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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 46-48

Evaluation of transtheoretical model-based questionnaire for tobacco cessation counseling of Class IV workers in Dhule district: A randomized controlled trial


1 Postgraduate Student, Department of Public Health Dentistry, ACPM Dental College, Dhule, Maharashtra, India
2 Professor, Department of Public Health Dentistry, ACPM Dental College, Dhule, Maharashtra, India
3 Professor and HOD, Department of Public Health Dentistry, ACPM Dental College, Dhule, Maharashtra, India
4 Senior Lecturer, Department of Public Health Dentistry, ACPM Dental College, Dhule, Maharashtra, India

Date of Submission23-Jul-2020
Date of Acceptance04-Aug-2020
Date of Web Publication29-Sep-2020

Correspondence Address:
Dr. Mayuri Nepale
Room No. 702, Building. Spectra C, Casa Bella Gold, Palava City, Dombivali . East, Mumbai - 421 204, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_34_20

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  Abstract 


Background: Small number of tobacco users are fully aware of its harmful effects. Warning labels on tobacco products are an effective way of communicating the consequences of tobacco use and bring about behavioral changes such as quitting.
Aim: The study aims to test the validity and reliability of a transtheoretical model (TTM) based questionnaire for tobacco cessation in Class IV workers.
Methodology: A descriptive randomized control trial was carried out among 268 participants who were randomly selected from Class IV workers of Jawahar Soot Girni, Dhule. The participants were randomly divided by the block randomization technique into two groups equally as Group A and B, where Group A received verbal tobacco counseling and Group B received tobacco counseling in the form of pictorial warning. TTM model-based questionnaire was used as a method of measurement to evaluate the effect of pictorial warning interventions.
Results: In the study group, preresponse 64% said no, they did not felt unease due to the presence of health warning, 35.1% of participants said yes, they felt unease due to the presence of health warning and post response was 22.4% said no, they did not felt unease due to the presence of health warning, 77.6% said yes, they felt unease due to the presence of health warning. The comparison showed there is a significant difference in pre- and postscore (P < 0.05). The pictorial warning was found to be statistically significant as compared to verbal instructions only.
Conclusion: Warning labels on tobacco packs effectively inform people about the adverse health effects of tobacco when compared to oral instructions.

Keywords: Effectiveness, tobacco, transtheoretical model, warning labels


How to cite this article:
Nepale M, Vishwakarma PY, Dodamani AS, Jain VM, Mali GV, Saxena AS. Evaluation of transtheoretical model-based questionnaire for tobacco cessation counseling of Class IV workers in Dhule district: A randomized controlled trial. Int J Prev Clin Dent Res 2020;7:46-8

How to cite this URL:
Nepale M, Vishwakarma PY, Dodamani AS, Jain VM, Mali GV, Saxena AS. Evaluation of transtheoretical model-based questionnaire for tobacco cessation counseling of Class IV workers in Dhule district: A randomized controlled trial. Int J Prev Clin Dent Res [serial online] 2020 [cited 2020 Oct 20];7:46-8. Available from: https://www.ijpcdr.org/text.asp?2020/7/3/46/296542




  Introduction Top


Oral cancer is among the top three types of cancers in India.[1],[2] More than 90% of oral cancer cases report using tobacco products. Tobacco use was found to be more common among the uneducated masses in India. In India, the nonawareness of the health hazards of tobacco is strongly associated with its use.[3] The Framework Convention on Tobacco Control sets forth evidence-based strategies that, when implemented, help countries address the tobacco epidemic. Effective warnings should be large, clear, visible, and legible, and should utilize a set of rotating messages. Preferably, they should occupy the top part of the principal display areas (front and back of the packaging) and occupy 50% or more of those areas. For enhanced effectiveness, Article 11 recommends the use of pictures or pictograms to form pictorial warning labels (PWLs), preferably through utilizing graphic or shocking images. Transtheoretical model (TTM), also known as “stages of change,” was developed by Prochaska and DiClemente in 1982, the model was first applied to smoking behavior to validate the model. TTM consist of four components: Stage of change (precontemplation, contemplation, preparation, action, and maintenance), which explains an individual's thoughts and behaviors regarding how to change behavior.[4] Display of pictorial warnings on tobacco products was one of the legislative measures taken under The Cigarettes and Other Tobacco Products Act enacted in 2003. They make them aware that tobacco use can cause serious illnesses and can kill the user. Hence, the aim of the study was to gauge the perception of pictorial warning and effectiveness of pictorial warning-based intervention using TTM-based questionnaire.


  Methodology Top


Trial design and sample size: The present study was a randomized control trial conducted on Class IV workers at Jawahar Soot Girni, Dhule. The study was conducted according to the CONSORT guidelines (2010). It is a randomized, double-blind, parallel study conducted for 8 weeks among 268 participants who fulfilled the eligibility criteria. The sample size was calculated using the prevalence of quitters after seeing pictorial warnings from the previous study.[5] Class IV workers consuming tobacco in smokeless and smoke form working in Jawahar soot Girni and participants willing to participate in the present study were included in the study. Whereas participants who filled questionnaires incompletely, not willing to give their consent for the present study, those who were suffering from any systemic disease, on any medications/therapy for any other chronic disease, and those who had undergone any periodontal therapy in the past 6 months were excluded from the study. The participants were randomly divided by the block randomization technique into two groups equally as Groups A and B where Group A received verbal tobacco counseling and Group B received tobacco counseling in the form of pictorial warning. TTM-based questionnaire was used as a method of measurement to evaluate the effect of pictorial warning interventions. Pre- and postquestionnaire were answered by both groups. Follow-up was taken after 8 weeks. No dropouts have been observed during the present study. Written and oral informed consent were obtained from the patients before the start of the study. The patient information sheet and consent form were made available both in the English and Marathi (Local language) for easy comprehension regarding the details of the study. Before the start of the study, the examiner was trained and calibrated in the Department on 15 Class IV workers who were excluded from the main study. Data were statistically analyzed with unpaired t-test and paired t-test using Social Sciences (SPSS) version 21.0 software IBM, Armonk, NY, United States of America.


