Mumbai Worksite Tobacco Control Study

描述（由申请人提供）：到2030年，约70%的烟草使用死亡将发生在低收入和中等收入国家，占全球死亡人数的1000多万。印度是世界第二大国家，为烟草控制提供了一个重要的案例。《印度烟草控制报告》保守估计，目前印度每年因烟草导致的死亡人数在80万至90万人之间，2002-2003年造成的损失为72亿美元。迫切需要采取循证干预措施，遏制这一流行病并减轻烟草使用的负担。在印度减少烟草使用可能不仅会对印度，而且会对全球的死亡率和发病率产生深远影响。作为《烟草控制框架公约》（FCTC）的签署国，印度案例的成功可以为全球烟草控制提供重要的经验教训。工作场所为接触大量烟草使用者提供了现成的渠道。在印度的工作场所，医务人员和职业健康与安全办公室提供了基础设施，可据此制定戒烟政策和规划。拟议的研究将调整以证据为基础的烟草控制干预措施，以便在印度制造工厂内应用。这种干预模式将工作场所健康促进干预与职业健康和安全相结合，并已被证明在促进戒烟方面是有效的，特别是对蓝领工人。我们将采用随机对照设计在孟买的生产场所测试这一综合控烟干预措施，以工作场所为干预和随机化的单位。我们将根据两个结果评估效果：参与工作场所的工人中戒烟人数增加（主要结果），以及工作场所烟草控制政策的采用和执行情况增加（次要结果）。我们还将研究在我们的概念模型中指定的中介机制和修改条件的作用。我们将使用过程评估来评估工作场所内的适应过程，采用该计划的工作场所实施干预的程度，以及分配到干预条件的工作场所的工人参与该计划。如果证明是有效的，这项研究将产生一个经过测试的工作场所控烟干预措施，准备在印度推广，并能够为其他发展中国家的工作场所控烟提供信息。我们在印度和美国的密切合作伙伴关系，我们来自印度和美国的多元化研究团队，以及与印度工业和职业健康团体的广泛伙伴关系，将促进政策干预计划的成功实施。

DESCRIPTION (provided by applicant): By 2030, about 70% of deaths attributed to tobacco use will occur in low- and middle-income countries, accounting for more than 10 million deaths globally. India, the second largest country in the world, provides an important case example for tobacco control. The Report on Tobacco Control in India conservatively estimated that tobacco-attributable deaths in India currently range from 800,000 to 900,000 per year, costing US$7.2 billion in 2002-2003. There is urgent need for evidence-based interventions that can stem the epidemic and reduce the burden of tobacco use. Reducing tobacco use in India likely will have profound impact on mortality and morbidity not just in India but also globally. As a signatory to the Framework Convention for Tobacco Control (FCTC), success in the Indian case could provide important lessons for tobacco control across the globe. Worksites provide a ready channel for reaching large numbers of tobacco users. In Indian worksites, medical officers and occupational health and safety offices provide an infrastructure from which to build tobacco use cessation policies and programs. The proposed study will adapt an evidence-based tobacco control intervention for application within Indian manufacturing worksites. This intervention model integrates worksite health promotion interventions with occupational health and safety, and has been shown to be efficacious in promoting smoking cessation, particularly for blue-collar workers. We will test this comprehensive tobacco control intervention in manufacturing worksites in Mumbai using a randomized controlled design, with the worksite as the unit of intervention and randomization. We will assess efficacy in terms of two outcomes: increased cessation of tobacco use among workers in participating worksites (primary outcome), and increased adoption and enforcement of worksite tobacco control policies (secondary outcome). We will additionally examine the role of mediating mechanisms and modifying conditions specified in our conceptual model. We will use process evaluation to assess the adaptation process within worksites, the extent of implementation of the intervention in worksites adopting the program, and worker participation in the program in worksites assigned to the intervention condition. If demonstrated to be effective, this study will result in a tested worksite tobacco control intervention ready for dissemination in India, and able to inform worksite tobacco control in other developing countries. Our close collaborative partnerships in India and the US, our diverse research team of members from India and the US, and extensive partnerships with industry and occupational health groups in India will facilitate the adoption of a successful program of policy intervention. PUBLIC HEALTH RELEVANCE: India provides an important case example of tobacco control efforts within a developing country, as the second largest country in the world and a solid foundation for tobacco control already in place. The purpose of this study is to adapt an evidence-based worksite tobacco control intervention for application to Indian manufacturing worksites, and test the efficacy of this intervention using a randomized controlled design, with the worksite as the unit of intervention and randomization. This study extends a well-established partnership between researchers in the US and India.