2004年-世界发展银行全球_New_Ways_of_Helping_Poor_Smokers_to_Quit_in_Central_Java_Indonesia_76页_3mb

Summary of "New Ways of Helping Poor Smokers to Quit in Central Java, Indonesia"

Core Content

This document presents the findings of a pilot smoking cessation study conducted in Central Java, Indonesia, aimed at evaluating the effectiveness of different interventions in helping poor smokers quit. The study, part of the Economics of Tobacco Control series by the World Bank and the World Health Organization, is the first of its kind in a low-income country setting. It tested three intervention strategies: group counseling, nicotine patches, and a combination of both.

The study was carried out in 18 villages across 6 sub-districts in Central Java, involving 788 participants. The interventions lasted 3 months, and follow-up surveys were conducted at 3, 6, and 12 months post-intervention. The main outcome measure was continuous abstinence from smoking, defined as not smoking even one cigarette during the follow-up period.

Main Findings

• Quit Rates:

  • Counseling Only: 27% at 3 months, 17% at 6 months, and 13% at 12 months.
  • Counseling + NRT (Nicotine Replacement Therapy): 17% at 3 months, 15% at 6 months, and 12% at 12 months.
  • NRT Only: 7% at 12 months.

• Relapse Rates:

  • About 52% of participants who were smoke-free after 3 months relapsed within the next 9 months.
  • The highest relapse rate occurred between 3 and 6 months (38%), while it was much lower between 6 and 12 months (21%).

• Comparison with Other Studies:

  • The results are comparable to those found in other countries, such as the US, Canada, Australia, the UK, and Europe.
  • The 12-month abstinence rate of 11% for the NRT group in Indonesia is consistent with global findings, but the study used a more stringent definition of success.

Key Interventions and Methods

• Group Counseling:

  • Sessions were held weekly for the first month, then twice a month for the next two months.
  • Counselors stayed in the villages to ensure accessibility.
  • The counseling-only group had the highest abstinence rate.

• Nicotine Patches:

  • Used as a nicotine replacement therapy (NRT) for those in the NRT-only and NRT + counseling groups.
  • Some participants experienced side effects such as dizziness and vomiting, leading to a 6% dropout rate.

• Community Engagement:

  • Posters and leaflets were used to raise awareness about the health risks of smoking and how to quit.
  • Monthly community meetings and Friday prayers included discussions on tobacco use and Islamic teachings.
  • The involvement of local and religious leaders was crucial in promoting the study and supporting participants.

Study Design and Logistics

• Participants:

  • 788 poor smokers were enrolled, with 47 dropping out due to various reasons, including health issues, side effects, or changing their minds.
  • The study included 720 participants who provided usable follow-up data.

• Training:

  • 12 healthcare providers (6 physicians and 6 nurses) were trained on smoking and health.
  • UGM graduates and students were trained to deliver counseling and conduct follow-ups.

• Costs:

  • Total study cost: $43,500.
  • $37,500 was administered by the University of Gadjah Mada, covering study operations.
  • $6,000 was used to bring counseling trainers from Singapore.
  • Variable costs per quitter: $179 for those who quit without counseling, and $214 for those who received counseling.

Policy Implications

• The study suggests that smoking cessation programs can be effective and cost-effective in Indonesia, even in a resource-poor setting.
• Counseling appears to be more effective than nicotine patches alone in helping participants quit.
• The results support the need for community-based interventions that take into account local cultural norms and social structures.
• The study highlights the importance of health education and community engagement in promoting smoking cessation among poor populations.
• It also underscores the addictive nature of tobacco and the necessity of supportive environments for quitting.

Conclusion

• The study demonstrates that counseling is a critical component of successful smoking cessation in low-income settings.
• The combination of counseling and nicotine patches yields similar results to counseling alone.
• Nicotine patches alone are less effective.
• The results provide a baseline for future tobacco control initiatives in Indonesia and other low-income countries.

Key Information

• Location: 18 villages in 6 sub-districts of Central Java, Indonesia.
• Duration: 3 months of intervention, with follow-ups at 3, 6, and 12 months.
• Sample Size: 788 participants, with 720 providing usable follow-up data.
• Intervention Types:
  • Counseling only
  • Nicotine patches only
  • Counseling + NRT
• Success Criteria: Continuous abstinence from smoking for 12 months post-intervention.
• Cost-Effectiveness: Average cost per quitter is higher in small-scale studies, but could be significantly reduced in a scaled-up program.
• Implications for Policy: The findings support the implementation of community-based cessation programs in low-income countries, emphasizing the role of behavioral interventions and counseling.