Screening for nicotine dependence and smoking behaviour in general surgical patients

Abstract

Background: Tobacco use is the single most important preventable health risk in the world and smoking-related mortality is set to rise in particular in developing countries including Pakistan. Smoking in surgical patients has been associated with local wound complications, pulmonary and cardiac complications, an increased need for postop intensive care and longer periods of hospitalisation. Aim: To ascertain the prevalence of smoking in Pakistani surgical outpatients and to assess their smoking behaviour with a view to increase awareness and suggest appropriate interventions. Study design: Cross-sectional survey Method: 300 consecutive general surgical outpatients were asked to identify if they smoked and were invited to take part in a semi-structured survey. The questionnaire had inbuilt questions from CAGE screening questionnaire modified for smoking and in addition asked questions about smoking behaviour and motivation to quit. Results: Prevalence of smoking in the study population was 45.6%. Out of these 45.2% screened positive for nicotine dependence. Majority of smokers acknowledged their habit. Boredom, anxiety or worry and feeling angry, depressed or lonely were identified as common themes of emotional state linked to smoking behaviour. Almost all the smokers identified health improvement and money saving as potential benefits of quitting. About two third (67.3%) of the nicotine dependent group and a half (50.7%) of the non-dependent group thought it was difficult to give up smoking. Nonetheless a significant majority in the both groups, 67.3% of the nicotine dependent and 80.9% of the non-dependent group considered that it was a good thing to quit smoking. Conclusion: Prevalence of smoking is high in Pakistani urban general surgical outpatients and is comparable to general population trends. A significant proportion of the smoking population may be dependent on nicotine. Smoking behaviour may be associated with a number of emotional states. Majority of the smokers are able to identify health and economic benefits of smoking cessation and have a positive attitude towards quitting despite thinking it may be difficult. Routine screening for smoking and nicotine dependence and appropriate support for smoking cessation and harm reduction should help promote a healthier lifestyle and improve outcomes in the pre and postoperative period.