title: Review of cigarette smoking and tuberculosis in China: intervention is needed for smoking cessation among tuberculosis patients.
abstract: BACKGROUND
  As a risk factor of tuberculosis (TB), tobacco smoking has increased substantially over the past three decades, especially in developing countries. However, the association between smoking and TB, which has been shown to exist in different studies with different ethnic background, has not yet received sufficient attention in terms of TB care standards and research in China.
  
  
  METHODS
  An observational study was conducted in two rural areas of China. A total of 613 TB patients frequency matched with 1226 controls were interviewed by using a structured questionnaire. The associations between cigarette smoking and risk of TB were estimated by computing odds ratios (ORs) and 95% confidence intervals (95% CIs) from logistic regression model. Patients' smoking behavior and patterns of smoking cessation were followed after TB diagnosis. Multivariate Cox proportional hazards model was applied to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) in analyzing the risk factors for smoking relapse. The Kaplan-Meier estimate was computed to plot the ability of smoking-free after cessation among different groups, with the Log-rank test being used to compare the difference.
  
  
  RESULTS
  The proportion of cigarette smoking was 54.6% in TB cases, which was significantly higher than that in controls (45.1%) with adjusted OR of 1.93(95% CI: 1.51-2.48). Though 54.9% smokers stopped smoking after being diagnosed with TB, more than 18% relapsed during the follow-up period. The proportion of relapse was higher within 6-9 months (6%) and 12-15 months (11%) after cessation. In the Cox regression estimates adjusted for age and gender, compared with those highly educated and previously treated patients, the hazard ratios of smoking relapse were 3.48(95% CI: 1.28-9.47) for less educated (<6 years) and 4.30(95% CI: 1.01-18.30) for newly treated patients, respectively.
  
  
  CONCLUSIONS
  Cigarette smoking is associated with TB in the Chinese. Interventions of smoking cessation are recommended to be included in the current TB control practice.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, PR China. merry21st@yahoo.com.cn
authors.forename: Jianming
authors.initials: J
authors.lastname: Wang
authors.forename: Hongbing
authors.initials: H
authors.lastname: Shen
mesh_terms: D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016016:Proportional Hazards Models; D012008:Recurrence; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology*; D014026:Nicotiana
references.citation: Nat Med. 1999 Jan;5(1):15-7
references.pmid: 9883828
references.citation: Int J Tuberc Lung Dis. 2008 Oct;12(10):1103
references.pmid: 18812035
references.citation: Lancet. 2007 Dec 15;370(9604):2030-43
references.pmid: 17719083
references.citation: Bull World Health Organ. 2007 Oct;85(10):820-1
references.pmid: 18038065
references.citation: Salud Publica Mex. 2006;48 Suppl 1:S140-7
references.pmid: 17684676
references.citation: Int J Epidemiol. 2008 Aug;37(4):841-51
references.pmid: 18556729
references.citation: Int J Tuberc Lung Dis. 2007 Jun;11(6):612-6
references.pmid: 17519091
references.citation: BMC Public Health. 2006 Mar 14;6:66
references.pmid: 16536868
references.citation: Int J Tuberc Lung Dis. 2007 Oct;11(10):1049-61
references.pmid: 17945060
references.citation: Expert Rev Anti Infect Ther. 2007 Jun;5(3):385-91
references.pmid: 17547503
references.citation: Nat Rev Immunol. 2002 May;2(5):372-7
references.pmid: 12033743
references.citation: Int J Tuberc Lung Dis. 2007 Mar;11(3):258-62
references.pmid: 17352089
references.citation: Int J Tuberc Lung Dis. 2007 Apr;11(4):381-5
references.pmid: 17394682
references.citation: Am J Respir Crit Care Med. 2004 Nov 1;170(9):1027-33
references.pmid: 15282201
references.citation: Int J Tuberc Lung Dis. 2005 May;9(5):556-61
references.pmid: 15875929
references.citation: PLoS Med. 2007 Jan;4(1):e20
references.pmid: 17227135
references.citation: Clin Cancer Res. 2009 Jan 1;15(1):400-5
references.pmid: 19118071
references.citation: Respirology. 2003 Mar;8(1):17-21
references.pmid: 12856737
references.citation: Arch Intern Med. 2007 Feb 26;167(4):335-42
references.pmid: 17325294
references.citation: J Infect Dis. 2006 Aug 15;194(4):479-85
references.pmid: 16845631