AND DESIGN: Community-based cervical cancer screening using VIA was implemented among socioeconomically disadvantaged women in Mumbai, India. METHODS: Cytology was performed on screen-positive women. All primarily screen-positive women underwent colposcopy. Directed biopsies were obtained among women with positive findings on colposcopy. The gold standard used for final disease status was histopathology or negative colposcopy. STATISTICAL ANALYSIS USED: Test characteristics of cytology as triage test. RESULTS: Among the 138,383 population, 16,424 eligible women were screened with VIA. 785 (4.78%) women were VIA positive and 580 women participated in triage with cytology. The sensitivity and specificity of cytology at threshold of atypical squamous cells of undetermined significance in detecting ≥cervical intraepithelial neoplasia (CIN) 2 were 75.0 and 94.7, respectively. The positive and negative predictive values of cytology as triage test were 23.1 and 99.4, respectively, and the false positivity and false negativity rates were 5.34 and 25.0, respectively. CONCLUSION: Cytology triage with VIA can reduce referrals for colposcopy to 4.97% of original referrals but may miss around 25%, of high-grade CIN. The substantial reduction in referrals has special implication for low-resource settings, wherein compliance to referral and availability of diagnostic facilities are poor.

Smokeless tobacco use in Urban Indian women: Prevalence and predictors.

CONTEXT: India is the second largest consumer of tobacco. Tobacco consumption in nonsmoking forms is culturally accepted even among women. AIMS: This study aimed at understanding the patterns and predictors of smokeless tobacco (SLT) use among the urban low-socioeconomic women in Mumbai, India. MATERIALS AND METHODS: This is a cross-sectional community-based survey of tobacco usage among women residing in seven low-socioeconomic communities in suburbs of Mumbai, India. Staff for the study was recruited, trained, clusters selected, accurately mapped, households identified, meetings held with community leaders, and household surveys conducted. Women using tobacco were invited to participate in the detailed survey and interviewed to document the various sociodemographic factors and in depth information on tobacco use. The data were computerized and analyzed. RESULTS: About 22.30% of the total female population consumed tobacco, mainly in the smokeless forms, with only 0.50% of the tobacco users using smoked tobacco. Masheri was the most common form of tobacco used, followed by chewing tobacco. The median frequency of use of different tobacco products varied from 2 to 4 per day. The mean age at initiation of tobacco was 26.23 years. According to the results of univariate and multivariate logistic regression analysis, illiterate women, with advancing age, belonging to Hindu, Muslim, or Buddhist communities, who were either manual laborers or housewives, divorced or separated, and speaking Marathi were at higher risk of being tobacco user. CONCLUSION: Patterns and predictors of SLT use among women have been identified in the present study. This will guide in planning prevention and control strategies.

Workplace tobacco cessation program in India: A success story.

CONTEXT: This paper describes the follow-up interventions and results of the work place tobacco cessation study. AIMS: To assess the tobacco quit rates among employees, through self report history, and validate it with rapid urine cotinine test; compare post-intervention KAP regarding tobacco consumption with the pre-intervention responses and assess the tobacco consumption pattern among contract employees and provide assistance to encourage quitting. SETTINGS AND DESIGN: This is a cohort study implemented in a chemical industry in rural Maharashtra, India. MATERIALS AND METHODS: All employees (104) were interviewed and screened for oral neoplasia. Active intervention in the form of awareness lectures, focus group discussions and if needed, pharmacotherapy was offered. Medical staff from the industrial medical unit and from a local referral hospital was trained. Awareness programs were arranged for the family members and contract employees. STATISTICAL ANALYSIS USED: Non-parametric statistical techniques and kappa. RESULTS: Forty eight per cent employees consumed tobacco. The tobacco quit rates increased with each follow-up intervention session and reached 40% at the end of one year. There was 96% agreement between self report tobacco history and results of rapid urine cotinine test. The post-intervention KAP showed considerable improvement over the pre-intervention KAP. 56% of contract employees used tobacco and 55% among them had oral pre-cancerous lesions. CONCLUSIONS: A positive atmosphere towards tobacco quitting and positive peer pressure assisting each other in tobacco cessation was remarkably noted on the entire industrial campus. A comprehensive model workplace tobacco cessation program has been established, which can be replicated elsewhere.

Establishing a model workplace tobacco cessation program in India.

BACKGROUND: Tobacco use is highly prevalent and culturally accepted in rural Maharashtra, India. AIMS: To study the knowledge, attitude, and practices (KAP) regarding tobacco consumption, identify reasons for initiation and continuation of tobacco use, identify prevalence of tobacco consumption and its relation with different precancerous lesions, provide professional help for quitting tobacco, and develop local manpower for tobacco cessation activities. SETTINGS, DESIGN, METHODS AND MATERIAL: The present study was conducted for one year in a chemical industrial unit in Ratnagiri district. All employees (104) were interviewed and screened for oral neoplasia. Their socio-demographic features, habits, awareness levels etc. were recorded. Active intervention in the form of awareness lectures, focus group discussions, one-to-one counseling and, if needed, pharmacotherapy was offered to the tobacco users. RESULTS: All employees actively participated in the program. Overall, 48.08% of the employees were found to use tobacco, among which the smokeless forms were predominant. Peer pressure and pleasure were the main reasons for initiation of tobacco consumption, and the belief that, though injurious, it would not harm them, avoiding physical discomfort on quitting and relieving stress were important factors for continuation of the habit. Employees had poor knowledge regarding the ill-effects of tobacco. 40% of tobacco users had oral precancerous lesions, which were predominant in employees consuming smokeless forms of tobacco. CONCLUSIONS: Identifying reasons for initiation and continuation of tobacco consumption along with baseline assessment of knowledge, attitudes, and practices regarding tobacco use, are important in formulating strategies for a comprehensive workplace tobacco cessation program.