Tobacco Problems in the North East: a Major Challenge s1

DR. BHUBANESWAR BOROOAH CANCER INSTITUTE GOPINATH NAGAR, GUWAHATI – 781016 ASSAM, INDIA PROJECT BRIEF

WHO PROJECT NO: SE/04/407621

TITLE OF THE PROJECT: TO ESTABLISH THE TOBACCO CESSATION CLINIC IN

DR. BHUBANESWAR BOROOAH CANCER INSTITUTE IN ASSAM

PROJECT AMOUNT: Rs. 2,15,000 (Rupees Two Lakhs Fifteen Thousand only)

START DATE: 01.01.2005. (01.10.2004.)

END DATE: 30.04.2006.

OBJECTIVES:

THE AIMS AND OBJECTIVES OF TOBACCO CESSATION CLINIC IS TO i. HELP PEOPLE TO QUIT TOBACCO ii. FORMING ANTI TOBACCO NETWORK iii. AWARENESS IN RURAL AND URBAN AREAS iv. SETTING UP SATELLITE CLINIC

EQUIPMENT SUPPLED:

CARBON-MONOXIDE MONITORING MACHINE

HP DESKTOP COMPUTER

HP DESKJET PRINTER

SONY COLOUR TV 21”

SONY DVD PLAYER

STAFF OF TCC

2 PRINCIPAL INVESTIGATOR Dr. Amal Chandra Kataki, MD Director, Dr. B. Borooah Cancer Institute, Gopinath Nagar, Guwahati Tel No. 91-361-2472364(O) Fax No. 91-361-2472636

CO-INVESTIGATOR

Dr. Joydeep Das, MD Jr. Consultant & I/C Dept. of Preventive Oncology Dr. B. Borooah Cancer Institute, Gopinath Nagar, Guwahati Tel No. Tel No. 91-361-2472366 Ext 242 (O) Fax No. 91-361-2472636

CLINICAL PSYCHOLOGIST

Ms. Madhuri R. Kujur, MA

MEDICAL-SOCIAL WORKER

Mr. Diganta Sarmah, M.Sc.

CONTACT DETAILS

Tobacco Cessation Clinic, New OPD Building, Room No. 3 Dr. B. Borooah Cancer Institute, Goipnath Nagar, Guwahati – 16 Tel No. Tel No. 91-361-2472366 Ext 242 (O) E mail : [email protected]

SUMMARY OF TCC, GUWAHATI FROM 1 st JANUARY 2005 TO 30 TH APRIL’2006

3 1. New Patients 222 2. Review Patients 207 3. Satellite Clinics 04 4. No. of Training Programme 04 ( 45 volunteers trained) 5. Awareness programme in Schools / 26 Schools, Colleges & Offices, Colleges / Institutes 80 teachers and over 2200 students being made aware 6. Awareness programme in 21 places, over 1600 people being Communities made aware 7. Awareness programme in Offices 04, over 230 people being made aware 8. Street Play 05, over 500 people being made aware 9. Exhibition 02, over 450 people viewed the exhibition 10. Pamplets and handbills 06 11. TV and radio spots 07 12. Display material 30

DR. B. BOROOAH CANCER INSTITUTE

Dr. Bhubaneswar Borooah Cancer Institute, the only comprehensive cancer hospital in the entire North Eastern region was set up by a voluntary organization called “Dr. Bhubaneswar Borooah Cancer Society Trust”. Dr. Bhubneswar Borooah was a great

4 physician and freedom fighter. In order to keep the memory of Dr. Borooah , it was decided to set up a cancer hospital at Guwahati in the year 1958. Thus on 18th of November in the year 1973 the Institute was finally inaugurated and named as “Dr. Bhubaneswar Borooah Cancer Institute”. In the year 1980 the Institute was recognized as Regional Cancer Centre by the Ministry of Health and Family Welfare, Govt. Of India. The hospital is being funded by Department of Atomic Energy, Govt. of India, North Eastern Council, Govt. of India and Govt. of Assam.

At present it is a 120 bedded hospital including the facilities of A/C cabins, non A/C cabins, semi paying cabins and general wards. The construction to increase the member up to 250 bed has already been completed. Investigation and treatment cost in the Institute are offered at a moderate rate and there are provisions for free treatment for the extremely poor patients under a scheme known as “Mukhyomantrir Jibon Jyoti Bima Achoni” which is financed by Govt. of Assam and distributed by ICICI Lombard GIC Ltd.

