Tobacco Cessation Among Acute Coronary Syndrome Patients in Kerala,India: Patient and Provider Perspectives

Abstract

Tobacco cessation is an important intervention to reduce mortality from ischemic heart disease, the leading cause of death in India. In this study, we explored facilitators, barriers, and cultural context to tobacco cessation among acute coronary syndrome (ACS, or heart attack) patients and providers in a tertiary care institution in the south Indian state of Kerala, with a focus on patient trajectories. Patients who quit tobacco after ACS expressed greater understanding about the link between tobacco and ACS, exerted more willpower at the time of discharge, and held less fatalistic beliefs about their health compared to those who continued tobacco use. The former were motivated by the fear of recurrent ACS, strong advice to quit from providers, and determination to survive and financially provide for their families. Systemic barriers included inadequate training, infrequent prescription of cessation pharmacotherapy, lack of ancillary staff to deliver counseling, and stigma against mental health services.

Keywords

tobacco cessation India qualitative research smoking heart attacks cardiac events quitting qualitative framework analysis South Asia

Get full access to this article

View all access options for this article.

References

Airhihenbuwa

C. O.

(1995). Health and culture: Beyond the Western paradigm. London: Sage.

Arora

Mathur

Gupta

V. K.

Nazar

G. P.

Reddy

K. S.

Sargent

J. D.

(2012). Tobacco use in Bollywood movies, tobacco promotional activities and their association with tobacco use among Indian adolescents. Tobacco Control, 21, 482–487.

Broom

A. F.

Doron

(2013). Traditional medicines, collective negotiation, and representations of risk in Indian cancer care. Qualitative Health Research, 23, 54–65. doi:10.1177/1049732312462242

Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. (2008). A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. American Journal of Preventive Medicine, 35, 158–176. doi:10.1016/j.amepre.2008.04.009

Critchley

J. A.

Capewell

(2003). Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: A systematic review. Journal of the American Medical Association, 290, 86–97. doi:10.1001/jama.290.1.86

Daivadanam

Wahlström

Thankappan

K. R.

Ravindran

T. K.

(2015). Balancing expectations amidst limitations: The dynamics of food decision-making in rural Kerala. BMC Public Health, 15(1), Article 644. doi:10.1186/s12889-015-1880-5

Fochsen

Deshpande

Thorson

(2006). Power imbalance and consumerism in the doctor-patient relationship: Health care providers’ experiences of patient encounters in a rural district in India. Qualitative Health Research, 16, 1236–1251. doi:10.1177/1049732306293776

Global Burden of Disease 2015 Risk Factors Collaborators. (2016). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the global burden of disease study 2015. The Lancet, 388, 1659–1724. doi:10.1016/S0140-6736(16)31679-8

Global Burden of Disease 2015 Tobacco Collaborators. (2017). Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: A systematic analysis from the global burden of disease study 2015. The Lancet, 389, 1885–1906. doi:10.1016/S0140-6736(17)30819-X

10.

Goenka

Tewari

Arora

Stigler

M. H.

Perry

C. L.

Arnold

J. P.

. . . Reddy

K. S.

(2010). Process evaluation of a tobacco prevention program in Indian schools—Methods, results and lessons learnt. Health Education Research, 25, 917–935. doi:10.1093/her/cyq042

11.

Helgason

A. R.

Lund

K. E.

(2002). General practitioners’ perceived barriers to smoking cessation-results from four Nordic countries. Scandinavian Journal of Public Health, 30, 141–147. doi:10.1177/14034948020300020801

12.

Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation. (2017). India: Health of the nation’s states—The India state level disease burden initiative. Retrieved from http://www.healthdata.org/sites/default/files/files/policy_report/2017/India_Health_of_the_Nation%27s_States_Report_2017.pdf

13.

Jha

MacLennan

Chaloupka

F. J.

Yurekli

Ramasundarahettige

Palipudi

Gupta

P. C.

(2015). Global hazards of tobacco and the benefits of smoking cessation and tobacco taxes. In Disease control priorities, Vol. 3: Cancer (pp. 175–193). doi:10.1596/978-1-4648-0349-9

14.

McBride

C. M.

Emmons

K. M.

Lipkus

I. M.

(2003). Understanding the potential of teachable moments: The case of smoking cessation. Health Education Research, 18, 156–170. doi:10.1093/her/18.2.156

15.

McEwen

West

(2001). Smoking cessation activities by general practitioners and practice nurses. Tobacco Control, 10, 27–32. doi:10.1136/tc.10.1.27

16.

Miles

B. M.

Huberman

M. A.

(1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). London: Sage.

17.

Ministry of Health and Family Welfare, Government of India. (2003). Cigarettes and Other Tobacco Products Act. Retrieved from www.who.int/fctc/reporting/Annexthreeindia.pdf

18.

Ministry of Health and Family Welfare, Government of India. (2010). Global adult tobacco survey (GATS): India 2009–2010. Retrieved from http://www.searo.who.int/tobacco/documents/2010-pub2.pdf

19.

Ministry of Health and Family Welfare, Government of India. (2016). National family health survey-4. Retrieved from http://rchiips.org/NFHS/pdf/NFHS4/KL_FactSheet.pdf

20.

Ministry of Health and Family Welfare, Government of India. (2017). GATS 2017 fact sheet. Retrieved from https://mohfw.gov.in/sites/default/files/GATS-2%20FactSheet.pdf

21.

National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. (2014). The health consequences of smoking—50 years of progress: A report of the surgeon general. Retrieved from https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf

22.

