ABSTRACT
Cigarette smoking is a major public health issue in India and leads to significant morbidity and mortality. Addressing the issue of smoking is a major challenge to public health, as the addiction is hard to break. Counseling smokers regarding smoking cessation is the first step to achieving cessation, but the quit rates remain low. Several pharmacological interventions have been developed over the years. Nicotine replacement therapy is available in a variety of formulations, each with different advantages, drawbacks, acceptability among smokers and quit rates. In addition, a range of novel nicotine and tobacco products, including Heated Tobacco Products (HTPs), have been developed which leverage nicotine to aid in smoking cessation. A group of medical experts convened to review the evidence on the burden of smoking, the concept of Tobacco Harm Reduction (THR), novel nicotine and tobacco products for THR, and the potential of HTPs to aid in smoking cessation. This paper outlines the findings and recommendations regarding THR in the Indian context. The panel opined that tobacco cessation centers and counseling remain the foundation of tobacco cessation in India. At the same time, there appears to be potential for the application of THR products in India. The relevant authorities must review the potential of THR products, and make these available, to provide the best possible cessation strategy for the Indian population that is currently at risk of mortality and severe morbidity.
ABSTRACT
Background:Tobacco harm reduction when advocated by care providers as continuum of care towards the goal of tobacco cessation might result in long-term abstinence than it is currently seen. This study aimed to qualitatively explore the healthcare professionals approach and self-reported practices related to tobacco harm reduction and smoking cessation. Methods: A purposive sample (N=36) of multi-specialty healthcare professionals providing tobacco related cessation services at six private medical teaching institutes were engaged in semi-structured qualitative interviews between July 2020 and October 2020 in Chennai. Results: The results indicated that majority of the healthcare professional抯 lack conceptual understanding about tobacco harm reduction. Harm reduction was practised and nicotine replacement therapy was prescribed by psychiatrists in this study. Majority of the healthcare professionals were found to have misconceptions that promoting harm reducing practices instead of cessation might result in continued addiction to nicotine products among the clientele. Conclusions: The findings reveal that tobacco harm reduction remains an under-utilized clinical practise in Indian setting due to knowledge and awareness gaps among multi-specialty healthcare professionals. Improved sensitization through continuous medical education updates is needed to inform effective clinician-affirmative tobacco harm reduction practices.