The Institute, in addition to patient treatment, lays emphasis on Prevention and Early detection of cancer through public awareness. A department of Preventive Oncology and Pain and Palliative Care Services were opened up along with a Speech Therapy Clinic. The department of Preventive Oncology in the Institute started a “Health Education Programme on Cancer and Tobacco” since 2003 in various Schools, Colleges and Institutes of Guwahati where harmful effects of tobacco are discussed. Also with the supports from W.H.O. (World Health Organization) and G.O.I. (Government of India), a “Tobacco Cessation Clinic” has been started in order to counsel and motivate the tobacco consumers who wants to quit the habit of tobacco consumption.

TOBACCO PROBLEMS IN THE NORTH EAST: A MAJOR CHALLENGE

Set on the misty hills North East creates the right for adventure of learning, for quiet relaxation and creative self discovery. Yet, it is unfortunate to know that the world of

5 tobacco has marched on leaving the youngsters, especially of the North East hopelessly behind. This is because of deep seated frustration and resentment. Experience in the North East has shown that this segment of youth is the most vulnerable and they have become soft targets for taking up tobacco addiction.

As we all know that tobacco is the most addictive substance and yet the use of pan masala, gutkha, betel nut quid, cigarette, bidi is so rampant in our society that it is considered part of a normal lifestyle. The tobacco epidemic is moving towards the poorer and the least educated section of the society. As a result the tobacco industry is targeting to introduce their products and have an enormous potential new market because of the flexibility in these places. Again this means that people in these areas who have little resources for health and who suffer from the burden of many communicable diseases are also suffering from tobacco consumption. As a result, tobacco in the North East has a negative impact on diverse areas of health and poverty.

With regard to addiction, it has been estimated that an average of 14 minutes of life is lost for each cigarette smoked. This means that tobacco users lose an average of 20-25 years of life expectancy than a non-smoker.

Tobacco related cancer alone accounts for over 40% of the cancer and as much as 35- 50% are due to foods and the contaminating materials in the food. Tobacco related cancers account for half of all the cancers in males and 1/4th of all cancers in females. b. Tobacco kills between 8 – 9 lakhs people each year in India i.e. 2220 deaths a day and 1 death every 40 seconds. There are 184 million tobacco consumers in India of which 20% smoke cigarettes, 40% smoke bidis and 40% chew tobacco in various forms. c. 55,000 children in India take up this habit annually. d. Indians smoke 90 billion cigarettes annually which cost about Rs. 180 billion Tobacco problem in the North-East is more complex than probably that any other state in India, with a large burden of tobacco related diseases and death. In the North Eastern states tobacco is smoked – in cigarettes, bidis and pipes. Tobacco is also chewed in the form of paans or betel nut with tobacco and slaked lime. In Assam, a fermented form of areca nut known as tamol or bura tamol is chewed extensively. Bura tamol is often

6 infected with fungus. Tobacco water (known as tuibur in Mizoram and hidakphu in Manipur) is also used by passing tobacco smoke through water. A very common feature in the North East is the use of gutkhas and pan masalas.

Tobacco use causes serious diseases because in addition to Nicotine, tobacco contains several toxic and carcinogenic chemicals. The quantity of tar is very high in Bidi (45- 50mg) while cigarette contains (18-28mg) of tar. This is to say that bidi is more harmful than cigarette. In addition, smokers ingest a highly toxic gas called carbon monoxide. This gas combines with haemoglobin in the blood and reduces its oxygen carrying capacity.

The National Family Health Survey (NFHS-2) survey conducted in 1998-99 among the individuals gender wise aged above 15 years and found that the consumption of tobacco use in Mizoram is very high compared with other states of the North East. According to the reports available it was seen that the prevalence of tobacco use among the male population was very high than female population. However it was found that about 67.1% of them were smokers and 60.3% chewed tobacco. Next to Mizoram, the state of Nagaland and Meghalaya also showed high rate of tobacco consumption. Here also we can see a vast difference in the use of tobacco between the male and female group. The male users rates are very high than the female users in Meghalaya. Almost 57.6% of the cases in Meghalaya are male smokers while 16.7% chew tobacco.

However, in comparison to Mizoram and Meghalaya, the state of Assam shows less use of tobacco. According to the data available it was found that about 34.9% of the male population smoke tobacco while a high rate of 48.2% chew tobacco. But still, the figures are very high compared to the national figures.

Survey on female population showed that there is less use of tobacco consumption among women than men. It is also observed that even the female group in Mizoram ranks high than other states of the country. About 22.1% of the female smoke tobacco and an equal rate to male population i.e. 60.7% chew tobacco. In Meghalaya the prevalence of women smokers was 6.8% and a high rate of 27.6% chewed tobacco. Nagaland also showed high percentage of tobacco consumption in both male and female group- smokers (49.5-2.5)% and chewers(45.3-16.5)%.

