Prevalence and factors associated with tobacco use among patients with tobacco related illness in four national referral hospitals of Kenya

Background Tobacco use is a risk factor for many chronic health conditions. Demonstrating the link between tobacco use and disease burden can strengthen tobacco control. We estimated the prevalence and correlates of tobacco use among patients with tobacco related illnesses (TRI) at four national referral hospitals in Kenya. Methods We conducted a cross-sectional study among patients with four TRI (cancer, cardiovascular diseases, cerebrovascular disease and pulmonary tuberculosis) during January–October 2022. Cases were identified from medical records and a questionnaire used to collect socio-demographic information and tobacco use history. Descriptive statistics were used to estimate prevalence of tobacco use. Multiple logistic regression models were used to identify factors associated tobacco use among patients with TRI. Results We identified 2032 individuals with TRI; 46% (939/2,032) had age ≥60 years, and 61% (1,241/2,032) were male. About 45% (923/2,032) were ever tobacco users (6% percent current and 39% former tobacco users). Comorbidities were present in 28% of the participants. Most (92%) of the patients had been diagnosed with the TRI within the previous five years. The most frequent TRI were oral pharyngeal cancer (36% [725/2,032]), nasopharyngeal cancer (12% [246/2.032]) and lung cancer (10% [202/2,032]). Patients >60 years (aOR 2.24, 95% CI: 1.84, 2.73) and not in a marital union (aOR 1.21, 95% CI: 1.03, 1.42) had higher odds of tobacco use. Female patients (aOR 0.35, 95% CI: 0.30, 0.41) and those with no history of alcohol use (aOR 0.27, 95% CI: 0.23, 0.31), had less odds of tobacco use. Odds of tobacco use increased with age and decreased with increasing education level. Conclusion Prevalence of tobacco use was high among patients with TRI in Kenya, especially among older, male, less educated, unmarried, and alcohol users. We recommend sustained tobacco use screening and cessation programs among patients with TRI as part of clinical care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was funded by the Development Gateway through a grant from Bill & Melinda Gates Foundation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study research protocol was reviewed and approved by the Kenyatta National Hospital-University of Nairobi ethics and research committee and Moi University/ Moi Teaching and Referral Hospital Institutional Research and Ethics Committee. The approval references were KNH-ERC/A/346 and FAN: 0003954 respectively. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The dataset underlying the findings of this publication is available and can be provided free of charge, on request. This is to ensure adherence to the local data protection regulations (Kenya).