Nichter

(2006). Introducing tobacco cessation in developing countries: An overview of Project Quit Tobacco International. Tobacco Control, 15(Suppl. 1), i12–i17. doi:10.1136/tc.2005.014704

23.

Nichter

Padmajam

Nichter

Sairu

Aswathy

Mini

G. K.

. . . Thankappan

K. R.

(2015). Developing a smoke free homes initiative in Kerala, India. BMC Public Health, 15(1), Article 480. doi:10.1186/s12889-015-1815-1

24.

Piasecki

T. M.

Niaura

Shadel

W. G.

Abrams

Goldstein

Fiore

M. C.

Baker

T. B.

(2000). Smoking withdrawal dynamics in unaided quitters. Journal of Abnormal Psychology, 109, 74–86.

25.

Pradeepkumar

A. S.

Thankappan

K. R.

Nichter

(2008). Smoking among tuberculosis patients in Kerala, India: Proactive cessation efforts are urgently needed. The International Journal of Tuberculosis and Lung Disease, 12, 1139–1145.

26.

Sarkar

B. K.

Arora

Gupta

V. K.

Reddy

K. S.

(2013). Determinants of tobacco cessation behaviour among smokers and smokeless tobacco users in the states of Gujarat and Andhra Pradesh, India. Asian Pacific Journal of Cancer Prevention, 14, 1931–1935. doi:10.7314/APJCP.2013.14.3.1931

27.

Sarma

Harikrishnan

Baldridge

A. S.

Devarajan

Mehta

Selvaraj

. . . Huffman

M. D.

(2017). Availability, sales, and affordability of tobacco cessation medicines in Kerala, India. Circulation: Cardiovascular Quality and Outcomes, 10(11), Article e004108. doi:10.1161/CIRCOUTCOMES.117.004108

28.

Shadel

W. G.

Niaura

(2003). Brief behavioral treatment. In Abrams

D. B

Niaura

Brown

R. A.

Emmons

K. M.

Goldstein

M. G .

Monti

P. M.

(Eds.), The tobacco dependence treatment handbook (pp. 101–117). New York: The Guilford Press.

29.

Sheffer

C. E.

Brackman

S. L.

Cottoms

Olsen

(2011). Understanding the barriers to use of free, proactive telephone counseling for tobacco dependence. Qualitative Health Research, 21, 1075–1085. doi:10.1177/1049732311404248

30.

Soman

C. R.

Kutty

V. R.

Safraj

Vijayakumar

Rajamohanan

Ajayan

& for the PROLIFE Study Group. (2011). All-cause mortality and cardiovascular mortality in Kerala state of India. Asia Pacific Journal of Public Health, 23, 896–903. doi:10.1177/1010539510365100

31.

Thankappan

K. R.

Mini

G. K.

Daivadanam

Vijayakumar

Sarma

P. S.

Nichter

(2013). Smoking cessation among diabetes patients: Results of a pilot randomized controlled trial in Kerala, India. BMC Public Health, 13(1), Article 1137. doi:10.1186/1471-2458-13-47

32.

Thankappan

K. R.

Pradeepkumar

A. S.

Nichter

(2009). Doctors’ behavior & skills for tobacco cessation in Kerala. Indian Journal of Medical Research, 129, 249–255.

33.

Thresia

C. U.

Thankappan

K. R.

Nichter

(2009). Smoking cessation and diabetes control in Kerala, India: An urgent need for health education. Health Education Research, 24, 839–845. doi:10.1093/her/cyp020

34.

Tiwari

Deb

Debbarma

Chauduri

Chakraborty

Lepcha

Chakraborti

(2006). Tobacco use and cardiovascular disease: A knowledge, attitude and practice study in rural Kerala. Indian Journal of Medical Sciences, 60, 271–276.

35.

Tolley

E. E.

Ulin

P. R.

Mack

Robinson

E. T.

Succop

S. M.

(2016). Qualitative methods in public health. San Francisco, CA: John Wiley.

36.

Twyman

Bonevski

Paul

Bryant

(2014). Perceived barriers to smoking cessation in selected vulnerable groups: A systematic review of the qualitative and quantitative literature. BMJ Open, 4(12), Article e006414. doi:10.1136/bmjopen-2014-006414

37.

Wiles

Kinmonth

A. L.

(2001). Patients’ understandings of heart attack: Implications for prevention of recurrence. Patient Education and Counseling, 44, 161–169.

38.

World Health Organization. (2003). WHO Framework Convention on Tobacco Control. Retrieved from http://www.who.int/fctc/cop/about/en/

39.

World Health Organization. (2012). India: WHO statistical profile. Retrieved from http://www.who.int/gho/countries/ind.pdf?ua=1

40.

Xavier

Gupta

Kamath

Sigamani

Devereaux

P. J.

George

. . . Yusuf

(2016). Community health worker-based intervention for adherence to drugs and lifestyle change after acute coronary syndrome: A multicentre, open, randomised controlled trial. The Lancet Diabetes & Endocrinology, 4, 244–253. doi:10.1016/S2213-8587(15)00480-5

41.

Zachariah

Harikrishnan

Krishnan

M. N.

Mohanan

P. P.

Sanjay

Venugopal

Thankappan

K. R.

(2013). Prevalence of coronary artery disease and coronary risk factors in Kerala, South India: A population survey–design and methods. Indian Heart Journal, 65, 243–249. doi:10.1186/s12872-016-0189-3

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.11 MB

0.06 MB