7 In summary, it was found that there is heavy use of tobacco in the North Eastern states. Also the rate of tobacco chewers in Assam is more than smokers showing greater risk for developing oesophagal cancer.

The NFHS 2 (1998-99), revealed that the percentage of tobacco consumption was higher in case of illiterates than educated individuals. Similarly, the percentage of tobacco users was twice as high in case of individuals whose standard of living was low than whose standard of living was high.

A survey done between 2000-2004 (Global Youth Tobacco Survey) supported by WHO in 26 major states of the country reveled that in NE states tobacco users who first used tobacco before the age of 10 years were more than 65% except in Mizoram where it was 24%. The study also revealed that those states having higher levels of curricular teaching have a low prevalence of tobacco use by students. A recent study in the children in the age group of 11-13 years have shown that exposure to tobacco is as high as 60% in the state of Nagaland.

Preventive Oncology department in Dr. B. Borooah Cancer Institute to mitigate this tobacco related problems started a ‘Health education Programme on Cancer and Tobacco’ since 2003 where the students of schools and colleges of Guwahati are being educated and made aware of harmful effects of tobacco on health as a whole. Similar activities have been conducted in the state of Meghalaya, Nagaland and Arunachal Pradesh.

In addition cancer screening camps and public awareness on tobacco related cancer for community are being organized from time to time. Regular awareness for female population on common cancer of females are being conducted in rural and urban areas. a ‘Tobacco Cessation Clinic’ has been started with support from World Health Organization and Government of India where the people who want to quit tobacco are counseled and motivated. The Clinic has been set up under Department of Preventive Oncology.

8 The aims and objectives of tobacco cessation clinic is to i. Help people to quit tobacco ii. Forming anti tobacco network iii. Awareness in rural and urban areas iv. Setting up satellite clinic

TOBACCO CESSATION CLINIC, GUWAHATI- AN OVERVIEW REPORT

TCC GUWAHATI- INAUGURATION - APRIL 20 TH , 2005

9 The Tobacco Cessation Clinic at Dr. B. Borooah Cancer Institute, Guwahati was formally inaugurated by the Chief Secretary to the Govt. of Assam, Sri S. Kabilan on 20th April ,2005.In delivering his speech, he expressed his concern over the high rate of tobacco consumption in the region and he also thanked Dr. B. Borooah Cancer Institute for taking the initiative to address this issue. On this occasion Sri. B. Dutta, Commissioner, Health & Family Welfare, Govt. of Assam focused on the huge impact of financial burden that is involved in the treatment of cancer patients especially for the common man which is very expensive. The Director of the Institute, Dr. A. C. Kataki dwelt on the measures taken by the Institute to curb the tobacco problems. He also stated that since 2003 the Institute has started a Health Education Programme on Cancer with special emphasis on the harmful effects of tobacco for School & College students in the NE states.

TCC – TRAINING PROGRAMME - MARCH 15 TH -18 TH ,2005 Everyone knows the harmful effects of tobacco, Yet it is difficult to give up……. But experience has shown that there are many effective ways & measures for tobacco control and that it can be used in different settings. It can have a significant impact on tobacco consumption. In order to have a wide impact on tobacco control , it is needed to study the psycho-social factors of tobacco use.

Over the past two years there has been a positive response from the 12 TCCs and having shown remarkable services, the Govt. of India with support from WHO in the year 2004 took the initiative of setting up of 5 more new centres at Guwahati, Mizoram, Hyderabad, Kolkata & Trivandrum. A 4-day training programme was arranged for this at NIMHANS, Bangalore from March 15-18, 2005. The training programme was formally inaugurated by the Director Vice-Chancellor of NIMHANS, Bangalore, Dr. D. Nagaraja in the presence of the Officials of WHO and the Professors of the Dept. of Psychiatry, NIMHANS. The training began with the introduction & overview of the running of TCC .The training focused on various cancer related topics such as Epidemiology of tobacco use, Legal Aspects of Tobacco Control in India, Promotion of Anti-tobacco Messages & Campaigns, Physical Effects of Tobacco Use, Pharmacotherapy, Counselling for the patient, use of TCC software and more… A field visit was also

10 arranged for the participants. Experiences were shared by some of the experts from other TCCs and NGOs.

