Strategies for Tobacco Control in India: A Systematic Review

<div><p>Background</p><p>Tobacco control needs in India are large and complex. Evaluation of outcomes to date has been limited.</p><p>Aim</p><p>To review the extent of tobacco control measures, and the outcomes of associated trialled interventions, in India.</p><p>Methods</p><p>Information was identified via database searches, journal hand-searches, reference and citation searching, and contact with experts. Studies of any population resident in India were included. Studies where outcomes were not yet available, not directly related to tobacco use, or not specific to India, were excluded. Pre-tested proformas were used for data extraction and quality assessment. Studies with reliability concerns were excluded from some aspects of analysis. The Framework Convention on Tobacco Control (FCTC) was use as a framework for synthesis. Heterogeneity limited meta-analysis options. Synthesis was therefore predominantly narrative.</p><p>Results</p><p>Additional to the Global Tobacco Surveillance System data, 80 studies were identified, 45 without reliability concerns. Most related to education (FCTC Article 12) and tobacco-use cessation (Article 14). They indicated widespread understanding of tobacco-related harm, but less knowledge about specific consequences of use. Healthcare professionals reported low confidence in cessation assistance, in keeping with low levels of training. Training for schoolteachers also appeared suboptimal. Educational and cessation assistance interventions demonstrated positive impact on tobacco use. Studies relating to smoke-free policies (Article 8), tobacco advertisements and availability (Articles 13 and 16) indicated increasingly widespread smoke-free policies, but persistence of high levels of SHS exposure, tobacco promotions and availability—including to minors. Data relating to taxation/pricing and packaging (Articles 6 and 11) were limited. We did not identify any studies of product regulation, alternative employment strategies, or illicit trade (Articles 9, 10, 15 and 17).</p><p>Conclusions</p><p>Tobacco-use outcomes could be improved by school/community-based and adult education interventions, and cessation assistance, facilitated by training for health professionals and schoolteachers. Additional tobacco control measures should be assessed.</p></div

Culture, diversity, and global health: challenges and opportunities

In an increasingly globalized world, we continue to face dramatic health disparities that impact adversely on Indigenous, migrant and refugee populations as well as other minority ethnic populations in most of the countries of the world. Culture plays an important role in how people experience health and illness, and how they access and experience healthcare. It impacts on the healthcare professionals as well as on their patients and the communities, modifying the healing relationship and presenting both barriers and opportunities for better health outcomes. This chapter will explore some of the key ways in which this happens with a view to highlight the opportunities that they represent. These include issues such as how the aetiology of disease is perceived, health-seeking behaviour, issues of racism, stigma and discrimination, as well as the impacts of stress, coping and resilience. Finally, this chapters presents specific suggestions for improved healthcare systems that are more inclusive and that work towards more equitable health outcomes for culturally diverse communities