Sharad Pawar Dental College and Hospital Sawangi (Meghe), Wardha Datta Meghe institute of Medical Sciences (DU), Nagpur “EVALUATION OF THE EFFECTIVENESS AND IMPACT OF TOBACCO DE-ADDICTION TOOL IN THE CONTEXT OF PRESENT ANTI-TOBACCO CAMPAIGNS” Thesis submitted for the degree of Doctor of Philosophy (Oral Medicine & Radiology) Faculty of Dentistry By Dr. Stuti Sharad Bhargava Research Supervisor Dr. Rahul R. Bhowate Professor & HOD, Department of Oral Medicine & Radiology Department of Oral Medicine & Radiology Sharad Pawar Dental College and Hospital Sawangi (Meghe), Wardha 2017 Declaration by the Candidate I hereby declare that the thesis entitled “Evaluation of the effectiveness and impact of tobacco de-addiction tool in the context of present anti tobacco campaigns” is a bonafide and genuine research work carried out by me under the guidance of Professor and Head, Department of Oral Medicine and Radiology , Dr. Rahul R. Bhowate. I hereby solemnly affirm that the contents of this thesis have not been submitted earlier in candidature for any degree elsewhere. The university is permitted to have its legal rights for its subsequent uses. Date: Place: Sawangi (Meghe), Wardha Dr. Stuti S. Bhargava, Ph.D. Scholar, Department of Oral Medicine and Radiology Sharad Pawar Dental College and Hospital Sawangi (Meghe),Wardha Department Of Oral Medicine & Radiology Sharad Pawar Dental College and Hospital Sawangi (Meghe), Wardha Certificate This is to certify that the work embodied in the thesis for the degree of Doctor of Philosophy (in Oral Medicine and Radiology) of Datta Meghe Institute of Medical Sciences (Deemed University), Nagpur, entitled “Evaluation of the effectiveness and impact of tobacco de-addiction tool in the context of present anti tobacco campaigns” , was undertaken by Dr. Stuti Sharad Bhargava and was carried out in the department of , Oral Medicine and Radiology , VSPM DCRC Nagpur , under my guidance and direct supervision to my satisfaction. This thesis fulfils the basic ordinance governing the submission of thesis laid down by Datta Meghe Institute of Medical Sciences University. Nagpur. Date: Place: Sawangi (Meghe), Wardha Dr. Rahul R. Bhowate, Professor and Head, Department of Oral Medicine & Radiology Sharad Pawar Dental College and Hospital Sawangi (Meghe), Wardha. Sharad Pawar Dental College and Hospital Sawangi (Meghe), Wardha Datta Meghe institute of Medical Sciences (DU), Nagpur This is to certify that the work entitled “Evaluation of the effectiveness and impact of tobacco de-addiction tool in the context of present anti tobacco campaigns”, for the degree of Doctor of Philosophy (Oral Medicine and Radiology) of Datta Meghe Institute of Medical Sciences (Deemed University), Nagpur, 2015-2017 is undertaken by Dr.Stuti Bhargava , Assistant Professor , OMR, VSPM DCRC . We have great pleasure in forwarding this thesis to Datta Meghe Institute of Medical Sciences (Deemed University), Nagpur. Date: Dr. Rahul R. Bhowate, Dr. A.J. Pakhan Professor and Head, Dean, Dept of Oral Medicine & Radiology SPDC Wardha Sharad Pawar Dental College and Hospital Sawangi (Meghe), Wardha Acknowledgements In the name of God, Most Gracious, Most Merciful It gives me immense pleasure to express my sincere thanks and deep sense of gratitude to my honorable guide and supervisor, Dr. Rahul R. Bhowate, Professor and Head, Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital Sawangi (Meghe), Wardha. His constant liberal support, encouragement, critical appraisal , unlimited patience and vast wisdom have all been a profound source of inspiration in realization of this endeavor. I’m thankful to him for instilling in me the qualities of a good researcher. He has been a source of knowledge and for learning innumerable new things in the realm of my fraternity. I will always remain indebted to him. Though not in any lesser measure, I am indebted to Dr. Minal Chaudhary, Professor, Department of Oral Pathology, Dean Examination Cell and Chairman PhD Cell and Dr. A. J. Pakhan, Dean SPDC for their valuable ideas and advice. Their continuous encouragement has contributed to a great extent in the completion of this task. I am also grateful to Dr. Usha Radke, Dean and Dr. S.R Shenoi, Vice Dean, and Dr. Mukta B. Motwani, Professor and HOD, OMR; VSPM DCRC for supporting me throughout the duration of my PhD work and encouraging my work. A special thanks to Dr.Dhananjay Raje PhD, Charted statistician for extending his valuable support in analyzing the results of this study and Dr. Sushil Naik , Lecturer Prosthodontics VSPM DCRC for his help with the translations. At the risk of sounding more of a fan than a pupil; I am very grateful for the immensely useful discussions with Dr.Ved Prakash Mishra sir, Chief Advisor DMIMS DU. Sir truly embodies Author Conan Doyle’s fabled “Art of Deduction” His analysis and troubleshooting have been awe inspiring and every interaction with him has been a very informative learning session. I hope to to have more learning opportunities with sir. Speaking of awe inspiring appreciation, I will also like to put in my words of admiration for Dr. Minal Chaudhary, Dr. Mukta Motwani and Dr. USha Radke madam. In times when women with voices may still be considered as vices, the three of them lead by example in living a balanced life; perfectly handling all personal and professional responsibilities. I am fortunate to belong to a profession which is so accommodative of women’s progress and I hope to follow the footsteps of my peers and inspirational seniors and make a meaningful contribution to the world around me. I am also thankful to Dr. S. Digwekar , Dr. Lohe , Dr. Dangore , Dr.Panchbhai , Dr.Mhod , Dept of OMR , SPDC ;Dr.Karemore , Dr.Chaudhary , Dr.Golhar and Dr. Mohite , Department of OMR VSPM DCRC , Dr. Langekar Dr.Kulkarni , Dr.Chandak SKDS DCH for their cooperation and support during the course of this project. My sincere gratitude to all well-wishers and participants in this project , who all are too many to name but I sincerely acknowledge their cooperation, support and time given to this project. My special thanks to my extended family and friends for their love, affection, consistent encouragement and blessings in countless ways. Words cease to be the medium to extend my profound sense of gratitude to my parents who are the wind beneath my wings. They have stood by me through thick and thin and everything in between with their unconditional love, affection and allowed me not just to dream but also to fulfill my dreams. Being blessed with limited means and seemingly more challenges; my parents instilled in me the jest to keep on growing as a person and a professional under all circumstances. They have blessed me with two most important gifts; that of higher education which I believe is an equally important privilege and asset in today’s times and the ability to differentiate between right and wrong which is the core of the humane existence I dedicate this enterprise to them for being the pillar of strength for all my endeavors. Most importantly, I would forever be grateful to the almighty God without whose abundant blessings, this accomplishment would have been just an ideal dream. I humbly pay my utmost reverence to all those who have directly or indirectly helped me in my study and through a very crucial period of my life. Dr. Stuti Bhargava Index Sr. TITLE PAGE No. NO. A. ABBREVIATIONS 1. INTRODUCTION 1 2. AIMS & OBJECTIVES 8 3. HYPOTHESIS 9 SECTION I : 4. KNOWLEDGE, ATTITUDE & PRACTICES OF TOBACCO 11 USERS & EFFECT OF ANTI-TOBACCO MEASURES 4.1 REVIEW OF LITERATURE a. Tobacco Use in India b. Anti Tobacco Measures :FCTC measures c. Tobacco Cessation Measures in India d. Ban on tobacco use in public e. Health warning labels f. Tobacco advertising, Promotion & Sponsorship g. Mass Media Intervention h. Price and Taxation i. Understanding the socio demographic co relates of tobacco use 4.2 MATERIAL AND METHODS 49 4.3 RESULTS 57 4.4 DISSCUSION 130 4.5 CONCLUSION 153 SR TITLE PAGE NO. NO. SECTION II: 169 TOBACCO CESSATION COUNSELLING 5. 5.1 REVIEW OF LITERATURE a. Interventions promoting tobacco cessation b. Role of Dentists in tobacco cessation counselling c. Assisting the tobacco users to quit 5.2 MATERIAL AND METHODS 189 5.3 RESULTS 196 5.4 DISSCUSION 217 5.5 CONCLUSION 235 6. SCOPE, LIMITATIONS & IMPLICATIONS 239 7. POSSIBLE CONTRIBUTIONS & TRANSLATORY 246 COMPONENT 8. REFERENCES 248 9. ANNEXURES i. Kuppuswamy’s Socio-Economic Status Scale 2014 i ii. Consent form ii iii. Interview Questionnaire iii iv. Intervention follow up record Sheet vi v. Tobacco Cessation Information Leaflet (Self –help) xi vi. Tobacco Cessation counselling Manual (i) 10. Master sheets 11. Publications Section - I List of Tables Sr. Title Page No. No. 1. Distribution of Age 75 2 a. Distribution of Gender 75 2 b. Distribution of participants according to gender in different age 75 groups 3a. Distribution of participants according to Educational 76 Qualification 3b. Distribution of Education Qualification according to Gender 76 4. Distribution of participants according to Occupation 76 5. Distribution of participants according to Income 77 6. Distribution of participants according to Accommodation 77 7. Distribution of participants according to Socioeconomic Status 77 8. Awareness of tobacco hazards during the initiation period 78 9. Awareness of different type of tobacco products & preparations 78 10. Awareness about tobacco hazards at the time of the interview 78 11. Awareness of health hazards from tobacco preparations