Browsing by Author "Pradeepkumar, AS"

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    Developing a smoke free homes initiative in initiative in Kerala, India
    (BMC Public Health., 2015-05) Nichter, M; Padmajam, S; Nichter, M; Sairu, P; Aswathy, S; Mini, GK; Bindu, VC; Pradeepkumar, AS; Thankappan, KR
    Background: Results of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities. Methods: Community-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support. Results: At baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband’s behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home. Conclusions: The smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.
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    Developing a smoke free homes initiative in Kerala, India
    (BMC PUBLIC HEALTH, 2015) Nichter, M; Padmajam, S; Nichter, M; Sairu, P; Aswathy, S; Mini, GK; Bindu, VC; Pradeepkumar, AS; Thankappan, KR
    Background: Results of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities. Methods: Community-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support. Results: At baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband's behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home. Conclusions: The smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.
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    Doctors' behaviour & skills for tobacco cessation in Kerala
    (INDIAN JOURNAL OF MEDICAL RESEARCH, 2009) Thankappan, KR; Pradeepkumar, AS; Nichter, M
    Background & objectives: Several studies have shown that health professionals' advice for tobacco cessation to tobacco users enhances quit rate. Little is known about doctor's present tobacco cessation efforts in India. We examined doctors' reported inquiry into patient's use of tobacco and assessed their perceived need for training in tobacco cessation. Methods: A cross-sectional survey was conducted in Kerala to collect information on doctor's practices, skills and perceived need for training in tobacco cessation. Pre-tested structured questionnaires were distributed in person to 432 male and 89 female doctors, of whom 264 male and 75 female doctors responded. Results: One third of all the doctors surveyed reported that they always ask patients about tobacco use, three fourths advise all patients routinely to quit irrespective of the smoking status of patients and one tenth offered useful information on how to quit. About 15 per cent reported they received information from medical representatives, 32 per cent reported they had sufficient training and 80 per cent expressed interest in receiving training to help smokers quit. Majority of all doctors surveyed most commonly asked and advised patients to quit tobacco when patients had lung, heart, mouth disease or cancer. Interpretation & conclusions: Most doctors inquired about tobacco use from a minority of their patients, though many reported to advise patients about quitting even without inquiring about their tobacco use status. There are several missed opportunities to promote quitting at a time when patients are motivated to listen.
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    Doctors’ behavior and Skills for tobacco cessation in Kerala.
    (Indian Journal of Medical Research, 2009) Thankappan, KR; Pradeepkumar, AS; Nichter,M
    BACKGROUND: Previous reports have indicated an association of monocyte chemoattractant protein-1 (MCP-1) with risk factors for atherosclerosis and coronary artery disease (CAD). Because some of these risk factors form components of metabolic syndrome, in the present study, we investigated the association of an important promoter region polymorphism of MCP-1, A-2518G, and its serum levels with metabolic syndrome in a South Indian cohort.METHODS: The study comprised of 126 healthy subjects aged 30-59 years from South India. Subjects were classified on the basis of presence or absence of metabolic syndrome and metabolic syndrome components as per the International Diabetes Federation definition. MCP-1 genotyping was done by polymerase chain reaction restriction fragment-length polymorphism, and serum levels were estimated by enzyme-linked immunosorbent assay.RESULTS: The MCP-1 -2518G allele frequency in the study population was 32.9% and the mean MCP-1 serum levels were 523 +/- 272.3 pg/mL. Subjects with metabolic syndrome showed an increased presence of the MCP-1 -2518G allele in comparison to those without metabolic syndrome (odds ratio [OR] = 5.03, P = 0.02). The association was related to a higher proportion of this allele in subjects with increased waist circumference (OR = 3.78, P = 0.05).CONCLUSIONS: The MCP-1 -2518G allele may be contributing to atherosclerosis and CAD by conferring an increased risk to metabolic syndrome and/or obesity.
