Perception and Practices of Physicians in Addressing the Smokeless Tobacco Epidemic: Findings from Two States in India

Background: Smokeless tobacco use in South Asia is believed to be a significant contributor to morbidityand mortality. In India, only a few studies involving health educational intervention by health care providershave demonstrated reduction in smokeless tobacco usage. In the present study we assessed the cessation effortstowards smokeless tobacco by physicians in two high tobacco prevalence states of India. The study also identifiedopportunities and barriers for integration of tobacco cessation services in routine practices of physicians.Materials and
Methods: This mixed method study involved qualitative (phase I) and quantitative researchstudy (phase II). In phase I, 59 in-depth interviews with physicians were conducted. In phase II, a quantitativestudy conducted among 238 physicians. An inductive approach was followed to analyze qualitative data usingATLAS. Ti software. The Chi-square test was employed to test the association between different variables ofinterest using SPSS version 17.
Results: The majority of physicians related only respiratory problems and cancerwith smokeless tobacco. Other major health effects like cardio-vascular problems, oral diseases, and effects onreproductive and neonatal health were recognized only by a few physicians. The age-group of 10-19 years wasidentified as most vulnerable to smokeless tobacco use. Less than one-third of physicians reported recordingsmokeless tobacco history of all patients. Findings indicated that less than half of physicians provided informationon harmful health effects of smokeless tobacco with regard to specific diseases.
Conclusions: The study revealeda low level of knowledge of physicians about harmful effects of tobacco and their suboptimal engagement intobacco control practices. The study indicates the need of capacity building initiatives to equip physicians withskills in tobacco cessation.