BACKROUND: Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation
advice, but data on such activities in South Africa are limited. The aim of this study was to determine the extent to
which participants were screened for and advised against tobacco use during consultations.
METHODS: This cross-sectional study involved 500 participants, 18 years and older, attended by doctors or PHC
nurses. Using an exit-interview questionnaire, information was obtained on participants’ tobacco use status, reason
(s) for seeking medical care, whether participants had been screened for and advised about their tobacco use and
patients’ level of comfort about being asked about and advised to quit tobacco use. Main outcome measures
included patients’ self-reports on having been screened and advised about tobacco use during their current clinic
visit and/or any other visit within the last year. Data analysis included the use of chi-square statistics, t-tests and
multiple logistic regression analysis.
RESULTS: Of the 500 participants, 14.9% were current smokers and 12.1% were smokeless tobacco users. Only 12.9%
of the participants were screened for tobacco use during their current visit, indicating the vast majority were not
screened. Among the 134 tobacco users, 11.9% reported being advised against tobacco use during the current
visit and 35.1% during any other visit within the last year. Of the participants not screened, 88% indicated they
would be ‘very comfortable’ with being screened. A pregnancy-related clinic visit was the single most significant
predictor for being screened during the current clinic visit (OR = 4.59; 95%CI = 2.13-9.88).
CONCLUSIONS: Opportunities for tobacco use screening and brief cessation advice were largely missed by clinicians.
Incorporating tobacco use status into the clinical vital signs as is done for pregnant patients during antenatal care
visits in South Africa has the potential to improve tobacco use screening rates and subsequent cessation.