Association between the heaviness of smoking index (HSI) and quit attempts and quit intentions among cigarette smokers in eight African countries

The increasing smoking population in Africa necessitates intensified tobacco cessation services. Assessing nicotine dependence with tools such as the heaviness of smoking index (HSI) aids in cessation efforts. This study evaluated the association between HSI and quit attempts and quit intentions among African cigarette smokers.

Global Adult Tobacco Survey (GATS) data from eight African countries collected between 2011 and 2018 were analysed. The time to first smoke (TTFS) and number of cigarettes per day (CPD) were used to estimate the HSI score and dependence level. The association between HSI dependence level and quit attempts and quit intentions was evaluated using likelihood ratios (LR).

Among 2,399 daily cigarette users, 1,618 (67.5%) were exclusive cigarette users. The average and median CPDs were 8.27 ± 8.3 and 5 (IQR: 2–18), respectively, with Ethiopia having the highest mean CPD (11.6). In Ethiopia, 51.5% of exclusive and 42% of nonexclusive users had low dependence (HSI < 2), whereas 43.9% and 31.3% of other African countries had low dependence. The association between low dependence and quit attempts was significant only for exclusive cigarette smokers in Ethiopia, with LR of 1.45 (95% CI: 1.08–1.93). The association between low dependence and quit intentions was significant in Ethiopia for both exclusive (LR = 1.42) and nonexclusive (LR = 1.53) users. None of the LR estimates were > 10 or < 0.1.

The association between low dependence (HSI < 2) and quit behaviour was limited in African settings, highlighting the complex interplay between usage patterns, dependence assessment, and quit behaviour. A contextual tool for assessing nicotine dependence tailored to African settings is warranted for effective smoking cessation.