The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

<p>Abstract</p> <p>Background</p> <p>There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this.</p> <p>Methods</p> <p>An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate.</p> <p>Results</p> <p>A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who received the conventional TB treatment alone (77.5% vs. 8.7%; p < 0.001). Furthermore, at the end of TB treatment (6 months or later), there were significantly higher rates of treatment default (15.2% vs. 2.5%; p = 0.019) and treatment failure (6.5% vs. 0%; p = 0.019) in the DOTS group than in the SCIDOTS group.</p> <p>Conclusion</p> <p>This study provides evidence that connecting TB-tobacco treatment strategy is significant among TB patients who are smokers. The findings suggest that the integrated approach may be beneficial and confer advantages on short-term outcomes and possibly on future lung health of TB patients who quit smoking. This study may have important implications on health policy and clinical practice related to TB management among tobacco users.</p

Doctors' behaviour & skills for tobacco cessation in Kerala

Background & objectives: Several studies have shown that health professionals' advice for tobacco cessation to tobacco users enhances quit rate. Little is known about doctor's present tobacco cessation efforts in India. We examined doctors' reported inquiry into patient's use of tobacco and assessed their perceived need for training in tobacco cessation. Methods: A cross-sectional survey was conducted in Kerala to collect information on doctor's practices, skills and perceived need for training in tobacco cessation. Pre-tested structured questionnaires were distributed in person to 432 male and 89 female doctors, of whom 264 male and 75 female doctors responded. Results: One third of all the doctors surveyed reported that they always ask patients about tobacco use, three fourths advise all patients routinely to quit irrespective of the smoking status of patients and one tenth offered useful information on how to quit. About 15 per cent reported they received information from medical representatives, 32 per cent reported they had sufficient training and 80 per cent expressed interest in receiving training to help smokers quit. Majority of all doctors surveyed most commonly asked and advised patients to quit tobacco when patients had lung, heart, mouth disease or cancer. Interpretation & conclusions: Most doctors inquired about tobacco use from a minority of their patients, though many reported to advise patients about quitting even without inquiring about their tobacco use status. There are several missed opportunities to promote quitting at a time when patients are motivated to listen

Smoking among Tuberculosis Patients in Kerala, India: Proactive Cessation Efforts are Urgently Needed

OBJECTIVES: To document smoking patterns among tuberculosis (TB) patients at eight different points of time before, during and after treatment, and to investigate the frequency and content of the quit smoking messages they received. DESIGN: A stratified random sample of 215 male TB patients from Kerala, India, who had completed treatment in the previous 9 months was surveyed using a pre-tested semi-structured interview schedule. RESULTS: Six months prior to diagnosis, 94.4% of male TB patients were ever smokers and 71.2% were current smokers. Although 87% of patients had quit smoking soon after diagnosis, 36% had relapsed by 6 months post treatment. One third relapsed during the first 3 months of treatment and another third during the next 3 months of treatment. Two thirds of all smokers received cessation advice from primary care physicians, but less than half received advice from others. Less than half of all messages were TB-specific; the rest were very general short instructions. Smoking more than 15 cigarettes/bidis at the time of diagnosis was significantly associated with a lower quit rate during treatment (OR 8.0, 95%CI 2.1-30.9). CONCLUSION: Messages to not smoke often go unheeded among TB patients. Proactive efforts are needed to encourage health staff and DOTS providers to give strong cessation messages

Tobacco Use in Kerala: Findings from three recent studies

BACKGROUND:We reviewed the literature on tobacco use in Kerala and present data from three recently conducted unpublished studies. METHODS:Three cross-sectional studies were conducted; a community-based study of 1,298 individuals aged 15 years and above (mean age 37.4 years, men 630), a school-based study of 1,323 boys (mean age 14.7 years), and a college-based study of 1,254 male students (mean age 18.2 years). Information on tobacco use and sociodemographic variables was collected using pre-tested, structured interview schedules and questionnaires.RESULTS: In the community study, 72% of men and 6% of women had ever used tobacco. Compared to men with > 12 years of schooling, those with 44 years. In the school study, the age at initiation among boys aged or = 16-year-old boys. Boys whose fathers and friends used tobacco were 2 times and 2.9 times more likely to use tobacco (OR 2.0, CI 1.3-3.1 and OR 2.9, CI 1.6-5.1), respectively, compared with their counterparts. In the college study, 29% of the commerce students used tobacco compared with 5.3% of polytechnic students (p < 0.001).CONCLUSION:Survey data suggest that the age at initiation of tobacco use appears to be falling. A series of cross-sectional studies with larger sample sizes of the youth is required to confirm this impression. Tobacco use habits of fathers and peers are significant influences on youth smoking. There is a need to focus on particular types of colleges as these appear to have high-risk tobacco use environments

Smokeless tobacco use among Tuberculosis patients in Karnataka, India: The need for cessation services.

India is home to the largest population of patients with tuberculosis and tobacco users in the world. Smokeless tobacco use exceeds smoking and is increasing. There is no study to date that reports smokeless tobacco use before and after the diagnosis and treatment of tuberculosis. We assessed smokeless tobacco use among former patients of tuberculosis in Karnataka, India