Introduction : Tobacco use remains a major preventable cause of morbidity and mortality globally and in India. Retention in tobacco cessation programmes is critical for sustained abstinence, yet follow-up and relapse remain major challenges. This study assessed determinants of retention, reduced tobacco use, and relapse among tobacco users enrolled in Tobacco Cessation Centres (TCCs) in Villupuram district, Tamil Nadu, during 2023–24.
Methods : A prospective cohort study was conducted between December 2023 and April 2024 among tobacco users attending non-communicable disease clinics across 65 primary health centres and the TCC at Villupuram Medical College. Tobacco dependence was assessed using the Fagerström Test for Nicotine Dependence. Participants with low dependence received behavioural counselling at PHCs, while moderate and high dependence users were referred to TCCs for behavioural counselling with nicotine replacement therapy (NRT) or medications. Participants were followed at 2 weeks, 4 weeks, 6 weeks, and 3 months. Incidence rate ratios (IRR) for reduced use and relapse were estimated.
RESULTS: Among 438 enrolled tobacco users, 74.2% demonstrated reduced tobacco use and 39.5% experienced relapse during follow-up. Overall retention declined from 77% at 2 weeks to 35% at 3 months. Male participants had higher reduced use (aIRR 1.7; 95% CI: 1.1–2.8) and higher relapse risk (aIRR 2.3; 95% CI: 1.2–4.4). Participants receiving counselling with NRT showed significantly lower relapse risk (aIRR 0.2; 95% CI: 0.1–0.3). Median time to reduced use was 2 weeks, while median time to relapse was 10 weeks. Shorter distance to TCCs and later age of tobacco initiation were associated with better retention.
CONCLUSION: Retention in tobacco cessation programmes declines substantially over time despite early reduction in tobacco use. Strengthening follow-up systems, improving accessibility to cessation services, integrating pharmacotherapy, and targeted interventions for high-risk groups may improve long-term cessation outcomes.