Smoking among tuberculosis patients in Kerala, India: proactive cessation efforts are urgently needed

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.

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.

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).

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.