Tobacco smoking behavior and health outcomes among patients with chronic diseases: a comparative study of tobacco-producing and non-producing areas in southern Thailand.

Tobacco use remains a substantial cause of morbidity among patients with noncommunicable diseases, especially in areas with localized tobacco production. This study looked into the tobacco smoking behavior and, adverse health outcomes, and predictors of smoking behavior among chronic disease patients in both tobacco-producing and non-producing areas of Nakhon Si Thammarat, Thailand. An analytical cross-sectional study was undertaken with 879 patients with chronic disease in tobacco producing and non-producing districts. Participants were recruited via simple random sampling from local primary care patient registries, with a fixed allocation technique. Data were collected by face-to-face interviews with a verified structured questionnaire. Ordinal logistic regression was used to identify predictors of smoking status. The overall smoking rate was 19.3% (7.5% current and 11.8% former). Males accounted for 98.5% of individuals who had previously smoked. High morbidity was noted, with 28.8% of smokers having COPD and 54.7% requiring at least four hospitalizations per year. Traditional hand-rolled tobacco (Yasen) dominated usage, especially in production regions (88.1% vs. 75.0%). Multivariable analysis found that females had 99.6% lower odds of smoking (AOR: 0.004, 95% CI: 0.002-0.009). Patients from non-planting areas (AOR: 0.47, 95% CI: 0.28-0.77) and low-income households (AOR: 0.50, 95% CI: 0.26-0.95) had considerably decreased smoking odds. While current prevalence is lower than national averages. Geographic closeness to production and higher household income both contribute to smoking in this group. Therefore, Interventions have to address physical and economic accessibility to traditional tobacco in agricultural communities.