title: Smoking cessation and smokefree environments for tuberculosis patients in Indonesia-a cohort study.
abstract: BACKGROUND
  Research indicates that smoking substantially increases the risk of tuberculosis (TB), delay in diagnosis, failure of TB treatment and death from TB. Quitting smoking is one of the best ways to prevent unwanted outcomes. Exposure to secondhand smoke increases the risks of both TB infection and development of active TB disease among children and adults. TB patients who smoke in the home are also placing their families at a greater risk of TB infection. It is very important to keep homes smokefree. The present study assessed the implementation and effectiveness of an intervention that promotes smoking cessation and smokefree environments for TB patients.
  
  
  METHODS
  All consecutive new sputum smear-positive TB patients (aged ≥ 15 years old) diagnosed and registered in 17 health centres between 1 January 2011 and 31 December 2012 were enrolled. The ABC (A=ask, B=brief advice, C=cessation support) intervention was offered for 5 to 10 minutes within DOTS services at each visit. Smoking status and smokefree environments at home were assessed at the first visit, each monthly follow up and at month six. Factors associated with quitting were analysed by univariable and multivariable analysis
  
  
  RESULTS
  Of the 750 TB patients registered, 582 (77.6%) were current smokers, 40 (5.3%) were ex-smokers and 128 (17.1%) were never smokers. Of the 582 current smokers, 66.8% had quit smoking at month six. A time from waking to first cigarette of >30 minutes, having a smokefree home and the display of "no smoking" signage at home at month six were significantly associated with quitting. Of the 750 TB patients, 86.1% had created a smokefree home at six month follow-up compared with 18.5% at baseline. All 80 health facilities were 100% tobacco-free at the end of 2012 compared with only 52 (65%) when the intervention began in March 2011.
  
  
  CONCLUSIONS
  Brief advice of 5-10 minutes with minimal cessation support at every visit of TB patients resulted in high quit rates and higher awareness of adverse health effects of secondhand smoke exposure, which led patients to make their homes smokefree and health providers to make health care tobacco-free.
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Robinson Road, Singapore. tsbam@theunion.org.
authors.forename: Tara Singh
authors.initials: TS
authors.lastname: Bam
authors.affiliation: Directorate General Disease Control and Environmental Health, Ministry of Health, Jakarta, Indonesia. doctjand@yahoo.com.
authors.forename: Tjandra Yoga
authors.initials: TY
authors.lastname: Aditama
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France. cychiang@theunion.org.|Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. cychiang@theunion.org.
authors.forename: Chen-Yuan
authors.initials: CY
authors.lastname: Chiang
authors.affiliation: Bogor City Health Office, Bogor, Indonesia. dr.rubaeah@gmail.com.
authors.forename: Rubaeah
authors.initials: R
authors.lastname: Rubaeah
authors.affiliation: No Tobacco Community, Bogor, Indonesia. no.tobacco.community@gmail.com.
authors.forename: Acep
authors.initials: A
authors.lastname: Suhaemi
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D012306:Risk; D016540:Smoking Cessation / Q000379:methods*; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D014029:Tobacco Use Disorder / Q000150:complications* / Q000628:therapy*; D014376:Tuberculosis / Q000150:complications*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution