Low- level smoking among diabetes patients in India: a smoking cessation challenge

Abstract

Background: Little research in low and middle-income countries has been conducted on shifts in levels of smoking among those suffering from chronic diseases exposed to cessation messages. We present data on such shifts among diabetes patients participating in a randomized controlled cessation trial in Kerala state, India. The two-arm trial tested the relative effectiveness of diabetes specific cessation messages from doctors and the added value of motivational interviewing by trained cessation counsellors. Methods: Two hundred twenty-four smokers who participated in the trial were followed for 2 years. Intention to treat analysis documented changes in levels of smoking. We defined low-level smoking as 1-5 sticks per day, medium-level as 6-10 sticks, and high-level as more than 10 sticks. Twenty-three lowlevel smokers were interviewed about why they continued to smoke, and household response to their smoking. Results: At baseline, 32% of the 224 diabetes patients were low-level smokers, 24% medium-level and 44% high-level smokers. At year two 34% of the participants in the trial had quit smoking, 37% were low-level smokers, 16% medium-level smokers and 13% high-level smokers. Forty-nine percent of low-level smokers at baseline continued to smoke at low level. Fifty percent of mid-level and 45% of high-level smokers who did not quit shifted to low level smoking A majority of low-level smokers and their families perceived low-level smoking to be safe. Conclusions: Low level smoking among diabetes patients is common. Proactive and sustained cessation efforts are called for that are attentive to disease complications as teachable moments.

Effectiveness of intensive stand-alone smoking cessation interventions for individuals with diabetes: A systematic review and intervention component analysis

“…As outlined in Table 1 , significant differences in smoking cessation between the intervention and control group were only reported in the studies by Canga et al 35 and Thankappan et al 31 at follow-up at 6 months, and in the studies by Pérez-Tortosa et al 32 and Thankappan et al 25 at follow-up at 1 year. Conversely, the other study authors 22 , 24 , 30 , 33 , 34 , 36 - 38 did not report a significant improvement in the smoking cessation rate of the intervention group when compared to the control group; and although Ng et al 38 reported a significant decrease in the self-reported smoking prevalence in both groups at follow-up at 6 months, in these studies the smoking abstinence rate in both the intervention and control group was also deemed to be insignificant. Given these inconsistent findings, and taking into consideration the high level of heterogeneity amongst the interventions of the studies, a narrative component analysis was conducted.…”

“…Both Lam et al 28 and Thankappan et al 29 published the findings from the randomized control trials by Li et al 30 and Thankappan et al 31 , respectively, in conference proceedings. Furthermore, in the publications by Thankappan et al 25 and Nichter et al 24 , the authors followed up participants from the Thankappan et al 31 trial for a total of one and two years, respectively, without providing any additional interventions. Additionally, Mini et al 23 reported on the biochemical verification of a sample of non-smokers who participated in the Thankappan et al 31 trail at follow-up at 1 year, in their publication.…”

“…Given that all studies were judged to be of concern of risk-of-bias in at least one domain, the overall risk-of-bias of most studies was also judged to be of some concern. Conversely, the overall risk-of-bias of the reports by Ng et al 38 , Thankappan et al 25 , 31 and Nichter et al 24 was judged ‘high’, as these were found to be at high risk-of-bias in the measurement of the smoking cessation outcome, being based on self-reported data.…”

Effectiveness of Therapeutic Patient Education Interventions in Obesity and Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…There were 16 interventions which aimed to deliver TPE interventions using a personalized and individual approach [5,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. All these interventions were focused on lifestyle and disease education and self-management techniques for diabetes except for four interventions which were primarily aimed at smoking cessation among patients with diabetes [48,50], personalized diabetes risk assessments during ophthalmologic visits [58] and improving physical activity [60].…”

Effectiveness of Therapeutic Patient Education Interventions in Obesity and Diabetes: A Critical Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Individually delivered interventions: There were 16 interventions which aimed to deliver TPE interventions using a personalized and individual approach [5,[44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]. All these interventions were focused on lifestyle and disease education and self-management techniques for diabetes except four interventions which were primarily aimed for smoking cessation among patients with diabetes [46,48]; personalized diabetes risk assessments during ophthalmologic visits [56] and improving physical activity [58].…”