“I know the harm of growing this deadly crop but I am forced to continue” - Tobacco farmers' perspective from India

Background India has been a Party of the World Health Organization Framework Convention on Tobacco Control since more than a Decade, National Tobacco-Control Program (NTCP), of India is in place. Though there were several tobacco control policies introduced in the country, the production side of tobacco menace, alternative crops to tobacco still need to strengthen further. Current study is based on a mixed methods observations study to explore various perspectives of tobacco farmers on their knowledge/awareness about health and tobacco, alternative crops options, and feasibility issues. Methods A mixed method study conducted to explore the farmers perspectives on tobacco and health, tobacco cultivation and alternative crops. A structured self-administered Quantitative questionnaire used for Tobacco farmers (N=150) of 6 districts, Andhra Pradesh state, India. Qualitative guide was used to conduct Focus Group Discussions (FGDs) for 36 tobacco farmers of 3 districts from Andhra Pradesh and Karnataka state. Results Awareness of tobacco related health hazards are, Tobacco crop is always profitable, previously the crop was profitable, always on losses 8%, 45%, 40%.and 72%% mentioned alternative crops are essential. 88% believed the tobacco causes various diseases, 4% consider the tobacco as a profitable crop rather public health concern. About 4% farmers have cancer patients in the family. About 28% said seek various forms of support from Govt, and 22% ask for financial benefits to quit tobacco cultivation. Only 8% said alternative crops not required. Qualitative findings revealed very interesting factors about why Farmers forced to grow tobacco though they know its deadly crop. Conclusions This shows the role of National tobacco control program must address the alternative crops alongside of efforts to reduce Tobacco consumption. Farmers also addressed tobacco industries monopoly in controlling tobacco price and taking over maximum benefit out of tobacco crop than the farmer