Trends in Prevalence of Tobacco Use by Sex and Socioeconomic Status in 22 Sub-Saharan African Countries, 2003-2019

Abstract

IMPORTANCETobacco companies have shifted their marketing and production to sub-Saharan African countries, which are in an early stage of the tobacco epidemic. OBJECTIVE To estimate changes in the prevalence of current tobacco use and socioeconomic inequalities among male and female participants from 22 sub-Saharan African countries from 2003 to 2019. DESIGN, SETTING, AND PARTICIPANTS Secondary data analyses were conducted of sequential Demographic and Health Surveys in 22 sub-Saharan African countries including male and female participants aged 15 to 49 years. The baseline surveys (2003-2011) and the most recent surveys (2011-2019) were pooled. EXPOSURES Household wealth index and highest educational level were the markers of inequality. MAIN OUTCOMES AND MEASURES Sex-specific absolute and relative changes in age-standardized prevalence of current tobacco use in each country and absolute and relative measures of inequality using pooled data. RESULTS The survey samples included 428 197 individuals (303 232 female participants [70.8%]; mean [SD] age, 28.6 [9.8] years) in the baseline surveys and 493 032 participants (348 490 female participants [70.7%]; mean [SD] age, 28.5 [9.4] years) in the most recent surveys. Both sexes were educated up to primary (35.7%) or secondary school (40.

Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries

“…36 37 Specifically, in line with the finding that higher female empowerment was found to be associated with lower female to male smoking prevalence ratios, 38 rising economic and educational standards could drive an increase in the smoking prevalence among men but not among women because of persisting social norms and restrictions on women's smoking. Although the differences in smoking prevalence between men and women have been described previously, 39 an additional contribution of our analysis is the finding that smokeless tobacco use among women is similar to, or even greater than, that among men in some low and middle income countries. Therefore, particularly in these countries, tobacco control efforts are important to not exclusively focus on men.…”

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“…. Current tobacco smoking involves the combustion of the tobacco product and inhalation of tobacco smoke through the mouth [8]. Current smokeless tobacco use was derived from the question asking respondents; 'Do you currently use any smokeless tobacco products such as snuff, chewing tobacco, betel?'…”

“…For instance, the prevalence of current tobacco use among male participants ranged from 4.5% in Ghana to 46.0% in Lesotho during the most recent surveys. Except for Lesotho, which also had the highest rate of tobacco use, in all other SSA countries except Zambia, tobacco use rates had significantly decreased in terms of prevalence rates ranging from 1.5% (Ghana) to 9.6% (Sierra Leone) [8]. The highest percentage decrease of tobacco smoking (43.7%) was in Cameroon (from 14.5 to 8.1%) between 2011 and 2018 [8].…”

“…A recent systematic review by Brathwaite et al [7] conducted using studies published between 2007 and 2014 found that men smoked tobacco products more than women in all the SSA countries represented. More recently a study using the latest Global Adult Tobacco Survey (GATS) data by Chandrashekhar et al [8] found that current tobacco smoking varied widely between countries among men and women. For instance, the prevalence of current tobacco use among male participants ranged from 4.5% in Ghana to 46.0% in Lesotho during the most recent surveys.…”

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