Abstract
BackgroundTuberculosis (TB) patients who smoke tobacco are at an increased risk for adverse TB treatment outcomes. This study describes tobacco use patterns among newly diagnosed TB patients, their readiness to quit, and their beliefs about tobacco-related health effects in a high HIV-burden setting in South Africa. Socio-economic and demographic factors associated with smoking were also determined.MethodsThis was a cross-sectional analysis of baseline data collected for a smoking cessation study at six large tuberculosis clinics in a South African township (N = 1926). We collected information on current and past tobacco use, socio-economic and demographic status, beliefs regarding the harmful effects of smoking and quit behaviour, and motivation, using structured interviewer-administered questionnaires. TB- and HIV-related information was obtained from patient records. Data analysis entailed descriptive statistics, followed by multivariate logistic regression with backward elimination, adjusted for clustering by facility.ResultsJust over one fifth of respondents (21.8%, 420/1924) reported currently smoking tobacco (males 37.6%, females 4.6%). By contrast, only 1.8% (35/1918) of all respondents reported being past smokers. Of the current smokers, about half (51.8%, 211/407) had previously attempted to quit, mainly for health reasons. The majority of respondents (89.3%, 1675/1875) believed tobacco smoking was harmful for their health and smokers were highly motivated to quit (median score 9, interquartile range 7–10). Smoking was less common among female respondents (Odds Ratio [OR] 0.10, 95% Confidence Interval [CI] 0.06-0.19) and respondents who had completed high school (OR 0.57, 95% CI 0.39-0.84), but was more common among respondents who do occasional work (OR 2.82, 95% CI 1.58-5.02), respondents who to bed hungry regularly (OR 4.19, 95% CI 2.42-7.25), those who have an alcohol problem (OR 5.79, 95% CI 3.24-10.34) and those who use illicit substances (OR 10.81, 95% CI 4.62-25.3).ConclusionsDespite documented evidence of its harmful effects, smoking is prevalent among male TB patients in this high HIV-prevalence population. Few patients have managed to quit smoking on their own. However, patients are highly motivated to stop smoking. We recommend implementing and evaluating a smoking cessation programme in tandem with TB services.
Highlights
Tuberculosis (TB) patients who smoke tobacco are at an increased risk for adverse TB treatment outcomes
Children and patients who had already been on treatment for over a month, very ill patients and those unable to communicate in the local language or in English were excluded from the study
Many of the current smokers appeared to be highly motivated to stop smoking, and both smokers and non-smokers strongly believed smoking was harmful to their health
Summary
Tuberculosis (TB) patients who smoke tobacco are at an increased risk for adverse TB treatment outcomes. The introduction of smoking cessation services into TB programmes has been advocated by several international bodies [13] In response to this recommendation, several tobacco cessation-related studies have been undertaken in TB settings [14,15,16], but to our knowledge none were conducted in countries with high HIV-TB-co-infection rates. There is only limited information on the patterns and prevalence of tobacco use in such settings, and on the attitudes held by TB patients about quitting Gaining insight into these patterns and on such prevalence could help policy-makers to identify people at risk of the negative health outcomes of the triple burden of tuberculosis, HIV and tobacco use, and establish the need for cessation services as a component of TB programmes
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