title: Community-Based Screening, Brief Intervention, and Referral for Treatment for Unhealthy Tobacco Use: Single Arm Study Experience and Implementation Success in Rural and Semi-Rural Settings, South-West Nigeria.
abstract: OBJECTIVE
  To determine whether screening, brief intervention, and referral for treatment can reduce the prevalence of tobacco use in rural and semi-rural settings.
  
  
  METHODS
  
  
  
  METHODS
  A non-randomized clinical trial with assessments at baseline and post-intervention assessments at 3 and 6 months was conducted in a rural and semi-rural district in South-West of Nigeria. A representative sample of 1203 persons consented to the study and had alcohol, smoking, and substance involvement screening test (ASSIST) administered to them by trained community health-care extension workers between October 2010 and April 2011. Follow-up participation was more than 99% at all points.
  
  
  METHODS
  Participants received a single ASSIST-linked brief intervention (BI) and referral for treatment (RT) at entry, and a booster ASSIST BI and RT at 3 months.
  
  
  METHODS
  The primary outcome was self-reported scores on ASSIST.
  
  
  RESULTS
  At baseline, out of 1203 respondents, lifetime prevalence and current prevalence of any tobacco products were 405 (33.7%) and 248 (20.6%), respectively. Of the current users, on the ASSIST, 79 (31.9%) scored 0-3 (low health risk), 130 (52.4%) scored 4-26 (moderate risk), and 39 (15.7%) scored 27+ (high risk). At 3 months, out of 1199 respondents, prevalence of current users was 199 (16.5%) and out of 1195 respondents, was 169 (14.1%) at 6 months. Prevalence of tobacco use reduced significantly at 3 months Z = -3.1, p = 0.01 and at 6 months when compared with baseline Z = 4.2, p = 0.001, but not at 6 months compared with at 3 months, Z = 2.1, p = 0.09. Multivariate analysis revealed that age at initiation of tobacco use, gender, marital status, setting of dwelling, and socioeconomic status were the only variables that were associated with current tobacco use at baseline, 3 and 6 months.
  
  
  CONCLUSIONS
  A one-time BI with a booster at 3 months had a significant effect on tobacco use in persons living in community settings. This finding suggests a need for promoting the adoption of this intervention for tobacco use in rural and semi-rural community settings.
authors.affiliation: Department of Psychiatry, College of Medicine, University of Ibadan , Ibadan , Nigeria.
authors.forename: Victor Olufolahan
authors.initials: VO
authors.lastname: Lasebikan
authors.affiliation: Department of Behavioral Sciences, Lagos State University , Lagos , Nigeria.
authors.forename: Bolanle Adeyemi
authors.initials: BA
authors.lastname: Ola
keywords: brief intervention; community; screening; smoking; tobacco