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Tobacco Use in South African Emergency Centre Patients: Opportunities for Intervention

  • Claire van der WesthuizenEmail author
  • Megan Malan
  • Tracey Naledi
  • Bronwyn Myers
  • Dan J. Stein
  • Katherine Sorsdahl
Brief Report
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Abstract

Tobacco-attributable deaths in South Africa have increased since 1990, yet data are scanty from healthcare settings. Internationally, emergency centre (EC) visits are increasingly utilised as opportunities for health risk behaviour screening and intervention, but this is not the case in South Africa. Effective advocacy for these services requires data on the prevalence and correlates of tobacco use among South African EC patients. The study objectives were to investigate tobacco prevalence and associated factors in ECs. Demographics, hospital presentation and substance use data were collected as part of a screening and brief intervention programme for alcohol and drugs in three ECs. We conducted descriptive statistics and utilised logistic regression to examine the associations of demographics, presenting complaint and substance use with moderate–high risk-tobacco use as the dependent variable. Of 12,522 patients screened, 37.0% used tobacco and 35.7% showed moderate–high risk for tobacco-related harms. Factors associated with tobacco-related harms included male gender and moderate–high risk for other substances. Of the patients who met criteria and received an intervention for alcohol or drugs, 65.5% were at moderate–high risk for tobacco-related harms. Given the high prevalence of tobacco use among patients attending ECs, intervening on this platform has the potential to reduce risk for non-communicable disease.

Keywords

Tobacco Screening Brief intervention Screening, brief intervention and referral to treatment Substance use Emergency centres 

Notes

Funding

This work was supported through the DELTAS Africa Initiative [DEL-15-01]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [DEL-15-01] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government.

