Low- level smoking among diabetes patients in India: a smoking cessation challenge

Mark Nichter, G. K. Mini, K. R. Thankappan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Little research in low and middle-income countries has been conducted on shifts in levels of smoking among those suffering from chronic diseases exposed to cessation messages. We present data on such shifts among diabetes patients participating in a randomized controlled cessation trial in Kerala state, India. The two-arm trial tested the relative effectiveness of diabetes specific cessation messages from doctors and the added value of motivational interviewing by trained cessation counsellors. Methods: Two hundred twenty-four smokers who participated in the trial were followed for 2 years. Intention to treat analysis documented changes in levels of smoking. We defined low-level smoking as 1-5 sticks per day, medium-level as 6-10 sticks, and high-level as more than 10 sticks. Twenty-three low-level smokers were interviewed about why they continued to smoke, and household response to their smoking. Results: At baseline, 32% of the 224 diabetes patients were low-level smokers, 24% medium-level and 44% high-level smokers. At year two 34% of the participants in the trial had quit smoking, 37% were low-level smokers, 16% medium-level smokers and 13% high-level smokers. Forty-nine percent of low-level smokers at baseline continued to smoke at low level. Fifty percent of mid-level and 45% of high-level smokers who did not quit shifted to low level smoking A majority of low-level smokers and their families perceived low-level smoking to be safe. Conclusions: Low level smoking among diabetes patients is common. Proactive and sustained cessation efforts are called for that are attentive to disease complications as teachable moments.

Original languageEnglish (US)
Pages (from-to)176-180
Number of pages5
JournalClinical Epidemiology and Global Health
Issue number4
StatePublished - Dec 2018


  • Cessation
  • Diabetes
  • India
  • Low-level smoking

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases


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