31st May, 2005- WORLD NO TOBACCO DAY On the occasion of “World No Tobacco Day”, a day long programme was organized under the aegis of Dr. B. Borooah Cancer Institute. The day long programme started with an Awareness Programme for the destitute children of Snehalaya run by Don Bosco Trust followed by a street play at the Institute which was directed by Prof. Sitanath Lahkar of Cotton College, Guwahati. The second phase of the programme was held at Pandu College. Chief Guest Padmashree Hem Bharali & other distinguished guests were present on this occasion. A general meeting was organized for the staff and the students of Pandu College, Guwahati. On this occasion the Chief Dignitaries & other guests spoke on the harmful effects of tobacco. The programme at Pandu College, Guwahati was a significant one because on this day the Students and the Professors of the College took an oath declaring their college to be a “Tobacco- Free Zone.” T

The third part of the day long programme was held at the Governor’s House. We had earlier organized an essay & poster competition for the students on the theme “Tobacco & Health”. On this day the awardees were given cash prizes & certificates by the Governor of Assam Lt. Gen. (Retd) Ajai Singh at Raj Bhawan.

Another programme on tobacco awareness was held for the officials of Assam Police. An audio-video presentation on the harmful effects of tobacco was shown to them. The day-long programme came to an end with a street play and a video presentation on the ill effects of tobacco at Hub Shopping Mall, Guwahati.

7TH NOVEMBER- NATIONAL CANCER AWARENESS DAY On the occasion of National Cancer Awareness Day, TCC Guwahati, took the lead role to celebrate the day with the support from various organizations. A Mock Demonstration and a Street Play was organized with the help of NGO’s in the Institute. The same programme was also conducted at Arya Vidyapith College and Pandu College, Guwahati. A general meeting was organized in the Institute. Prof. Sampat Kumar, Secy. General, International Society for Human Values, Switzerland was also present on this

11 occasion. Earlier we had organized an Essay & Slogan Writing competition for the students of Guwahati on the topic “Tobacco & Youth” and “Smoking to Death”. An open meeting was also held at Pandu College on the problems of tobacco related Cancer in India. Another programme was also organized by the Lions Club of Guwahati. On 14th November 2005 , in connection with the National Cancer Awareness Day , the Students were awarded Cash prizes & Certificates by the Guest of Honour Dr. Bhumidhar Barman, Health Minister, Govt. of Assam .

HOW WE DEAL WITH THE SUBJECTS COME TO THE CLINIC

12 The TCC Guwahati was set up in the year 2004-05 with support from World Health Organization &Government of India. The basic aim of the clinic is to form an anti- tobacco network and help those tobacco consumers who are in need.

At the very onset we would like to congratulate those subjects who visited with an honest motive to overcome their tobacco habits. The first step they have taken on the way to quit tobacco is sincerely admired by the TCC, Guwahati. Since its inception we have noticed that subjects from the entire North Eastern region come to the clinic with great enthusiasm. They show their humble respect and strongest belief to the clinic. The subjects who come to the clinic with their tobacco problems without getting a reliable solution are treated with a very strong positive response. Their problems are thoroughly discussed with them and the utmost care is taken to help them to quit the habit of tobacco consumption.

We make them feel comfortable with us with an easy and relaxed manner. They are treated in such a homely fashion that they can express their problems, their inner feelings with a very frank and clear voice. We let them have a feeling that confidentiality would be maintained on the problems they are going to share with us. We let them speak under what circumstances they have come to the clinic. The circumstances vary with different subjects. Some of them say that, they learn about the clinic from some reliable sources like paper advertisements and express their eagerness to know the suggestions on the way to get rid of the habit of tobacco consumption. They also believe that their economic status and familial bond to be one of the factors which led them to us. Their habit of tobacco consumption has created lots of disturbances in their economic life and hampered their family life for which they are neglected in their family. They express their grief that in spite of knowing these negative effects, they are still continuing with the deadly habit. Some of them express their great concern on the health related issues which are due to tobacco consumption. The preventive measures of those diseases which are due to consumption of tobacco are also thoroughly discussed to make them understand and aware of the harmful effects of tobacco. The colored and designed pamphlets with the cursed pictures of oral cancer of those patients which are due to tobacco consumption are distributed among the subjects coming to the clinic. Also the handbills containing the warning signals of the diseases and the address of the clinic are distributed among the subjects.

