Prevalence, patterns, and factors associated with tobacco use among patients with priority tobacco related illnesses at four Kenyan national referral hospitals, 2022.

Tobacco use is a risk factor for many chronic health conditions. Quantifying burden of tobacco use among people with tobacco-related illnesses (TRI) can strengthen cessation programs. This study estimated prevalence, patterns and correlates of tobacco use among patients with TRI at four national referral hospitals in Kenya. We conducted a cross-sectional study among patients with five TRI (cancer, cardiovascular diseases, cerebrovascular disease, chronic obstructive pulmonary disease, and pulmonary tuberculosis) during January-July 2022. Cases identified from medical records were interviewed on socio-demographic, tobacco use and cessation information. Descriptive statistics were used to characterize patterns of tobacco use. Multiple logistic regression models were used to identify associations with tobacco use. We identified 2,032 individuals with TRI; 46% (939/2,032) had age ≥60 years, and 61% (1,241/2,032) were male. About 45% (923/2,032) were ever tobacco users (6% percent current and 39% former tobacco users). Approximately half of smokers and 58% of smokeless tobacco users had attempted quitting in the last month; 42% through cessation counselling. Comorbidities were present in 28% of the participants. Most (92%) of the patients had been diagnosed with TRI within the previous five years. The most frequent TRI were oral pharyngeal cancer (36% [725/2,032]), nasopharyngeal cancer (12% [246/2.032]) and lung cancer (10% [202/2,032]). Patients >60 years (aOR 2.24, 95% CI: 1.84, 2.73) and unmarried (aOR 1.21, 95% CI: 1.03, 1.42) had higher odds of tobacco use. Female patients (aOR 0.35, 95% CI: 0.30, 0.41) and those with no history of alcohol use (aOR 0.27, 95% CI: 0.23, 0.31), had less odds of tobacco use. Our study shows high prevalence of tobacco use among patients with TRI in Kenya, especially among older, male, less educated, unmarried, and alcohol users. We recommend tobacco use screening and cessation programs among patients with TRI as part of clinical care.

Quasi-experimental evaluation of Kenya's pictorial health warnings versus Zambia's single text-only warning: findings from the International Tobacco Control (ITC) Project.

BACKGROUND: Population studies in mostly high-income countries have shown that pictorial health warnings (PHWs) are much more effective than text-only warnings. This is the first quasi-experimental evaluation of the introduction of PHWs in Africa, comparing the change from text-only to PHWs in Kenya to the unchanged text-only health warning in Zambia. METHODS: Data were from International Tobacco Control (ITC) Surveys in Kenya (n=1495), and Zambia (n=1628), cohort surveys of nationally representative samples of adult smokers in each country. The ITC Kenya Survey was conducted in 2012 and 2018 (2 years after the 2016 introduction of three PHWs). The ITC Zambia Survey was conducted in 2012 and 2014 with no change to the single text-only warning. Validated indicators of health warning effectiveness (HWIs) (salience: noticing, reading; cognitive reactions: thinking about health risks, thinking about quitting; and behavioural reactions: avoiding warnings; forgoing a cigarette because of the warnings), and a summary measure-the Labels Impact Index (LII)-measured changes in warning impact between the two countries. RESULTS: PHWs implemented in Kenya led to a significant increase in all HWIs and the LII, compared with the text-only warning in Zambia. The failure to implement PHWs in Zambia led to a substantial missed opportunity to increase warning effectiveness (eg, an estimated additional 168 392 smokers in Zambia would have noticed the warnings). CONCLUSIONS: The introduction of PHWs in Kenya substantially increased the effectiveness of warnings. These results provide strong empirical support for 34 African countries that still have text-only warnings, of which 31 are Parties of the Framework Convention on Tobacco Control and are thus obligated to implement PHWs.

Prevalence, perceptions and factors associated with menthol cigarette smoking: findings from the ITC Kenya and Zambia Surveys.

