Nichter Mark, Padmawati Siwi, Ng Nawi
University of Arizona, School of Anthropology, USA.
Universitas Gadjah Mada, School of Public Health, Indonesia.
Soc Sci Med. 2016 Mar;152:70-9. doi: 10.1016/j.socscimed.2016.01.028. Epub 2016 Jan 22.
There is a dearth of information about the smoking habits of people currently and formerly treated for tuberculosis (TB) in low- and middle-income countries (LMICs). In this paper we describe research carried out in Indonesia between 2007 and 2011 designed to investigate both the impact of TB-specific quit smoking messages in the TB clinic and at home, and shifts in patterns of smoking among those formerly treated for TB who continue to smoke. The results of a modest two-arm smoking cessation trial involving 87 patients undergoing Directly Observed Therapy Short course treatment (DOTS) for TB are presented. In one arm patients received a TB-specific quit smoking message delivered by doctors and a TB and smoking educational booklet and quit smoking guide. In the second, family support arm, patients also received on-going cessation messages delivered by family members trained to be DOTS supporters. The study followed patients twice during their six months of DOTS treatment and twice six months post treatment. Both arms of the study reduced rates of smoking during and following TB treatment significantly with 73% of patients in the doctor arm and 71% in the family support arm remaining quit at the end of the treatment (month 6). When complete abstinence at six months after treatment was taken as a primary outcome measure, no statistical difference was found in the effectiveness of the two arms of the intervention. Notably, 67% of higher-level smokers at baseline and 33% of low-moderate level smokers at baseline quit entirely. Many of those who resumed smoking did so at low-moderate levels (<6 cigarettes a day). Eighty-four percent of patients who quit during treatment maintained their abstinence six months after treatment, 13% resumed smoking at a low-moderate level (<6 cigarettes), and only 3% resumed smoking at a higher level. A purposeful sample of 15 patients who shifted from heavy smoking (20-40 cigarettes per day) to low-moderate levels of smoking post treatment were followed for an additional 12 months. We report on their ability to sustain lower levels of smoking and self-perceived smoking status given their dramatic reduction in cigarette consumption. This is the first study of low-moderate level smoking among patients formerly treated for TB conducted anywhere in South-East Asia.
在低收入和中等收入国家（LMICs），目前关于正在接受治疗和曾经接受过结核病（TB）治疗的人群吸烟习惯的信息匮乏。在本文中，我们描述了2007年至2011年在印度尼西亚开展的一项研究，该研究旨在调查结核病诊所和家中针对结核病的戒烟信息的影响，以及曾经接受过结核病治疗且仍在吸烟的人群吸烟模式的变化。本文呈现了一项适度的双臂戒烟试验的结果，该试验涉及87名正在接受结核病短程直接观察治疗（DOTS）的患者。在其中一组中，患者收到了医生提供的针对结核病的戒烟信息、一本结核病与吸烟教育手册以及一份戒烟指南。在第二组，即家庭支持组中，患者还收到了由接受过DOTS支持者培训的家庭成员持续提供的戒烟信息。该研究在患者接受6个月DOTS治疗期间随访了两次，在治疗后6个月又随访了两次。研究的两组在结核病治疗期间及之后的吸烟率均显著降低，在医生组中73%的患者以及在家庭支持组中71%的患者在治疗结束时（第6个月）仍保持戒烟状态。当将治疗后6个月的完全戒烟作为主要结局指标时，发现两组干预措施的有效性没有统计学差异。值得注意的是，基线时67%的重度吸烟者和33%的中低度吸烟者完全戒烟。许多复吸者的吸烟量处于中低水平（每天<6支香烟）。在治疗期间戒烟的患者中，84%在治疗后6个月保持了戒烟状态，13%以中低水平（<6支香烟）复吸，只有3%以较高水平复吸。对15名治疗后从重度吸烟（每天20 - 40支香烟）转变为中低水平吸烟的患者进行了有目的抽样，并对他们进行了额外12个月的随访。我们报告了鉴于他们大幅减少了香烟消费量，他们维持较低吸烟水平的能力以及自我感知的吸烟状况。这是东南亚地区开展的第一项关于曾经接受过结核病治疗的患者中低水平吸烟情况的研究。