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    Smokeless tobacco use among patients with tuberculosis in Karnataka: The need for cessation services
    (NATIONAL MEDICAL JOURNAL OF INDIA, 2012) Deepak, KG; Daivadanam, M; Pradeepkumar, AS; Mini, GK; Thankappan, KR; Nichter, M
    Background. India is home to the largest population of patients with tuberculosis and tobacco users in the world. Smokeless tobacco use exceeds smoking and is increasing. There is no study to date that reports smokeless tobacco use before and after the diagnosis and treatment of tuberculosis. We assessed smokeless tobacco use among former patients of tuberculosis in Karnataka, India. Methods. We conducted a community-based, cross-sectional study among 202 men, who had been diagnosed and treated for tuberculosis (mean age 48 years), selected by multistage, random sampling. Using a semi-structured interview schedule, retrospective smoking and smokeless tobacco use were captured at eight time-points before and after the diagnosis and treatment of tuberculosis. Results. Most patients suspended tobacco use during treatment. A high 44% prevalence of smokeless tobacco use 6 months before diagnosis was reduced to just 8% during the intensive phase of treatment and climbed to 27% 6 months after treatment. The tobacco use relapse rate 6 months after completion of treatment was higher for smokeless tobacco use (52%, 95% CI 41%-62%) than for smoking (36%, 95% CI 26%-45%). We also found that many patients who were advised to quit smoking continued using smokeless tobacco after completion of treatment. Additionally, new smokeless tobacco use was documented. Of the 11 new exclusive smokeless tobacco users, 10 shifted from smoking to smokeless tobacco use as a form of harm reduction. Conclusion. Patients with tuberculosis are advised by their doctors, at the time of diagnosis, to quit smoking. Several patients shift from smoking to smokeless tobacco use, which needs to be addressed while providing tobacco cessation services. Nati Med J India 2012;25:142-5
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    Smokeless tobacco use among Tuberculosis patients in Karnataka, India: The need for cessation services.
    (The National Medical Journal of India, 2012) Deepak, KG; Daivadanam, M; Pradeepkumar, AS; Mini, GK; Thankappan, KR; Nichter, M
    India is home to the largest population of patients with tuberculosis and tobacco users in the world. Smokeless tobacco use exceeds smoking and is increasing. There is no study to date that reports smokeless tobacco use before and after the diagnosis and treatment of tuberculosis. We assessed smokeless tobacco use among former patients of tuberculosis in Karnataka, India.
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    Smoking among Tuberculosis Patients in Kerala, India: Proactive Cessation Efforts are Urgently Needed
    (International Journal of Tuberculosis and Lung Disease, 2008) Pradeepkumar, AS; Thankappan, KR; Nichter, M
    OBJECTIVES: To document smoking patterns among tuberculosis (TB) patients at eight different points of time before, during and after treatment, and to investigate the frequency and content of the quit smoking messages they received. DESIGN: A stratified random sample of 215 male TB patients from Kerala, India, who had completed treatment in the previous 9 months was surveyed using a pre-tested semi-structured interview schedule. RESULTS: Six months prior to diagnosis, 94.4% of male TB patients were ever smokers and 71.2% were current smokers. Although 87% of patients had quit smoking soon after diagnosis, 36% had relapsed by 6 months post treatment. One third relapsed during the first 3 months of treatment and another third during the next 3 months of treatment. Two thirds of all smokers received cessation advice from primary care physicians, but less than half received advice from others. Less than half of all messages were TB-specific; the rest were very general short instructions. Smoking more than 15 cigarettes/bidis at the time of diagnosis was significantly associated with a lower quit rate during treatment (OR 8.0, 95%CI 2.1-30.9). CONCLUSION: Messages to not smoke often go unheeded among TB patients. Proactive efforts are needed to encourage health staff and DOTS providers to give strong cessation messages.
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    Tobacco use among medical professionals in Kerala, India: The need for enhanced tobacco cessation and control efforts
    (Addictive Behaviors, 2006) Mohan, S; Pradeepkumar, AS; Thresia, CU; Thankappan, KR; Poston, WSC; Haddock, CK; Pinkston, MM; Muramoto, ML; Nichter, M; Nichter, M; Lando, HA
    In developing nations where reductions in tobacco use have not been realized, it is critical that health professionals be encouraged to abstain from tobacco use. Data on tobacco use among health professionals in India are limited. We conducted cross-sectional surveys among 110 male medical school faculty (MSF), 229 physicians (67% male), 1130 medical students (46% male), and 73 female nursing students. Information on tobacco use and quit attempts was collected using structured questionnaires. Among the male respondents, current smokers were 15.1% of MSF, 13.1% of physicians, and 14.1% of medical students. Among current smokers, 42% of MSF and physicians and 51% of medical students had not attempted quitting in the last year. However, one third of MSF and physicians and 16% of medical students had attempted to quit at least 4 times. This is one of the first studies among health care professionals in India. Our findings show that a substantial proportion of physicians and medical students in Kerala continue to smoke. Smoking cessation programs are warranted in medical schools in Kerala. An initiative is presently underway by the authors to incorporate tobacco education into the medical school curriculum.
