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.