1. Author: Ms. Leni Chaudhuri, M.Phil 1 Co Authors: Dr. Shoba Ramanadhan ScD, MPH 2 Dr. Vaibhav Thawal, MPH CTTS 1 Dr. Himanshu Gupte MBBS, MD, DPH 1 Ms. Ratandeep Chawla Ba Dc 3 Dr. Vish Viswanath PhD 2 1 Narotam Sekhsaria Foundation 2 Harvard School of Public Health 3 Salaam Bombay Foundation

2. Introduction and Background LifeFirst, an initiative of Narotam Sekhsaria Foundation along with co-partners Salaam Bombay Foundation, Prince Aly Khan Hospital and Mind Temple is a tobacco dependence treatment service. It is built upon international evidence based standards and protocols and adapted to the Indian context. Comprehensive counseling, pharmacotherapy and follow-up services are provided by Tobacco Treatment Specialists (TTS) that have been trained by trainers trained at Mayo Clinic Nicotine Dependence Centre (NDC). To build a team of competent healthcare professionals with skills to provide evidence-based tobacco dependence treatment in a variety of healthcare settings across Maharashtra, India.

3. Introduction and Background LifeFirst, an initiative of Narotam Sekhsaria Foundation along with co-partners Salaam Bombay Foundation, Prince Aly Khan Hospital and Mind Temple is a tobacco dependence treatment service. It is built upon international evidence based standards and protocols and adapted to the Indian context. Comprehensive counseling, pharmacotherapy and follow-up services are provided by Tobacco Treatment Specialists (TTS) that have been trained by trainers trained at Mayo Clinic Nicotine Dependence Centre (NDC). To build a team of competent healthcare professionals with skills to provide evidence-based tobacco dependence treatment in a variety of healthcare settings across Maharashtra, India.

4. LifeFirst Training Key Objectives: To train about 2000 healthcare professionals in effectively asking about tobacco use and provide brief advice on quitting. Conduct training for about 600 healthcare professionals to provide tobacco dependence treatment to all identified tobacco users through evidence-based cessation techniques. Establish a network of trained healthcare professionals across a wide variety of healthcare settings for providing effective tobacco dependence treatment to people from all social strata. Create a training module for tobacco dependence treatment specially suited for the Indian scenario focusing on smokeless tobacco with the help of innovative internet based training methods and e-apps.

5. Trainings Trainings: Two levels of training are provided as a part of the programme: Level 1: Brief Advice Training Level 2: Tobacco Treatment Counselor Training Level 1: Brief Advice Training This training session includes role-plays for participants to give them hands-on experience of dealing with situations like: Systematically asking about tobacco use Identifying tobacco users and their types of patterns of tobacco use Provide information on the harms of tobacco and benefits of quitting Giving brief advice Referring to specialist tobacco treatment services where available Conducting follow-ups of patients enrolled in the service

6. The Study Study: This study is part of a larger training project ‘LifeFirst’ an initiative of the Narotam Sekhsaria Foundation (NSF) in collaboration with Salaam Bombay Foundation and Mindtemple. The goal of the LifeFirst training project is to build a team of competent healthcare professionals by imparting skills needed to provide evidence-based tobacco dependence treatment in a variety of healthcare settings. Aim: The primary aim of the study is to identify the knowledge and attitudes of Health Care Professionals (HCPs) regarding tobacco use and cessation and assess effectiveness of the training in improving their intervention- related knowledge, attitude and practices pre and post- training.

7. Rationale 1. Currently, no standardized tobacco cessation treatment training module exists in India. 2. The existing evidence based modules available worldwide focus primarily on providing tobacco treatment to patients using smoking forms of tobacco. 3. Health care providers have an extended reach into the population of tobacco users. 4. Increasing the number and variety of health care providers that deliver the evidence based, brief interventions for tobacco cessation prescribed by the Public Health Service Clinical Practice Guideline is likely to result in more tobacco users exposed to evidence-based treatments and more successful quit attempts.

8. Process followed Process for developing training curriculum Developing framework and learning objectives Curriculum, pre post test, trainer notes, exercises, role plays and handouts Testing of modules with pilot groups Making revisions as necessary Conducting Train the trainer for LifeFirst team Providing training to different HCPs Database of Govt. and private institutio ns Individual and foundatio ns contacts to approach institutio ns Cold calls for appoint ments Meetin gs with MDs, CEOs and Govt. officials Present ation LifeFirs t training s Plannin g and setting up training s Conduc ting Level 1 training s Level 2 trainings for intereste d participa nts Process for developing training curriculum

9. HCPs trained in tobacco cessation

10. Study Participant Details Total participants 1002 Consent available 922 Pre post available for 864

11. Categories of HCPs

12. Categories of Institutions-HCPs Affiliated to

13. Average scores - Knowledge

14. Perceived skills to Practice 5 As

15. Perceived skills to motivate patients

16. Ability to customize cessation counseling

17. Intent to Practice 5As

18. Perceptions about HCPs in Tobacco Cessation

19. Self Efficacy to Practice 5 As

20. Preparedness to start cessation services- organization & individual

22. Thank You