Tobacco dependence among people with mental illness: a facility-based cross sectional study from Southwest Ethiopia

Abstract

BackgroundTobacco smoking is a health care issue in developed as well as in developing countries. Tobacco smoking among people with mental illness is significantly higher than in the general population. Tobacco smoking has negative effects on physical, mental and financial well-being of people with mental illness but little is known about tobacco dependence among mental health service users in sub-Saharan African countries, including Ethiopia. Therefore, this study attempted to assess the prevalence of tobacco dependence and associated factors among mental health service users at Jimma University teaching hospital.MethodsA cross-sectional study was conducted among 305 male and 117 female mental health service users at Jimma University teaching Hospital in 2014. The Fagerstrom Test for Nicotine Dependence (FTND) was used to assess tobacco dependence. Logistic regression analysis was used for bivariate and multivariate analysis. Variables with a P value of <0.05 were considered to be associated with tobacco dependence in the final model.ResultsThe prevalence of current tobacco dependence among the study participants was 18.5%. Amongst people with tobacco dependence, 57.7, 29.5 and 12.8% had moderate, high and very high level of tobacco dependence respectively. All mental health service users with tobacco dependence were males. There was a significant association between tobacco dependence and high school education (AOR 3.02, 95% CI 1.07, 8. 48), alcohol use disorder (AOR 4.14, 95% CI = 1.54, 11.11), daily khat chewing (AOR 13.51, 95% CI = 4.27, 42.74), chewing khat 2–3 times per week (AOR 5.09, 95% CI = 1.37,18.95), chewing khat once a week (AOR 4.31, 95%CI = 1.04,17.78), having friends who smoke tobacco (AOR 4.88, 95% CI = 2.12, 11.25) and being diagnosed with schizophrenia compared to a diagnosis of major depression (AOR 5.26, 95% CI = 2.07, 13.37). However, daily attendance at a place of worship (AOR 0.46, 95% CI = 0.22, 0.95) was associated negatively with tobacco dependence.ConclusionIn this study, there was a high prevalence of tobacco dependence among mental health services users. There is a pressing need to increase availability of psychological and pharmacological interventions to reduce tobacco dependence and tobacco-related medical illness in this vulnerable group.

Prevalence and Socio-Demographic Correlates of Tobacco and Alcohol Use in Four Sub-Saharan African Countries: A Cross-Sectional Study of Middle-Aged Adults

“…Age was neither strongly correlated with current smoking nor smokeless tobacco consumption in our study. Adults in the highest wealth categories and those who had attained higher education levels were less likely to use tobacco products, in concordance with previous studies in Africa (2,4,12,13,18,(20)(21)(22). Alcohol consumption was strongly associated with tobacco use.…”

“…In the combined sample, more than half of the men ever smoked, and 34.5% were current smokers. A similarly high prevalence of current smoking was previously reported in men from other African countries (2,4,12,13,18,(20)(21)(22). Age was neither strongly correlated with current smoking nor smokeless tobacco consumption in our study.…”

“…Results for each of the sites showed a much higher prevalence of smoking in the AWI-Gen cohort compared to the age-adjusted prevalence for men in their respective countries in 2015 (Nanoro 13.6% vs Burkina Faso 12.5%, Navrongo 42.0% vs Ghana 5.8%, Nairobi 23.5% vs Kenya 14.9%, and Agincourt 27.2%, Dikgale 63.4%, and Soweto 52.8% vs South Africa 21.9%) (37). Patterns of tobacco use were highly sex-speci c, with smoking tobacco most common among men and women preferring snuff or chewing tobacco, supporting previous ndings in SA, Ethiopia, the Gambia, Kenya and Angola (2,4,12,13,18,(20)(21)(22). In the combined sample, more than half of the men ever smoked, and 34.5% were current smokers.…”

Nicotine dependence, socioeconomic status, lifestyle behaviours and lifetime quit attempts among adult smokers in South Africa

“…The finding that most smokers in this study had LND confirms the findings of previous community-based studies conducted in SA [27] and among mental health patients elsewhere in Africa. [28] More importantly, considering that smokers with LND are more likely than those with HND to quit and to do so without pharmacotherapy, [29] this finding suggests that most smokers in SA would be amenable to being assisted with counselling and/or behavioural therapy only. However, the 14.5% assessed as having HND (Table 1) amount to a considerable number of smokers at a population level and underscore the need for the SA health system to consider providing pharmacotherapy for smokers who are motivated to quit but may find it difficult to do so with non-pharmacological interventions alone.…”

Tobacco use and its clinical correlates among Psychiatric in-patients at a tertiary care Psychiatric Hospital: A cross sectional study

“…9 Patients with tobacco dependence also tended to use other substances like khat and alcohol which have their independent impact on medication adherence and prognosis of the mental illness. 10 In patients with bipolar disorder, tobacco smoking, both independently and in the presence of other substance use, was significantly associated with recurrent suicide attempts. 11 Thus, tobacco consumption may predispose or worsen the psychiatric illnesses.…”