13 Respecting to their problems they have discussed with us is very strongly taken care of. We try to give them necessary solution to the problems they are facing. We keep their record in detail including the address and the phone numbers of the subjects. We suggest them to maintain a regular diary in which their details of tobacco consumption should be mentioned. They are also suggested to fix a quit date in the diary and to decrease the rate of tobacco consumption to reach the quit date. It is also suggested that if the quit date is a very special one like the subjects birth date or on some other occasions would be much more helpful on the way to get rid of the problem. The subjects are followed up in detail either by their presence in the clinic or through phone calls. Sometimes it is also observed that, if incase the subject is not able to come for a follow -up their relatives come to the clinic with the progress report or the difficulties faced by the subject on the way to quit tobacco. Despite our regular effort to stay in touch with the subjects by phone calls, some subjects never turn back for a second visit. These subjects are considered to be lost to follow- up. Now coming to the clinical aspects of the tobacco related problem, two types of therapies are administered with the subjects. One is Behavioral therapy (BT) and the other one is Behavioral therapy with the Nicotine Replacement therapy (BT+ NRT). At the very first approach the behavioral therapy is preferred with lots of tips and suggestions. The tips are discussed thoroughly with the subjects. Under some of the really working tips, we suggest them to count from 100 backwards slowly. By the time they reach to 1, the urge might have gone down. We also tell them to light incense sticks or perfumed candles. They are also suggested to do some work in their kitchen garden to avoid the urge. If someone is interested in music, they are suggested to play on some of their favorite instruments. If their urge is becoming more and more, they are advised to call a friend who has already quitted or trying to quit. They can also have a round with a non- smoker friend. They are also suggested to hide their ashtray or throw out their match box and lighters. We try to give them the feeling that these tips are really working. In this way the will power of the subjects can be judged by themselves or by us. In the long run of the TCC, it is observed that a number of subjects prefer BT and the success rate is almost 50% of the total success rate. On the other hand, if the NRT is administered the technique to chew the gum is discussed in detail. We make the subjects understand about both the therapies and it is their decision to choose the right therapy they need. We

14 discuss in detail about the therapies but never force them to choose. They are free to pick up the right therapy they need.

TOBACCO CESSATION CLINIC - OUR EXPERIENCE

15 Tobacco consumption in the entire North East Region including the state of Assam is the major problem which really need a solution with a effective and sincere thought. People of almost all age group are continuing with this deadly habit for decades. It is observed that the teenagers especially the school and college going students are influenced with the habit of tobacco consumption.

We, from TCC (Guwahati) have been conducting series of awareness programmes at different colleges and schools within and outside the city of Guwahati. Even though our target group is the school and college going students but at the same time we also catch hold of different individuals from different offices and organizations basically which include the Bank sector and NGO’s. From such awareness camps we came to know the different smoking and smokeless habits of the target group. In schools and colleges not only the males but also the females are fond of chewing tobacco like Gutkha.

It is also observed in a very common way that the management of few schools and institute are not taking any step for the prohibition of tobacco consumption in their own premises which really influence the students to take up the habit of tobacco consumption.

It is also worth mentioning that the TCC (Guwahati) succeeded in setting up a tobacco free college in the city area which is declared ‘No Tobacco Zone’ where consumption of tobacco in any from is prohibited.

Here are a few factors which lead all the way a student to the habit of tobacco consumption. The common questions that comes up after awareness programme on tobacco….

1. There is no such Government actions to impose ban on different tobacco companies. As it is easily available in the market they fail to realize the harmful effects of tobacco consumption. 2. There should be some sort of law and order situation which prohibits smoking in public places.

16 3. The students also enquire about the harmful effects of alcohol consumption because they feel that a smoker is influenced to smoke because of the habit of alcohol consumption. 4. They also feel that by consuming tobacco in any form keeps them away from any kind of mental anxiety, stress etc.

5. They also think that along with such type awareness camp, it is the duty of different students organizations to burn out all the tobacco products sold in pan-shops.

17 COMMUNITY ACTIVITY

1. Conducted tobacco awareness campaign amongst general people of Beltola, Guwahati on January, 2005 being organized by SBI Lady’s Club

2. Conducted tobacco awareness campaign amongst school students of Maria’s Public School, Betkuchi, Guwahati

3. Conducted tobacco awareness campaign amongst general people of Nazria, Sibsagar district of Assam.

4. Helped an NGO with IEC materials to conduct tobacco awareness campaign in Tinsukia district of Assam.

5. Helped an NGO with IEC materials to conduct tobacco awareness campaign in Kohima, Nagaland.

6. Approached other school and colleges for conducting tobacco awareness campaign

7. The Clinic activity of TCC also started

8. The indoor patients were taken Sankardev Kalashetra by the staff of TCC on the occasion of World health day – 7th April, 05.

9. A tobacco awareness campaign was done amongst the senior students of Happy Child School, Guwahati on 12.04.2005.

10. Regular TV shows showing awareness programme on tobacco are shown to the patients and their attendants visiting the OPD clinic.

