A narrative review of facilitators and barriers to smoking cessation and tobacco-dependence treatment in patients with tuberculosis in low- and middle-income countries

Abstract

INTRODUCTION Smoking is a substantial cause of premature death in patients with tuberculosis (TB), particularly in low-and middle-income countries (LMICs) with high TB prevalence. The importance of incorporating smoking cessation and tobacco-dependence treatment (TDT) into TB care is highlighted in the most recent TB care guidelines. Our objective is to identify the likely key facilitators of and barriers to smoking cessation for patients with TB in LMICs. METHODS A systematic search of studies with English-language abstracts published between January 2000 and May 2019 was undertaken in the EMBASE, MEDLINE, EBSCO, ProQuest, Cochrane and Web of Science databases. Data extraction was followed by study-quality assessment and a descriptive and narrative synthesis of findings. RESULTS Out of 267 potentially eligible articles, 36 satisfied the inclusion criteria. Methodological quality of non-randomized studies was variable; low risk of bias was assessed in most randomized controlled studies. Identified facilitators included brief, repeated interventions, personalized behavioural counselling, offer of pharmacotherapy, smoke-free homes and a reasonable awareness of smoking-associated risks. Barriers included craving for a cigarette, low level of education, unemployment, easy access to tobacco in the hospital setting, lack of knowledge about quit strategies, and limited space and privacy at the clinics. Findings show that the risk of smoking relapse could be reduced through consistent follow-up upon completion of TB therapy and receiving a disease-specific smoking cessation message. CONCLUSIONS Raising awareness of smoking-related health risks in patients with TB and implementing guideline-recommended standardized TDT within national TB programmes could increase smoking cessation rates in this high-risk population.

Factors affecting smoking initiation and cessation among adult smokers in Fiji: A qualitative study

“…Religious factors, such as the observance of the Lent season among Christians and EID among Muslims, have also been found in this study as an important reason for smokers to quit smoking. On the other hand, similar to other studies, it is noted that some of the barriers to smoking cessation found in this study include: strong influence from smoking friends and families 35 ; nicotine addiction [36][37][38] ; accessibility of cigarettes 39 ; misunderstanding that quitting smoking can damage health; lack of support from social networks such as family and friends 39,40 ; misperception and/or misunderstanding that accepting cigarettes from a friend is a token of friendship 41,42 ; and the lack of willpower to refuse a cigarette when being offered by a smoking friend 39 .…”

Identifying Hotspots of People Diagnosed of Tuberculosis with Addiction to Alcohol, Tobacco, and Other Drugs through a Geospatial Intelligence Application in Communities from Southern Brazil

“…A study showed that when developing policies and actions aimed at abstinence from smoking among patients diagnosed with TB, there was a decrease in the rate of diagnoses and deaths after smoking cessation [31]. Thus, after six weeks of smoking cessation, the adverse effects of tobacco on the immune system disappear and contribute to a better clinical evolution of the patient [32].…”

“…A systematic review pointed out that among facilitators to assist in smoking cessation are repeated brief interventions (including motivational therapy and leaflet distribution), followed by behavioral counseling incorporated into the routine of health care for patients with TB [31].…”

Smoking cessation knowledge, attitude and practices among tuberculosis physicians: A qualitative study

“…A study conducted by Aryanpur et al 29 reported that at the time of TB diagnosis, 23.8% of newly diagnosed smoking TB patients quit immediately and 52.4% of patients who continued to smoke had intention to quit during the following month. Other studies also confirmed that the diagnosis of TB was an opportunity for initiating smoking cessation interventions, suggesting that smoking cessation should be adopted into TB care to ensure a successful integration of TB and tobacco control activities 30 - 31 . The finding indicating that women are less receptive to smoking cessation compared to men was consistent with the literature 32 - 35 ; however, in our study this phenomenon was discussed as an opportunity for initiating smoking cessation interventions specifically among Armenian TB patients who are, in fact, predominantly men 10 .…”