Smoking behavior among former tuberculosis patients in Indonesia: intervention is needed.

SETTING

Five lung clinics in Jogjakarta Province, Indonesia.

OBJECTIVE

To document smoking patterns among tuberculosis (TB) patients before diagnosis and following treatment, to identify smoking-related messages given by health professionals and DOTS providers and to identify predictors of smoking relapse.

DESIGN

A cross-sectional survey of 239 male TB patients completed DOTS-based treatment during 2005-2006. Subjects were interviewed at home using a semi-structured questionnaire. Female patients were excluded, as very few smoke.

RESULTS

Most TB patients quit smoking when under treatment, but over one third relapsed at 6 months post-treatment. About 30% were never asked about their smoking behavior or advised about quitting. Of relapsed smokers, 60% received only general health messages and not TB-specific smoking messages. DOTS providers are not currently involved in cessation activities. The perception that any level of smoking is harmless for ex-TB patients was a significant predictor for smoking relapse.

CONCLUSION

Physicians and DOTS providers should be actively involved in smoking cessation activities among TB and ex-TB patients. Based on these data, the Quit Tobacco Indonesia Project is mounting a pilot intervention to train DOTS providers, who are mostly family members of patients, to deliver smoking cessation messages and reinforce the cessation advice provided by physicians during and following TB treatment.