Mumbai Worksite Tobacco Control Study

到2030年，约70%的烟草使用导致的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。印度是世界上第二大国家，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，印度目前每年因烟草造成的死亡人数在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，以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会对死亡率和发病率产生深远的影响，不仅在印度，而且在全球。作为《烟草控制框架公约》的签署国，印度的成功可以为地球仪的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一个基础设施，以建立戒烟政策和计划。拟议的研究将采用循证烟草控制干预措施，以适用于印度制造业工作场所。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，已被证明在促进戒烟方面是有效的，特别是对蓝领工人。我们将在孟买的制造业工作场所使用随机对照设计测试这种全面的烟草控制干预，工作场所作为干预和随机化的单位。我们将从两个方面评估效果：参与工作场所的工人戒烟率增加（主要结果），以及工作场所烟草控制政策的采用和执行率增加（次要结果）。此外，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，在采用该计划的工作场所实施干预的程度，以及在指定干预条件的工作场所工人参与该计划的程度。如果证明是有效的，这项研究将导致一个测试的工作场所烟草控制干预准备在印度传播，并能够告知其他发展中国家的工作场所烟草控制。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成员组成的多元化研究团队，以及与印度工业和职业健康团体的广泛合作伙伴关系，将有助于通过一个成功的政策干预计划。 公共卫生相关性：印度是世界上第二大国家，而且已经为烟草控制奠定了坚实的基础，因此，印度为发展中国家的烟草控制努力提供了一个重要的案例。本研究的目的是适应以证据为基础的工作场所烟草控制干预应用于印度制造业的工作场所，并测试这种干预的有效性，使用随机对照设计，与工作场所作为干预和随机化的单位。这项研究扩展了美国和印度研究人员之间建立良好的伙伴关系。

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.