11. The TCC was formally inaugurated by the Chief Secretary of Govt. of Assam Sri S. Kabilan, IAS on 20.04.2005. at 11.00 AM. Also present was the Commissioner & Secretary, Health & Family Welfare, Govt. of Assam, Sri Biren Dutta, IAS. During the inaugural function people from other streams were also present. The inaugural function was covered by Guwahati Doordarsan, Local Cable channels – NE TV and Prag TV. There was extensive coverage in English national and local daily and in Assamese local daily.

12. The staff of TCC took the indoor patients to Neheru park on 25.04.2005.

13. A lecture on anti-tobacco was delivered by TCC staff in an awareness camp in Tetelia, Sonapur (60 kms from Guwahati) on 30.04.2005.

14. A lecture on anti-tobacco was delivered by TCC staff in an awareness camp in Maloibari, Sonapur (60 kms from Guwahati) on 30.04.2005.

15. A programme on the activities of TCC, Guwahati was shown in Rashtriya Sahara news channel on 05.5.2005.

18 16. The indoor patients were taken Sankardev Kalashetra by the staff of TCC on 07.05.2005. accompanied by the Director of the Institute.

17. Dr. R.J.Das took part in ‘Hello Kalyani’ programme on ill effects of tobacco telecasted live by Guwahati Doordarshan

18. Dr. Joydeep Das, delivered a talk on tobacco and its harmful effects amongst the students and staff of Handique College on 11.5.2005.

19. Dr. Joydeep Das participated in Live phone in programme on tobacco and activities of TCC on 15.05.2005. aired by Prasar Bharati (All India Radio).

20. Dr. B. K. Das delivered a talk on tobacco and its harmful effects amongst the students and staff of TC School on 21.05.2005.

21. The staff of TCC took the indoor patients to Guwahati Planetarium on 21.05.2005.

22. Mr. Arup Jyoti Kalita participated in a 2 day workshop conducted by Assam Science Society and Kasturba Gandhi Memorial Trust and delivered a talk on tobacco problems and activities of TCC on 24.05.2005.

23. Tobacco and cancer awareness programme conducted in Tawang, Nygmadoung and Dirang in Arunachal Pradesh (500 Kms from Guwahati) from 05.06.2005. to 08.06.2005. by Dr. J. Das.

24. The staff of TCC took the indoor patients to Guwahati Science Museum on 11.06.2005.

25. Dr. J. Das delivered a lecture on harmful effects of tobacco on 25.06.2005. at HDFC Bank, Guwahati.

26. The indoor patients were taken Sankardev Kalashetra by the staff of TCC on 25.06.2005.

27. The staff of TCC took part in a cancer awareness and detection clinic at Amranga, Mirza, (60 kms from Guwahati) on 02.07.2005. They counseled the patients on anti tobacco measures.

28. Tobacco awareness programme at SOS Children Village, Borjhar, on 13.07.2005.

29. Tobacco awareness programme at SOS Children Village, Borjhar, on 20.07.2005.

30. Tobacco awareness programme at Snehalaya, Dhirenpara on 21.07.2005.

31. Tobacco awareness programme at SBI Zonal Head Office, Guwahati on 23.07.2005.

19 32. The NSS volunteers of Pandu College were trained on 05.08.05. for setting up a Tobacco Cessation Clinic in their campus. The Clinic in the college will function twice a week.

33. Tobacco awareness programme at Kamrup Academy, Guwahati Club on 10.08.2005.

34. Tobacco and Cancer awareness programme at Step by Step School, Hengrabari on 17.08.2005.

35. Tobacco and Cancer awareness programme at Kaliram Baruah School, Bharalamukh on 18.08.2005.

36. Tobacco and Cancer awareness programme at Swadeshi Academy on 29.08.2005.

37. Tobacco and Cancer awareness programme at Aryabhatta College on 07.09.05./13.09.05./14.09.05. Awareness prog. at DC’s Court on 18.10.05. Dispur Law College on 19.10.05

38. Awareness programme at Faculty School on 29.10.05.

39. Visit To Pandu College (Satellite Clinic) to review and to arrange TCC prog.

40. Awareness programme on Tobacco and cancer on 05.11.05.arranged with help of NGO Pubali Sangha

41. Radio talk by Dr. A. C. Kataki aired on 05.11.05.

42. Radio talk by Dr. Joydeep Das aired on 05.11.05.

43. Street play and Mock demonstration on harmful effects of tobacco on 07.11.05. at Dr. B. B. Cancer Hospital.

44. Street play on harmful effects of tobacco on 07.11.05. at Pandu College, Guwahati

45. Street play on harmful effects of tobacco on 07.11.05. at Pandu College, Guwahati

46. Talk on cancer awareness on 07.11.05. at Lions Club by Dr. J. Das

47. Awareness programme at Faculty School on 10.11.2005. & 11.11.05.

48. Mock demonstration on harmful effects of tobacco on 12.11.05. from Beltola area to Dispur.

49. Training of NGO for opening of Satellite Clinic at Nalbari from 15.11.05. to 17.11.05.

50. Mock demonstration on harmful effects of tobacco on 21.11.05. from Maligaon area to Adabari bus terminus

20 51. Tobacco awareness programme with Assam Institute of Management in Faculty School, Guwahati on 29.11.05.

