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.
Similar content being viewed by others
References
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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/
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
World Health Organization. (2013). Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: World Health Organization.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
van der Westhuizen, C., Malan, M., Naledi, T. et al. Tobacco Use in South African Emergency Centre Patients: Opportunities for Intervention. Int J Ment Health Addiction 17, 1229–1236 (2019). https://doi.org/10.1007/s11469-018-0042-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11469-018-0042-2