Predictors of tobacco smoking abstinence among tuberculosis patients in South Africa

Abstract

This study examines predictors of smoking cessation in tuberculosis patients with high HIV co-infection rates in a South African primary care setting. Current smokers were randomly allocated to brief motivational interviewing (n=205) or receipt of a brief message (n=204).Multi-level logistic regression was performed to identify predictors of sustained 3-and 6-month abstinence and 7-day point prevalence abstinence (PPA) at 1 month, with the facility as a random effect. The intervention was ineffective among smokers with high nicotinedependence at 1 month, but was effective for all smokers over longer periods. Higher baseline self-efficacy predicted the 1-month 7-day PPA, but not sustained abstinence. HIVpositive participants' odds of sustained abstinence were about three times higher than those of their HIV-negative counterparts. Results support a more intensive motivational intervention and/or coping skills' training to increase self-efficacy and abstinence rates.Tobacco cessation services can be introduced in tuberculosis services where high HIV coinfection rates occur.

A narrative review of facilitators and barriers to smoking cessation and tobacco-dependence treatment in patients with tuberculosis in low- and middle-income countries

“…Similarly, Pradeepkumar et al 42 and Nichter et al 41 found that most relapses occurred after completion of treatment. Short duration of pharmacotherapy might influence the number of patients who quit smoking, according to the randomized controlled study of Sharma et al 18 . Possessing a disease-specific cessation message and focusing on all forms of tobacco use may decrease the probability of tobacco-dependence relapse 29 , 40 .…”

“…All studies but one (in French) were published in English. Eight of the included studies were RCS [13][14][15][16][17][18][19][20] , 28 articles reported on non-randomized studies . Characteristics of the studies and their main findings are presented in Tables 1 and 2.…”

“…High nicotine dependence 18 Misclassification of current smokers as former smokers at the time of TB diagnosis (= quit smoking at the onset of TB symptoms 34 )…”

“…Male gender, lower education, high nicotine dependence and daily smoking of more than 15 cigarettes/bidis at the time of diagnosis, may be marked as non-influenceable risk factors that are negatively associated with success in smoking cessation/TDT 18,38,42 . Possible patients' barriers to quit smoking may be less knowledge that smoking increases risk of cardiovascular diseases 36 and their beliefs that smoking is fun and helps to deal with stress 23 .…”

A systematic review of the effectiveness of smoking cessation interventions among patients with tuberculosis

“…51 Both qualitative and quantitative studies of TB patients who have and those who have not successfully quit smoking would further elucidate what was most helpful about specific interventions, how interventions impact patients beyond just smoking cessation, such as improving overall quality of life, and other factors that contribute to smoking cessation, such as self-efficacy. 52,53 Nichter et al included qualitative interviews of patients who continued smoking after the 6-month TB treatment period and intervention. 14 These interviews suggested that the smokers did not see low-level smoking as harmful and that they resumed smoking to demonstrate that they were healthy enough to smoke.…”