Compliance with Ethical Standards

Ethical approval for an overall programme evaluation study was granted by the Western Cape Provincial Health Research Committee (WC_2017RP39_880) and the Human Research Ethics Committee at a South African university.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. Ayo-Yusuf, O. A., Olutola, B. G., & Agaku, I. T. (2015). Cigarette smoking trends and social disparities among South African adults, 2003–2011. Nicotine & Tobacco Research, 17(8), 1049–1055.  https://doi.org/10.1093/ntr/ntu264.CrossRefGoogle Scholar
  2. Beaglehole, R., Bonita, R., Horton, R., Adams, C., Alleyne, G., Asaria, P., et al. (2011). Priority actions for the non-communicable disease crisis. The Lancet, 377(9775), 1438–1447.Google Scholar
  3. Bernstein, S. L., & D’Onofrio, G. (2017). Screening, treatment initiation, and referral for substance use disorders. Addiction Science & Clinical Practice, 12, 18.  https://doi.org/10.1186/s13722-017-0083-z.CrossRefGoogle Scholar
  4. Bernstein, S. L., Boudreaux, E. D., Cydulka, R. K., Rhodes, K. V., Lettman, N. A., Almeida, S.-L., et al. (2006). Tobacco control interventions in the emergency department: a joint statement of emergency medicine organizations. Journal of Emergency Nursing, 32(5), 370–381.  https://doi.org/10.1016/j.jen.2006.06.006.CrossRefPubMedGoogle Scholar
  5. Carter, P., Ranney, M., Zimmerman, M., Blow, F., Booth, B., Goldstick, J., et al. (2015). Violent reinjury and mortality among youth seeking emergency department care for assault-related injury a 2-year prospective cohort study. JAMA Pediatrics, 0(1), 63–70.Google Scholar
  6. Cherpitel, C. J. (2007). Alcohol and injuries: a review of international emergency room studies since 1995. Drug and Alcohol Review, 26(2), 201–214.  https://doi.org/10.1080/09595230601146686.CrossRefPubMedGoogle Scholar
  7. Cunningham, R. M., Chermack, S. T., Zimmerman, M. A., Shope, J. T., Bingham, C. R., Blow, F. C., & Walton, M. A. (2012). Brief motivational interviewing intervention for peer violence and alcohol use in teens: one-year follow-up. Pediatrics, 129(6), 1083–1090.  https://doi.org/10.1542/peds.2011-3419.CrossRefPubMedPubMedCentralGoogle Scholar
  8. D’Onofrio, G., Becker, B., & Woolard, R. H. (2006). The impact of alcohol, tobacco, and other drug use and abuse in the emergency department. Emergency Medicine Clinics of North America, 24(4), 925–967.  https://doi.org/10.1016/j.emc.2006.06.008.CrossRefPubMedGoogle Scholar
  9. Gakidou, E., Afshin, A., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., et al. (2017). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1345–1422.  https://doi.org/10.1016/S0140-6736(17)32366-8.CrossRefGoogle Scholar
  10. Global Burden of Disease Study 2015 Tobacco Collaborators. (2017). Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet, 389(10082), 1885–1906.  https://doi.org/10.1016/s0140-6736(17)30819-x.CrossRefGoogle Scholar
  11. Horn, K., Dino, G., Hamilton, C., & Noerachmanto, N. (2007). Efficacy of an emergency department-based motivational teenage smoking intervention. Preventing Chronic Disease, 4(1), A08.PubMedGoogle Scholar
  12. Humeniuk, R., Henry-Edwards, S., Ali, R., Poznyak, V., & Monteiro, M. (2010). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): manual for use in primary care. Geneva: World Health Organization.Google Scholar
  13. Institute for Health Metrics and Evaluation (IHME). (2018). GBD Compare Data Visualization: number of deaths due to tobacco use, arrow diagram. Retrieved from https://vizhub.healthdata.org/gbd-compare/
  14. Joubert, J., Rao, C., Bradshaw, D., Vos, T., & Lopez, A. D. (2013). Evaluating the quality of national mortality statistics from civil registration in South Africa, 1997–2007. PLoS One, 8(5), e64592.  https://doi.org/10.1371/journal.pone.0064592.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Lemhoefer, C., Rabe, G. L., Wellmann, J., Bernstein, S. L., Cheung, K. W., McCarthy, W. J., et al. (2017). Emergency department-initiated tobacco control: update of a systematic review and meta-analysis of randomized controlled trials. Preventing Chronic Disease, 14, E89.  https://doi.org/10.5888/pcd14.160434.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Louwagie, G. M. C., & Ayo-Yusuf, O. A. (2013). Tobacco use patterns in tuberculosis patients with high rates of human immunodeficiency virus co-infection in South Africa. BMC Public Health, 13, 1031.  https://doi.org/10.1186/1471-2458-13-1031.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Lynch, A., & Quigley, P. (2010). ExHALED study: prevalence of smoking and harm levels in an emergency department cohort. Emergency Medicine Australasia, 22(4), 287–295.  https://doi.org/10.1111/j.1742-6723.2010.01299.x.CrossRefPubMedGoogle Scholar
  18. McCabe, C. T., Woodruff, S. I., & Zúñiga, M. L. (2011). Sociodemographic and substance use correlates of tobacco use in a large, multi-ethnic sample of emergency department patients. Addictive Behaviors, 36(9), 899–905.  https://doi.org/10.1016/j.addbeh.2011.04.002.CrossRefPubMedGoogle Scholar
  19. Melzer-Lange, M. D., Zonfrillo, M. R., & Gittelman, M. A. (2013). Injury prevention: opportunities in the emergency department. Pediatric Clinics of North America, 60(5), 1241–1253.  https://doi.org/10.1016/j.pcl.2013.06.010.CrossRefPubMedGoogle Scholar
  20. Pelletier, J. H., Strout, T. D., & Baumann, M. R. (2014). A systematic review of smoking cessation interventions in the emergency setting. The American Journal of Emergency Medicine, 32(7), 713–724.  https://doi.org/10.1016/j.ajem.2014.03.042.CrossRefPubMedGoogle Scholar
  21. Rabe, G. L., Wellmann, J., Bagos, P., Busch, M. A., Hense, H.-W., Spies, C., et al. (2013). Efficacy of emergency department-initiated tobacco control--systematic review and meta-analysis of randomized controlled trials. Nicotine and Tobacco Research, 15(3), 643–655.  https://doi.org/10.1093/ntr/nts212.CrossRefPubMedGoogle Scholar
  22. Reddy, P., Zuma, K., Shisana, O., Kim, J., & Sewpaul, R. (2015). Prevalence of tobacco use among adults in South Africa: results from the first South African National Health and Nutrition Examination Survey. South African Medical Journal, 105(8), 648–655.CrossRefGoogle Scholar
  23. Tzoulaki, I., Elliott, P., Kontis, V., & Ezzati, M. (2016). Worldwide exposures to cardiovascular risk factors and associated health effects: current knowledge and data gaps. Circulation, 133(23), 2314–2333.  https://doi.org/10.1161/circulationaha.115.008718.CrossRefPubMedGoogle Scholar
  24. Weiland, T., Jelinek, G., Taylor, S., & Taylor, D. (2016). Tobacco smoking by adult emergency department patients in Australia: a point-prevalence study. Public Health Research & Practice, 26(3), e2631634.Google Scholar
  25. World Health Organization. (2013). Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
  2. 2.Western Cape Department of HealthCape TownSouth Africa
  3. 3.Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council/Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
  4. 4.Department of Psychiatry and Mental HealthUniversity of Cape Town and MRC Unit on Risk and Resilience in Mental DisordersCape TownSouth Africa

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