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    Tobacco Use in Kerala: Findings from three recent studies
    (National Medical Journal of India, 2005) Pradeepkumar, AS; Sailesh Mohan; Gopalakrishnan, P; Sarma, PS; Thankappan, KR; Nichter, M
    BACKGROUND:We reviewed the literature on tobacco use in Kerala and present data from three recently conducted unpublished studies. METHODS:Three cross-sectional studies were conducted; a community-based study of 1,298 individuals aged 15 years and above (mean age 37.4 years, men 630), a school-based study of 1,323 boys (mean age 14.7 years), and a college-based study of 1,254 male students (mean age 18.2 years). Information on tobacco use and sociodemographic variables was collected using pre-tested, structured interview schedules and questionnaires.RESULTS: In the community study, 72% of men and 6% of women had ever used tobacco. Compared to men with > 12 years of schooling, those with < 5 years of schooling were 7 times more likely to smoke (OR 7, CI 3.2-15.6). The age at initiation of smoking was 19 years among those < 25 years of age compared to 25.5 years among ever smokers > 44 years. In the school study, the age at initiation among boys aged < or = 1 3 years was 10.7 years compared with 13.2 years among > or = 16-year-old boys. Boys whose fathers and friends used tobacco were 2 times and 2.9 times more likely to use tobacco (OR 2.0, CI 1.3-3.1 and OR 2.9, CI 1.6-5.1), respectively, compared with their counterparts. In the college study, 29% of the commerce students used tobacco compared with 5.3% of polytechnic students (p < 0.001).CONCLUSION:Survey data suggest that the age at initiation of tobacco use appears to be falling. A series of cross-sectional studies with larger sample sizes of the youth is required to confirm this impression. Tobacco use habits of fathers and peers are significant influences on youth smoking. There is a need to focus on particular types of colleges as these appear to have high-risk tobacco use environments.
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    Tobacco use in Kerala: Findings from three recent studies
    (NATIONAL MEDICAL JOURNAL OF INDIA, 2005)
    Background. We reviewed the literature on tobacco use in Kerala and present data from three recently conducted unpublished studies.Methods. Three cross-sectional studies were conducted; a community-based study of 1298 individuals aged 15 years and above (mean age 37.4 years, men 630), a school-based study of 132 3 boys (mean age 14.7 years), and a college-based study of 1254 male students (mean age 18.2 years). Information on tobacco use and sociodemographic variables was collected using pre-tested, structured interview schedules and questionnaires.Results. In the community study, 72% of men and 6% of women had ever used tobacco. Compared to men with > 12 years of schooling, those with <5 years of schooling were 7 times more likely to smoke (OR 7, Cl 3.2-15.6). The age at initiation of smoking was 19 years among those <25 years of age compared to 25.5 years among ever smokers >44 years. In the school study, the age at initiation among boys aged: 13 years was 10.7 years compared with 13.2 years among 2:16-year-old boys. Boys whose fathers and friends used tobacco were 2 times and 2.9 times more likely to use tobacco (OR 2.0, Cl 1.3-3.1 and OR 2.9, Cl 1.6-5.1), respectively, compared with their counterparts. In the college study, 29% of the commerce students used tobacco compared with 5.3% of polytechnic students (p<0.001).Conclusion. Survey data suggest that the age at initiation of tobacco use appears to be failing. A series of cross-sectional studies with larger sample sizes of the youth is required to confirm this impression. Tobacco use habits of fathers and peers are significant influences on youth smoking. There is a need to focus on particular types of colleges as these appear to have high-risk tobacco use environments.