Cessation of all forms of tobacco is necessary for controlling mortality associated with coronary artery diseases (CADs). In India, smokeless tobacco (SLT) is the most used form of tobacco. With around 60% of the world’s smokeless tobacco users living in India, the task of tobacco cessation has become daunting and complicated for Indian researchers and policy makers.
Objective
We conducted the present study to understand CAD patients’ perspectives towards their SLT use and to identify barriers of SLT cessation.
Methods
Using a semi-structured interview method, we obtained data from 12 CAD patients who were currently using some form of SLT.
Results
Thematic analysis suggests that CAD patients were unable to quit SLT addiction due to (a) certain socio-environmental factors that support SLT, (b) prevalence of misconceptions about the link between SLT use and their cardiac condition, (c) perceived lower self-efficacy to quit, (d) fatalistic attitude towards health outcomes and (e) substituting addiction with perceived lesser harmful products.
Discussion
The findings reveal that factors responsible for the continuation of SLT usage are multipronged. Current SLT users’ perspectives can facilitate the development of effective intervention and rehabilitation programs aimed at de-addiction of cardiac patients.
GuptaPCAroraMSinhaD, et al. Smokeless tobacco and public health in India. Ministry of health & family welfare.
New Delhi:
Government of India, 2016.
3.
Tata Institute of Social Sciences (TISS). Mumbai and Ministry of Health and Family Welfare, Government of India. Global Adult Tobacco Survey GATS 2.
India:
Author, 2016, p.17.
4.
SinhaDNGuptaPCKumarA, et al.
The poorest of poor suffer the greatest burden from smokeless tobacco use: a study from 140 countries. Nicotine Tobacco Res2018;
20: 1529–1532.
5.
GuptaPC andRayCS.Smokeless tobacco and health in India and South Asia. Respirology2003;
8: 419–431.
6.
AsthanaSLabaniSKailashU, et al.
Association of smokeless tobacco use and oral cancer: a systematic global review and Meta-analysis. Nicotine and Tobacco Res2019;
21: 1162–1171.
7.
GuptaRGuptaSSharmaS, et al.
A systematic review on association between smokeless tobacco & cardiovascular diseases. Indian J Med Res2018;
148: 77–89.
8.
HirschJMHednerJWernstedtL, et al.
Hemodynamic effects of the use of oral snuff. Clin Pharmacol Ther1992;
52: 394–401.
9.
WolkRShamsuzzamanASSvatikovaA, et al.
Hemodynamic and autonomic effects of smokeless tobacco in healthy young men. J Am Coll Cardiol2005;
45: 910–914.
10.
RohaniM andAgewallS.Oral snuff impairs endothelial function in healthy snuff users. J Intern Med2004;
255: 379–383.
11.
GranberryMCSmithIIETroillettRD, et al.
Forearm endothelial response in smokeless tobacco users compared with cigarette smokers and nonusers of tobacco. Pharmacotherapy2003;
23: 974–978.
PrabhakaranDJeemonPSharmaM, et al.
The changing patterns of cardiovascular diseases and their risk factors in the states of India: the global burden of disease study 1990–2016. Lancet Global Health2018;
6: e1339–e1351.
CritchleyJA andCapewellS.Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. Jama2003;
290: 86–97.
16.
ArefalkGHambraeusKLindL, et al.
Discontinuation of smokeless tobacco and mortality risk after myocardial infarction. Circulation2014;
130: 325–332.
17.
SarkarBKAroraMGuptaVK, et al.
Determinants of tobacco cessation behaviour among smokers and smokeless tobacco users in the states of Gujarat and Andhra Pradesh, India. Asian Pac J Cancer Prev2013;
14: 1931–1935.
Public Health Foundation of India, and Institute of Health Metrics and Evaluation. India: health of the nation’s states – the India state-level disease burden initiative.
New Delhi, India:
ICMR PHFI, Indian Council of Medical Research and IHME, 2017.
20.
BhaumikSSPlacekCKochumoniR, et al.
Tobacco cessation among acute coronary syndrome patients in Kerala, India: patient and provider perspectives. Qual Health Res2019;
29: 1145–1160.
21.
TiwariRDebPDebbarmaA, et al.
Tobacco use and cardiovascular disease: a knowledge, attitude and practice study in rural Kerala. Indian J Med Sci2006;
60: 271–276.
22.
BanerjeeSCOstroffJSD'AgostinoTA, et al.
Disengagement beliefs in South Asian immigrant smokeless tobacco users: a qualitative study. Addict Res Theory2014;
22: 229–238.
23.
JeemonP andReddyKS.Social determinants of cardiovascular disease outcomes in Indians. Indian J Med Res2010;
132: 617–622.
24.
GuptaSGudapatiRGauravK, et al.
Emerging risk factors for cardiovascular diseases: Indian context. Indian J Endocrinol Metab2013;
17: 806–814.
25.
DudalaSRReddyKA andPrabhuGR.Prasad's socio-economic status classification – an update for 2014. Int J Res Health Sci2014;
2: 875–878.
26.
MorseJM (ed.). Critical issues in qualitative research methods.
Thousand Oaks, CA:
Sage, 1994.
