RESUMO
PIP: This report of the Smoking Intervention Project pertains to women in Kerala and Andhra, India. The typical woman in Kerala is a fulltime housewife who also works in the fields, growing, tending, and harvesting a paddy. The rural woman is somewhat literate, and she is alert, independent, and individualistic. She chews tobacco with betel leaf and areca nut, has her own private supply of chewing material, and uses it whenever she wants. Her counterpart in Andhra is less literate, probably has more children, seems poorer, and may chew tobacco but smokes a locally made cigar/cheroot called a chutta. She lights it and when well lit puts the glowing end inside her mouth. The Kerala woman typically suffers from precancerous lesions in right or left buccal mucosa, buccal groove, on or under the tongue. The Andhra woman also has lesions on the palate. Both are totally unaware of the ill effects of tobacco. Oral cancer may be called the national cancer of India. More suffer from it than from any other cancer. The Smoking Intervention Project is divided into 3 phases: phase 1 -- a cross sectional field survey, determined the prevalence rates of oral precancerous lesions and their association with tobacco habits in a population of 50,915; phase 2 -- a 10 year follow-up study of 3/5 of the original study population, which indicated that oral cancer and precancerous lesions occurred almost solely among those who smoked or chewed tobacco and oral cancer was almost always preceded by some type of precancerous lesions; and phase 3 -- the intervention part of the project is to make people give up tobacco and to investigate any effect this might have on incidence and regression rate of precancerous lesions. The intervention program outlined a timetable for employing different communication media and regulating the information flow so as not to overwhelm the target population and to make the message more easily understandable, if necessary. Intervention strategies have been continually evolving. They are reassessed and modified annually and pretested on the study population to determine suitability and effectiveness. Strategies employed to wean people away from tobacco include: 1 to 1 interaction or personal communication; production of a film to create an awareness, give information on the close link that exists between tobacco habits and oral cancer, and to lead to change in attitude toward consuming tobacco; the use of posters; newspaper articles; folk drama; radio programs; and slides. The effectiveness of these strategies is being assessed. The 6th follow-up is in progress. It is possible to intervene in the tobacco habits of people even though they seem psychologically and physically dependent on them. Personal communication is the most effective technique in convincing people about the dangers of smoking, followed by film and burrakatha. In Andhra conventional smoking is eaier to give up than reverse smoking. In Kerala results indicate that chewing is easier to reduce or give up than smoking.^ieng