  Results Top


The mean pre score is 1.81, and the mean post score is 3.55. Comparison showed a significant difference between pre- and postscores (P ≤ 0.05). Shows that in the study group, in pre response 86.6% of participants said no, health warning on tobacco packets does not affect them to consider quit and 13.4% of participants said yes, health warning on tobacco packets affect them to consider quitting. In post response, 46.3% of participants said no, health warning on tobacco packets does not affect them to consider quit and 53.7% of participants said yes, health warning on tobacco packets affects them to consider quit. The comparison showed a significant difference between pre- and postscores (P ≤ 0.05). [Table 1] and [Table 2] all group variables were seen to be statistically significant when compared to control group variables. [Graph 1] shows Do you feel the unease due to the presence of health warning on tobacco packets in the study group.
Table 1: Group variables

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Table 2: Group variables

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  Discussion Top


The present study showed that there was no significant difference seen after verbal counseling to the question “tobacco is harmful” but a significant difference was seen after pictorial warning counseling. One possible explanation for this finding is that people from the lower socioeconomic group, i.e., Class IV workers in our study may have been previously unaware of the ill effects caused by tobacco usage. In the present study, there was no significant difference found after verbal counseling to the question “Do you feel unease due to the presence of health warning” but significant difference was seen after pictorial warning counseling. This might be attributed to the fact that Peterson et al.[6] showed that graphic warning labels generated higher levels of visual attention and were more likely to be accurately recalled than the traditional warning messages. In the present study, there was no significant difference found after verbal counseling to the question “did any health warning on tobacco packets affect you to the extent you are considering quitting?” but significant difference was seen after pictorial warning counseling. These findings are in accordance with a study conducted by Heydari et al.[7] who reported considerable proportions of smokers report that warning labels to increase their motivation to quit and help them to sustain abstinence after quitting. In the present study, there was no significant difference found after verbal counseling to the question “are you thinking to quit?” but a significant difference was seen after pictorial warning counseling. This is in accordance with the study conducted by a study which stated that 63.7% had sometimes thought to quit tobacco and 67.2% had sometimes advised others to quit the habit, which was similar to some studies.[8],[9] Maximum study participants had noticed tobacco warning labels which were in concordance with a study done by the Centers for Disease Control and Prevention.[10]


  Conclusion Top


It is noted from the results of the current study that graphic warning labels generate higher levels of visual attention, which increases motivation to quit and help tobacco users sustain abstinence after quitting. Hence, warning labels on tobacco packs effectively inform people about the adverse health effects of tobacco when compared to verbal instructions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. WHO Report on the Global Tobacco Epidemic 2013. Tobacco Free Initiative (TFI); 2013. Available from: http://www.who.int/tobacco/global_report/2013/en/. [Last accessed on 2020 Mar 20].  Back to cited text no. 1
    
2.
WHO Framework Convention on Tobacco Control. 2003. Available from: http://www.who.int/fctc/text_download/en/. [Last accessed on 2020 Mar 20].  Back to cited text no. 2
    
3.
Guidelines for Implementation of Article 11. Guidelines on Packaging and Labelling of Tobacco Products. WHO. 2008. Available from: http://www.who.int/fctc/guidelines/adopted/article_11/en/. [Last accessed on 2020 Mar 20].  Back to cited text no. 3
    
4.
Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol 1992;47:1102-14.  Back to cited text no. 4
    
5.
Brewer NT, Hall MG, Noar SM, Parada H, Stein-Seroussi A, Bach LE, et al. Effect of pictorial cigarette pack warnings on changes in smoking behavior: A randomized clinical trial. JAMA Intern Med 2016;176:905-12.  Back to cited text no. 5
    
6.
Peterson EB, Thomsen S, Lindsay G, John K. Adolescents' attention to traditional and graphic tobacco warning labels: An eye-tracking approach. J Drug Educ 2010;40:227-44.  Back to cited text no. 6
    
7.
Heydari GR, Ramezankhani A, Talischi F. The impacts of cigarette packaging pictorial warning labels on smokers in the city of Tehran. Tanaffos 2011;10:40-7.  Back to cited text no. 7
    
8.
Shah VR, Dave VR, Sonaliya KN. Impact of anti-tobacco warning labels on behaviour of tobacco users in one of the cities of Gujarat, India. J Prev Med Hyg 2013;54:109-13.  Back to cited text no. 8
    
9.
Chopra A, Rao NC, Gupta N, Vashisth S. Communicating tobacco health risks: How effective are the warning labels on tobacco products? Niger Med J 2014;55:411-6.  Back to cited text no. 9
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10.
Centers for Disease Control and Prevention (CDC). Cigarette package health warnings and interest in quitting smoking-14 countries, 2008-2010. MMWR Morb Mortal Wkly Rep 2011;60:645-51.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]



 

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