Nicotine dependence, socioeconomic status, lifestyle behaviours and lifetime quit attempts among adult smokers in South Africa.

BACKGROUND: Smoking cessation is a complex process influenced by factors such as smokers' nicotine dependence levels, socioeconomic status (SES) and other lifestyle behaviours. Little is known about these relationships in South Africa (SA). OBJECTIVES: To explore the relationship between nicotine dependence, SES, lifestyle behaviours and lifetime quit attempts among adult smokers in SA. METHODS: This study used data from 2 651 participants aged ≥16 years in the 2011 South African Social Attitudes Survey. Information on SES (measured by asset ownership), binge drinking, physical activity, fruit and vegetable intake, intention to quit smoking and lifetime quit attempts was extracted. Nicotine dependence was measured using the Heaviness of Smoking Index (HSI). All data were weighted to account for the complex survey design and to yield nationally representative estimates. Data analysis included binary logistic regression with high nicotine dependence (HND) defined as HSI ≥4 and lifetime quit attempts as separate outcomes. RESULTS: The prevalence of smoking was 20.1% (31.6% for males and 9.5% for females), and was highest in the mixed-ancestry group (37.0%). Overall, 14.5% of smokers had HND, with a higher proportion in the high-SES group. The odds of HND increased with every 10  years of smoking history (odds ratio (OR) 2.05; 95% confidence interval (CI) 1.40 - 3.00) but decreased among participants who reported frequent physical activity (OR 0.4; 95% CI 0.18 - 0.86) and those who planned to quit (OR 0.37; 95% CI 0.19 - 0.75). Quit attempts were more likely among participants who reported frequent fruit and vegetable intake (OR 1.8; 95% CI 1.07 - 2.98) and less likely among those reporting binge drinking (OR 0.31; 95% CI 0.16 - 0.59) or assessed as having HND (OR 0.32; 95% CI 0.17 - 0.58). CONCLUSIONS: Most adult smokers in SA have low nicotine dependence. However, the association of HND with high SES in this study suggests that although cessation treatment based on an integrated lifestyle behavioural intervention package may suffice for most smokers, a more intense cessation treatment package is needed for smokers of higher SES.

Prevalence and sociodemographic correlates of cardiovascular risk factors among patients with hypertension in South African primary care.

OBJECTIVE: To determine the prevalence and sociodemographic correlates of cardiovascular risk factors among patients with hypertension at Johan Heyns Community Health Centre, Sedibeng district, South Africa. METHODS: A total of 328 participants were systematically sampled. A researcher-administered questionnaire collected information on: socio-demography, presence of diabetes, family history of hypercholesterolaemia, family history of fatal cardiovascular (CV) events, and engagement in physical activities. Other measurements included: blood pressure (BP), weight, height, abdominal circumference and electrocardiography (ECG). Data analysis included descriptive statistics, chi-squared test and regression analysis. Main outcome measures included the proportions of participants with each CV risk and their significant sociodemographic determinants. RESULTS: Participants' mean age was 57.7 years. Most participants were black (86.0%), female (79%) and pensioners (43.6%). The mean BP was 139/84 mmHg, and 60.7% had their BP controlled to targets. There was an average of 3.7 CV risk factors per participant and the prevalence of CV risk factors was: abdominal obesity (80.8%), physical inactivity (73.2%), diabetes (30.2%), alcohol use (28.0%), hypercholesterolaemia (26.5%), smoking (11.9%), past family history of fatal CV event (14.9%), and left ventricular hypertrophy (5.2%). Sociodemographic factors significantly associated with each CV risk factor were: obesity and being female (p = 0.00); alcohol use and young age (p = 0.00); smoking, being male and race other than black (p = 0.00 and p = 0.00, respectively); physical inactivity, being a pensioner and male (p = 0.02 and p = 0.02, respectively); diabetes and being male (p = 0.03); hypercholesterolaemia and race other than black (p = 0.03); family history of hypercholesterolaemia and race other than black (p = 0.00); and family history of fatal CV event and race other than black (p = 0.00). CONCLUSIONS: There is a high burden of CV risk factors among patients with hypertension in South African primary care, signifying a substantial risk of cardiovascular disease (CVD) in this setting. Interventions aimed at CVD risk reduction need to take cognisance of the sociodemographic correlates of CV risk factors.

Factors associated with blood pressure control among patients attending the outpatient clinic of a South African district hospital.

OBJECTIVE: To determine the prevalence and factors associated with blood pressure (BP) control. METHODS: In a cross-sectional study involving 251 consecutively-sampled patients, a semi-structured questionnaire collected information on socio-demography, co-morbidities, hypertension treatments and BP control. Data analysis included descriptive statistics and logistic regression. RESULTS: Most participants were: on treatment for >5 years (60.6%); on three or more drugs (93.6%); treated according to guidelines (77%); and reported not missing medications in the last week (86.5%). BP control was achieved in only 31.5% and 16.7% of participants at the current and last visits, respectively. In multivariate regression analysis, a history of myocardial infarction (odd ratio [OR] = 0.41; P = 0.04) and being divorced/widowed (OR = 3.1; P = 0.01) predicted poor BP control. CONCLUSION: This study confirms the prevalent sub-optimal control of BP and suggests the need for further studies to examine the relationship between marital support, critical medical events and BP control.

Postoperative analgesia following caesarean deliveries in a rural health district of South Africa.

The under-treatment of postoperative pain is prevalent worldwide. This cross-sectional study examined general practitioners' (GPs) knowledge and practices regarding postoperative analgesia in Caesarean deliveries. Postoperative analgesia was said to ensure that patients were pain-free (38.7%), achieved early mobilization (19.4%) and enabled early breast feeding (16%). Pethidine was the opioid of choice; normally prescribed eight hourly (69%) and was combined with non-steroidal anti-inflammatory drugs (NSAID) by 48.6% of doctors and used solely by 51.6%. The prescription of analgesics was mainly influenced by drug availability (45.2%) and potency (19.4%). Most doctors (93.5%) had never attended a pain management course or used pain scores. Doctors at level 1 hospitals were less likely to use pethidine in combination with NSAID (odds ratio: 0.11; confidence interval: 0.02-0.59) compared to those in the specialized hospital. The GPs recognized the importance of postoperative analgesia, but their practices made patients vulnerable to pain after caesarean section.