27.
BraunV andClarkeV.Using thematic analysis in psychology. Qual Res Psychol2006;
3: 77–101.
DalalAK andMisraG (eds). New directions in health psychology.
New Delhi:
SAGE Publications India, 2012.
30.
AyyappaGKunteRYadavAK, et al.
Is occupation the “driving force” for tobacco consumption? A cross-sectional study to assess prevalence, patterns, and attitude towards tobacco use among long-distance bus drivers and conductors in Western Maharashtra. Ind Psychiatry J2019;
28: 237.
31.
RawatRGoudaJ andShekharC.Smokeless tobacco use among adult males in India and selected states: assessment of education and occupation linkages. J Hum Behav Soc Environ2016 ;
26: 236–246.
32.
PrabhakarBNarakeSS andPednekarMS.Social disparities in tobacco use in India: the roles of occupation, education and gender. Indian J Cancer2012;
49: 401–409.
33.
WestJHBlumbergEJKelleyNJ, et al.
Does proximity to retailers influence alcohol and tobacco use among Latino adolescents?J Immigr Minor Health2010;
12: 626–633.
34.
LarsenKToTIrvingHM, et al.
Smoking and binge-drinking among adolescents, Ontario, Canada: does the school neighbourhood matter?Health Place2017;
47: 108–114.
35.
AdhikariKPednekarMSStepanovI, et al.
Observed circumvention of the Gutka smokeless tobacco ban in Mumbai, India. Tob Regul Sci2020;
6: 331–335.
36.
ElwellLPoveyRGroganS, et al.
Patients’ and practitioners’ views on health behaviour change: a qualitative study. Psychol Health2013;
28: 653–674.
37.
RotterJB.Generalized expectancies for internal versus external control of reinforcement. Psychol Monographs: General Appl1966;
80: 1–28.
38.
HeinstromJ.From fear to flow: personality and information interaction.
Amsterdam:
Elsevier, 2010.
39.
LassiGTaylorAEMahedyL, et al.
Locus of control is associated with tobacco and alcohol consumption in young adults of the Avon longitudinal study of parents and children. R Soc Open Sci2019;
6: 1–9.
40.
ChavanSS andKrC.Prevalence, knowledge, and attitude towards smokeless tobacco use in adolescents of selected colleges at Dakshina Kannada district, Karnataka, India. J Indian Assoc Child Adolesc Mental Health2020;
16: 139–161.
41.
BuchbinderMWilburRZuskovD, et al.
Teachable moments and missed opportunities for smoking cessation counseling in a hospital emergency department: a mixed-methods study of patient-provider communication. BMC Health Serv Res2014;
14: 651.
42.
NewhallKSuckowBSpanglerEBrookeBS, et al.
Impact and duration of brief surgeon-delivered smoking cessation advice on attitudes regarding nicotine dependence and tobacco harms for patients with peripheral arterial disease. Ann Vasc Surg2017;
38: 113–121.
43.
TworekCSchauerGLWuCC, et al.
Youth tobacco cessation: quitting intentions and past-year quit attempts. Am J Prev Med2014;
47: S15–27.
44.
GreenECMurphyEM andGryboskiK. The health belief model. In: Kate Sweeny, Meghan L. Robbins, Lee M. Cohen (eds), The Wiley encyclopedia of health psychology. San Francisco, USA: John Wiley & Sons Ltd.2020, pp.211–214.
45.
RichardsonAPearsonJXiaoH, et al.
Prevalence, harm perceptions, and reasons for using noncombustible tobacco products among current and former smokers. Am J Public Health2014;
104: 1437–1444.
46.
XuYGuoYLiuK, et al.
E-cigarette awareness, use, and harm perception among adults: a meta-analysis of observational studies. PLoS One2016;
11: e0165938.
47.
GalottiKM.Cognitive psychology in and out of the laboratory. 5th ed.
New Delhi, India:
Sage Publications, 2017.
48.
ZwaanLMonteiroSSherbinoJ, et al.
Is bias in the eye of the beholder? A vignette study to assess recognition of cognitive biases in clinical case workups. BMJ Qual Saf2017;
26: 104–110.
49.
Quist-PaulsenPBakkePS andGallefossF.Predictors of smoking cessation in patients admitted for acute coronary heart disease. Eur J Cardiovasc Prev Rehabil2005;
12: 472–477.
50.
NoureddineS andMassouhA.Factors associated with continued smoking in Lebanese patients with acute coronary syndrome. J Cardiovasc Nurs2019;
34: 94–98.
51.
LeporeSJCollinsBN andSosnowskiDW.Self-efficacy as a pathway to long-term smoking cessation among low-income parents in the multilevel kids safe and smokefree intervention. Drug and Alcohol Dependence2019;
204: 107496.
52.
GwaltneyCJMetrikJKahlerCW, et al.
Self-efficacy and smoking cessation: a meta-analysis. Psychol Addict Behav2009;
23: 56–66.
53.
SubramanianSVCorsiDJSubramanyamMA, et al.
Jumping the gun: the problematic discourse on socioeconomic status and cardiovascular health in India. Int J Epidemiol2013;
42: 1410–1426.
