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


Background: Prevalence of tobacco use is higher in the rural than urban areas of India. Unlike tobaccocessation clinics located in urban areas, community-based smoking cessation intervention has the potential toreach a wider section of the community to assist in smoking cessation in the rural setting. The present studyaimed 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 blocksin rural Kerala were randomly allocated to intervention and control groups. The intervention group receivedmultiple approaches in which priority was given to face-to-face interviews and telephone counselling. Initiallyeducational materials on tobacco hazards were distributed. Further, four rounds of counselling sessions wereconducted which included a group counselling with a medical camp as well as individual counselling by trainedmedical social workers. The control group received general awareness training on tobacco hazards along withan anti-tobacco leaflet. Self-reported smoking status was assessed after 6 and 12 months. Factors associated withtobacco cessation were estimated using binomial regression method.
Results: Overall prevalence of smokingabstinence 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 smokingby 50% or more at the end of 12 months. Lower number of cigarettes/ bidi used, low nicotine dependence andconsultation 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 inrural areas of India.