52. Anti-tobacco campaign within the hospital campus

53. 3 days - Tobacco awareness programme and exhibition in K.C.Das Commerce College from 17.12.05. – 19.11.05.

54. Tobacco awareness programme at India Club of Guwahati on 15.12.05.

55. Tobacco awareness programme at Rotary Club of Guwahati on 17.12.05.

56. Tobacco awareness programme in Maharshi Vidya Mandir School on 24.12.05

57. Tobacco awareness programme at Sawalkuchi on 24.12.05.

58. Tobacco awareness programme at KC Das Commerce College on 18.01.2006.

59. Tobacco awareness programme at Bonda on 24.01.2006.

60. Cancers awareness and screening camp at Damunichaki, on 28.01.06

61. Cancer Awareness Day and Cancer Survivors Day, 04.02.06.

62. An exhibition was organized at the Institute on the occasion of Cancer Awareness Day and Cancer Survivors Day, 04.02.06. The exhibition was viewed by many guest and attendants of the patients.

63. Visit to Don Bosco Institute on 02.02.06. and 07.02.06 –for discussion and awareness programme. Trained the few volunteers of Institute.

64. Cancers awareness and screening camp at Hajo on 11.02.06.

65. Visit to SBOA Public School, DPS, MVM, Gurukul, Betkuchi for Tobacco Awareness Programme on 20.02.2006.

66. Tobacco awareness programme at Maharshi Vidya Mandir, Lokhra, 27.02.2006.

67. Tobacco awareness programme at Azara on 28.03.06.

68. Tobacco awareness programme at Don Bosco Institute, Kharguli on 11.04.06. and 12.04.06.

69. Tobacco awareness programme at Kendriya Vidyalaya, Narengi on 17.04.06. and 18.04.06.

70. Tobacco awareness programme at Kendriya Vidyalaya, Maligaon on 24.04.06. and 25.04.06.

21 WORLD NO TOBACCO DAY - 31ST MAY 2005

PROGRAMME

1. Essay competition for school students of Std. VIII to Std. X on theme ‘Tobacco and Health’, handwritten within 1000 words in A4 paper countersigned by Principal of the school. Last date of submission – 25.05.2005. 2. Poster / Painting competition for school students of Std. VIII to Std. X on theme ‘Tobacco and Health’, in plain paper countersigned by Principal of the school. Last date of submission – 25.05.2005. 31.05.2005. 3. 9.00 AM – Awareness programme amongst destitute children of Snehalaya – street play at BBCI directed by Prof. Sitanath Lahkar, Cotton College, Guwahati 4. 11.00 AM – General meeting at Pandu College Speech by – Dr. A. C. Kataki, Director, BBCI Talk on Tobacco Problem – Dr. Joydeep Das, I/C, Dept. of Prev. Onco., BBCI Speech by Chief Guest – Padmashree Smt. Hem Bharali, Speech by Distinguished Guest – Smt. Damyanti Devi, Katurba Gandhi Trust Speech by Distinguished Guest – Mr. Monoram Gogoi, Noted Journalist Declaration of ‘Tobacco Free area’ by Chief Guest and general oath taking by Staff and students of the college, Vote of thanks by Principal Pandu College, Street play and light refreshment 5. 12.30 PM – All the awardees of essay and poster competition was awarded prize and certificates by Hon’ble Governor of Assam at Raj Bhavan in presence of Director, BBCI 6. 3.00 PM – Tobacco awareness programme amongst Police officials of Assam Police at Police Reserve, AT Road, Guwahati. 7. 5.00 PM - Tobacco Awareness programme and street play in HUB – commercial complex 8. 6.00 PM – Awareness meeting at Maligaon attended by Director, BBCI  Distribution of tobacco awareness leaflets in Residential flats.  Awareness programme on local TV channels, Doordarshan, Rashtriya Sahara, ETV and Channel-7  Articles in print media

