Abstract
BackgroundPrimary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited. The aim of this study was to determine the extent to which participants were screened for and advised against tobacco use during consultations.MethodsThis cross-sectional study involved 500 participants, 18 years and older, attended by doctors or PHC nurses. Using an exit-interview questionnaire, information was obtained on participants' tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised about their tobacco use and patients' level of comfort about being asked about and advised to quit tobacco use. Main outcome measures included patients' self-reports on having been screened and advised about tobacco use during their current clinic visit and/or any other visit within the last year. Data analysis included the use of chi-square statistics, t-tests and multiple logistic regression analysis.ResultsOf the 500 participants, 14.9% were current smokers and 12.1% were smokeless tobacco users. Only 12.9% of the participants were screened for tobacco use during their current visit, indicating the vast majority were not screened. Among the 134 tobacco users, 11.9% reported being advised against tobacco use during the current visit and 35.1% during any other visit within the last year. Of the participants not screened, 88% indicated they would be 'very comfortable' with being screened. A pregnancy-related clinic visit was the single most significant predictor for being screened during the current clinic visit (OR = 4.59; 95%CI = 2.13-9.88).ConclusionOpportunities for tobacco use screening and brief cessation advice were largely missed by clinicians. Incorporating tobacco use status into the clinical vital signs as is done for pregnant patients during antenatal care visits in South Africa has the potential to improve tobacco use screening rates and subsequent cessation.
Highlights
Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited
12.9% (n = 63) of the participants reported having been screened for tobacco use during the current visit and 10.6% (n = 53) reported that they had been screened during prior visits within the last year. Of those who reported that they had been screened during the current visit, 10.4% (n = 14) were current tobacco users
The magnitude of missed opportunities documented in this study threatens tobacco control efforts in South Africa and undermines the important role that PHC practitioners can play in further reducing the prevalence of tobacco use in South Africa
Summary
Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited. The last South African Demography and Health Survey (SADHS) of 2003 reported a cigarette smoking prevalence of 35% among men and 10% among women. 3% of men had ever used smokeless tobacco (SLT), compared to 12% of women. Fewer Black South Africans smoke cigarettes compared to other racial groups, the majority of SLT users were Black women [2]. The health implications of tobacco use are well documented and include deaths attributable to direct smoking, passive smoking and the use of SLT [3]. Smoking currently accounts for 8% to 9% of all deaths in South Africa; and tobacco use is ranked third, after unsafe sex and high blood pressure, as the most important of 17 evaluated risk factors for mortality in South Africa [4]. Irrespective of the form in which users use tobacco, complete cessation reduces the risks associated with tobacco use [5,6,7,8]
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