Depression symptoms and quitting among a nationally representative sample of smokers from Africa

Background There are mixed reports as to whether depression is associated with quitting among smokers, but almost all of these studies have been conducted in high income countries (HICs); nothing is known about this association in low- and middle-income countries (LMICs) including African countries. This is the first population-based study in Africa to examine the relationship between depression symptoms and key cessation variables—quit intentions and quit attempts. Methods Data were analyzed from the International Tobacco Control (ITC) Kenya Wave 1 (2012) and Zambia Wave 2 (2014) surveys of nationally representative samples of adult smokers (N=2,055). This study examined the relation between five symptoms of depression and quit intentions and quit attempts. Logistic regression analyses adjusted for sex, age, location, smoking status, and time-in-sample. Results 40% of Kenyan smokers and 51% of Zambian smokers had “ever” tried to quit smoking;17% of Kenyan and 27% of Zambian smokers planned to quit smoking within the next 6 months. Quit attempts were positively associated with 4 depressive symptoms: having a poor appetite (OR=2.43; 95% CI 1.61-3.67), not being able to control important things of life (OR=1.69; 95% CI 1.15-2.48), feeling sad (OR=1.59; 95% CI 1.15-2.19), and feeling that people disliked them (OR=1.39; 95% CI 1.05-2.85). Intending to quit was positively associated with 1 symptom—having a poor appetite (OR=1.76; 95% CI 1.22-2.54). Moreover, being hopeful about the future was positively associated with both quit attempts (OR=1.50; 95% CI 1.17-1.90) and intending to quit (OR=1.41; 95% CI 1.06-1.87). There were no significant differences between Zambia and Kenya. Conclusions In both Kenya and Zambia, depression symptoms were positively associated with quit attempts and quit intentions, consistent with findings from high-income ITC countries (Canada, United Kingdom, USA, Australia), suggesting that this association between depression and quit attempts/intentions is considerably broader than being limited to HICs