22 PERFORMANCE OF TCC

AGE GROUP OF SUBJECTS AGE GROUP NUMBER < 20 15 21-30 69 31-40 65 41-50 52 51-60 13 >60 8

NUMBER OF SUBJECTS BY AGE GROUP 80 69 70 65 60 52 S T

C 50 E J

B 40 U S

F 30 O

O 20 13

N 8 10 0 < 20 21-30 31-40 41-50 51-60 >60 AGE GROUP

COMMENTS: Maximum subjects were in the age group of 21 – 30, 31 – 40 and 41 – 50 years of age group

23 EDUCATIONAL STATUS EDUCATION MUMBER PRIMARY 5 MIDDLE 23 SR. SECONDARY 48 GRADUATE 122 POST GRADUATE 24

EDUCATIONAL STATUS OF SUBJECTS

140 122 S

T 120 C

E 100 J

B 80 U S 60 48 F O

40 . 23 24 O 20 5 N 0

EDUCATION STATUS

COMMENTS: Majority of the subjects reporting to TCC were graduate

24 EMPLOYMENT STATUS PROFESSIONAL AND SEMI PROFESSIONAL 151 SKILLED, SEMI-SKILLED, UNSKILLED 40 RETIRED 10 STUDENTS 17 OTHERS 4

EMPLOYMENT STATUS OF SUBJECTS

160 151 S

T 140 C

E 120 J

B 100 U

F 60 O

O 40 17 N 20 1 10 4 - L L I S

0 D S A A M T E D R N N I , E N R E E I O O M S D E I I L

H T , E E L S S D I T E L S D S S

U K L R O E I E E T S D L F F K S N N L I S O O A U K R R S P P EMPLOYEMENT

COMMENTS: Majority of the subjects reporting to TCC were professional and semi-professionals

25 EXPENSES ON TOBACCO PER MONTH RUPEES NOS. < 200 85 201-400 50 401-600 37 601-800 15 801-1000 18 >1000 17

EXPENSES ON TOBACCO

S 70 T C

E 60 J 50 B 50 U S

F 40 O

. 30 O 18 N 17 20 15 10 0 < 200 201-400 401-600 601-800 801-1000 >1000 EXPENSES IN Rs.

COMMENTS: Maximum of the subjects reporting to TCC spent less than Rs.200 pm on tobacco and 17 subjects spent more than Rs.1000 pm on tobacco.

26 TOBACCO USE SMOKING 90 SMOKELESS 53 BOTH 79

TOBACCO USE

36% 40%

SMOKING SMOKELESS BOTH

COMMENTS: Out of 222 subjects who reported to TCC, 40% were smokers, 24% used smokeless tobacco and 36% used both.

27 TYPE OF SMOKING CIGARETTE 138 BIDI 31

TYPE OF SMOKING

CIGARETTE BIDI

COMMENTS: Out of 169 subjects who were smoking, majority were cigarette smokers.

28 MODE OF INTERVENTION BT 91 BT + NRT 131

MODE OF INTERVENTION

BT BT + NRT

COMMENTS: Out of 222 subjects seen in TCC, 59% received both behavioral therapy and Nicotine replacement therapy in the form of gums and only 41% received behavioral therapy.

29 OUTCOME OF INTERVENTION NO CHANGE 47 SUSTAINED TOTAL ABSTINENCE 33 PARTIAL ABSTINENCE 112 RESUMED 15 LOST TO FOLLOW UP 15

OUTCOME OF INTERVENTION

7% 7% 21%

15% 50%

NO CHANGE SUSTAINED TOTAL ABSTINENCE PARTIAL ABSTINENCE RESUMED LOST TO FOLLOW UP

COMMENTS: Out of 222 subjects seen in TCC, in 50% subjects the outcome was partial abstinence. No change was seen in 21% subjects and 7% subjects were lost to follow up.

30 OUTCOME OF INTERVENTION WITH BT NO CHANGE 24 SUSTAINED TOTAL ABSTINENCE 20 PARTIAL ABSTINENCE 38 RESUMED 6 LOST TO FOLLOW UP 3

OUTCOME OF INTERVENTION WITH BT 3% 7% 26%

42% 22%

COMMENTS: Out of 91 subjects who were given only behavioral therapy, in 42% there was partial abstinence, in 26% there was no change and in 22% there was sustained total abstinence.

31 OUTCOME OF INTERVENTION WITH BT + NRT NO CHANGE 23 SUSTAINED TOTAL ABSTINENCE 13 PARTIAL ABSTINENCE 74 RESUMED 9 LOST TO FOLLOW UP 12

OUTCOME OF INTERVENTION WITH BT + NRT 7% 9% 18% 10%

COMMENTS: Out of 131 subjects who were administered behavioral therapy with Nicotine Replacement therapy, it was observed that in majority of cases there was partial abstinence. Sustained total abstinence was seen on only 10% subjects.