BACKGROUND: Menthol masks the harshness of cigarette smoke, promotes youth smoking and encourages health-concerned smokers who incorrectly believe that menthols are less harmful to smoke menthols. This study of smokers in Kenya and Zambia is the first study in Africa to examine menthol use, smokers' beliefs about its harmfulness and the factors associated with menthols. METHODS: Data were from the International Tobacco Control (ITC) Kenya Wave 2 (2018) and Zambia Wave 2 Survey (2014), involving nationally representative samples of smokers. This study focuses on 1246 adult smokers (644 in Kenya, 602 in Zambia) who reported smoking a usual brand of cigarettes (menthol or non-menthol). RESULTS: Overall, menthol use was significantly higher among smokers in Zambia than in Kenya (48.0% vs 19.0%), females (45.6% vs 31.2% males), non-daily smokers (43.8% vs 30.0% daily) and those who exclusively smoked factory-made (FM) cigarettes (43.0% vs 15.2%). The erroneous belief that menthols are less harmful was more likely among smokers in Zambia than in Kenya (53.4% vs 29.3%) and among female smokers (38.5% vs 28.2%). In Kenya, menthol smoking was associated with being female (adjusted odds ratios (AOR)=3.07; p=0.03), worrying about future health (AOR=2.28; p=0.02) and disagreeing with the statement that smoking was calming (AOR=2.05; p=0.04). In Zambia, menthol use was associated with being female (AOR=3.91; p=0.002), completing primary school (AOR=2.14; p=0.03), being a non-daily smoker (AOR=2.29; p=0.03), exclusively using FM cigarettes (AOR=14.7; p<0.001), having a past quit attempt (AOR=1.54; p=0.02), believing that menthols are less harmful (AOR=3.80; p<0.001) and choosing menthols because they believed it was less harmful (AOR=3.52; p<0.001). CONCLUSIONS: Menthols are highly prevalent among females in both countries. There is a need in African countries to combat the myth that menthols are less harmful and to ban menthol and other flavourings.

Identifying factors associated with quit intentions among smokers from two nationally representative samples in Africa: Findings from the ITC Kenya and Zambia Surveys.

It is well established that intentions to quit smoking is the strongest predictor of future quit attempts. However, most studies on quit intentions have been conducted in high-income countries with very few in low- and middle-income countries particularly in Africa. This is the first population-based study to compare factors associated with quit intentions among smokers in two African countries. Data were from the International Tobacco Control (ITC) Kenya and Zambia Surveys (2012), face-to-face surveys of nationally representative samples of 2291 adult smokers (Kenya = 1103; Zambia = 1188). Multivariate logistic regression analyses were conducted to identify predictors of quit intentions. Most Kenyan (65.1%) and Zambian (69.1%) smokers had quit intentions of which 54.8% planned to quit within the next 6 months. Five factors were significantly associated with quit intentions in both countries: being younger, having tried to quit previously, perceiving that quitting is beneficial to health, worrying about future health consequences of smoking, and being low in nicotine dependence. The predictive strength of these factors did not differ in the two countries. Four additional factors were significant predictors in Zambia only: having a quit attempt lasting six months or more, lower smoking enjoyment, having a negative opinion about smoking, and concern about cigarette expenses. The factors predicting quit intentions were similar to those in other ITC countries including Canada, US, UK, China and Mauritius. These findings highlight the need for stronger tobacco control policies in Kenya and Zambia including increased taxation, greater access to cessation services, and anti-smoking campaigns denormalizing tobacco use.

The effects on tuberculosis treatment adherence from utilising community health workers: a comparison of selected rural and urban settings in Kenya.

INTRODUCTION: Community Health Workers (CHWs) have been utilised for various primary health care activities in different settings especially in developing countries. Usually when utilised in well defined terms, they have a positive impact. To support Kenya's policy on engagement of CHWs for tuberculosis (TB) control, there is need to demonstrate effects of utilising them. OBJECTIVES: This study assessed TB treatment adherence among patients who utilised CHWs in management of their illness in comparison to those who did not in urban and rural settings. METHODS: A retrospective cohort study was conducted in selected health facilities using standard clinical records for each TB patient registered for treatment between 2005 to 2011. Qualitative data was collected from CHWs and health care providers. RESULTS: The study assessed 2778 tuberculosis patients and among them 1499 (54%) utilized CHWs for their TB treatment. The urban setting in comparison with the rural setting contributed 70% of patients utilising the CHWs (p<0.001). Overall treatment adherence of the cohort was 79%. Categorizing by use of CHWs, adherence among patients who had utilized CHWs was 83% versus 68% among those that had not (p<0.001). In comparison between the rural and urban settings adherence was 76% and 81.5% (p<0.001) respectively and when categorized by use of CHWs it was 73% and 90% (p<0.001) for the rural and urban set ups respectively. Utilisation of CHWs remained significant in enhancing treatment adherence in the cohort with unadjusted and adjusted ORs; OR 2.25, (95% 1.86-2.73) p<0.001 and OR 1.98 (95% 1.51-2.5) p<0.001 respectively. It was most effective in the urban set-up, OR 2.65 (95% 2.02-3.48, p<0.001) in comparison to the rural set up, OR 0.74 (95% 0.56-0.97) p = 0.032. CONCLUSION: Utilisation of CHWs enhanced TB treatment adherence and the best effects were in the urban set-up.