Development & Pilot Testing of a Novel Multi-component Intervention Using Biomarker Feedback and Cognitive-Social Health Information-Processing (C-SHIP) Model Based Intervention for Smokeless Tobacco Cessation during Pregnancy

Studies have reported that tobacco use during pregnancy has been associated with pregnancy complications (ie, placenta praevia, placental abruption, and pre-eclampsia) and poor fetal outcomes (ie, low birthweight, premature birth, and overall perinatal mortality). Global Adult Tobacco Survey (GATS) India reported that the prevalence of overall tobacco use among females is 14.2 percent. Prevalence of smoking among females is 2 percent whereas the prevalence of smokeless tobacco products (Gutkha, Khaini, Paan Masala,Gul, Mawa, Misri, etc.) among females is 12.8% .Various studies report that no differences have been noted between pregnant and non-pregnant women in smokeless tobacco prevalence and use patterns.

Healthcare professionals routinely ask a pregnant woman about tobacco use during antenatal visits and provide counselling to pregnant women to give up tobacco at least during pregnancy and possibly forever. Unfortunately, most of the pregnant women continue to use smokeless tobacco after getting registration at Antenatal Clinic (ANC). It reflects that only counselling is not effective intervention for smokeless to tobacco cessation in pregnancy. Also, several forms of smokeless tobacco are sometimes considered by pregnant women as a form of medicine to treat common ailments. Use of smokeless tobacco by women is well accepted in Indian society, and use of Mishri (tobacco containing teeth cleaning powder) is very common. Most of the pregnant women are not aware about any harmful effects of smokeless tobacco. There is a dearth of studies on effective interventions for smokeless tobacco use in pregnancy in most of low- and middle- income countries. There are currently no up-to-date, evidence based guidelines for identifying and managing smokeless tobacco use in pregnancy in India. There have been no trials to study effect of multicomponent intervention in pregnant women using smokeless tobacco. A 2011 Cochrane review of interventions for smokeless tobacco cessation identified 12 trials involving behavioural interventions in the adults, but these trials did not involve pregnant women. Pregnancy is a ‘teachable moment’ for women. Such a study has still not been conducted in the Indian population. Hence there is a great need to design effective smokeless tobacco cessation interventions for healthcare professionals to help pregnant women in quitting smokeless tobacco as cessation of tobacco during the pregnancy is very important for primary prevention of low birth weight and other adverse perinatal health outcomes.