CONTENTS

• Why bother about tobacco?
  
• How is tobacco use apread?
  
• Determining what works and what dose not
  
• Reasons for success and failure so far
  
• General principles for health sector initiatives
  
• Implementing community preventive responses
  
• Implementing community cessation responses
  
• Measuring progress
  
• Reaching new heights
  
• Appendix (guidelines for quitting)
  
• Further reading

This manual is intended for people interested in reducing problems caused by tobacco. The damage caused by tobacco is so serious that everybody should really be interested in doing something about it. But this manual is for those who want to do a little bit more than the ‘average citizen’.

Although tobacco is a deadly serious issue, the flavour of activities that are needed to prevent its spread dose not have to be heavy and serious. Tobacco use is spread by making it look appealing, attractive, casual and fun. The preventive effort cannot allow itself to appear serious, heavy, boring and uninspiring.But for efforts to be sustained some amount of underlying seriousness is necessary.

We try to avoid the usual formats that make any activity look initially heavy or daunting. The approach used is therefore to give priority to the kinds of things that we need to say to people rather than to the means of organizing action groups, monitoring their activities, record keeping, evaluating impact and so on. But we have integrated these ideas too, into the day to day actions that are proposed.

The manual is intended primarily for people who work in a health facility serving a ‘local’ population. A doctor or nurse or someone else in the health facility can use that guidelines to create changes in the communities served by them. But people outside the medical or health professions too can use these guidelines effectively. The interventions (except a few sections in chapter in chapter 8 on ‘cessation’) can be implemented by any concerned individual, and do not require special medical expertise.

The manual can be used for self-instruction or for training. The activities suggested are for implementation at  the level of local communities, not at national level. So the emphasis is on action relevant to a community or a clinic.

Chapter 1-5 cover general theoretical issues, chapter 6 preventive measures, and Chapter 8 cessation of tobacco use. Theoretical issues dealt with in chapter 1 to 5 are restricted to basic information and background underlying the recommendations for action (made in the ‘guidelines for action’ in chapter 6 and 7). This overview of theory is not intended to be a comprehensive review of the existing studies

There is a great deal of progress in the world, in understanding how the spread or the tobacco habit can be curtailed. Some of the opinions that are currently held (base on existing evidence) are presented in chapters 1 to 5. It is helpful to keep in touch with new developments in the world even if we work in a very remote location, or with just one small community.    

The content in these five chapters will be mostly redundant to those who are familiar with the basic issues in smoking prevention and cessation. But the guidelines are meant to be used even by those who are not familiar with the subject, as a tool for training and monitoring activities. Someone who is already convinced of the need for action and familiar with the basic issues can skip the rest of the introductory section, and move directly to the sections on prevention or cessation.

Just reading through the manual should provide ideas for a person interested in taking practical measures to curtail the harm caused by tobacco use. But for maximum usefulness they should be used as a guide for action in stages, where an intervention suggested is carried out and then the next step taken up.
               
The Strategy employed has been to put across the flavour of a given intervention by providing several examples, mostly in the form of questions that we should all try to answer and analyze. Some questions or issues that are relevant to prevention as well as to cessation efforts are mentioned in both. This repetition sis intentional, as some readers may want to concentrate on either prevention or cessation alone.  All sections in all parts do not need to be read completely, for success in implementation. The user can select the areas of interest to read in detail or to skim over or even omit.

For interventions to succeed they need to be sustained. This is usually seen to require funds or resources. Interventions described in this manual require no extra funds for implementation. All the activities suggested can be carried out if there is enough interest and concern even in one person. Just two or three people working in a clinic or school can achieve significant results. The extent of change that is achieved can, of course, be increased that much more if there are more people interested.

Many activities can be spread more widely and effectively if we have money. But we should try to do only those things that we know we can sustain. Once a activities are in motion and there is a good momentum build up, additional resources may be used to increase the scope and coverage of our work. It is generally unwise to start work on the basis of a small amount of funds that have become available. If any money becomes available at the outset it can be set aside for later use after some momentum is achieved. Momentum is best built up on goodwill and public interest.

We would like to place on record that this manual is the outcome of the hard work of Dyanath Samrasinghe, Associate Professor of Psychological Medicine, Faculty of Medicine, University of Colombo, Sri Lanka and his assistant Varuan De Silva. We would also like to acknowledge that useful contributions made by all those who managed to find time to review this manual in order to improve its contents as well as its structure.

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