Social Determinants of Health, Religiosity and Tobacco Use in Sub-saharan Africa: Evidence From the Global Adult Tobacco Survey in Seven Countries.

Abstract

AbstractBackground Tobacco use is projected to increase in sub-Saharan Africa (SSA) over the next century, and delineating the patterns of inequality in tobacco use will facilitate its control within this region. Methods Using nationally representative data from Global Adult Tobacco Surveys (GATS) conducted in seven SSA countries (2012–2018), this study explores the association between the social determinants of health and tobacco use among SSA adults. The surveys provided information on 47,246 adults aged 15 years or older in Cameroon, Ethiopia, Kenya, Nigeria, Senegal, Tanzania, and Uganda. Current tobacco use prevalence was estimated in each country overall and across socioeconomic and demographic factors (sex, age, residence, education, wealth, religion, marital status, and tobacco health knowledge). Multiple logistic regression analysis was used to assess the association of these determinants with current tobacco use in each country and for the combined dataset. The pooled data analysis was further stratified by tobacco product category and sex. Results We found significant homogenous associations between the social determinants and tobacco use across all countries. For the pooled data, smoking was independently associated with male sex, rural residence, greater age, lower education and health knowledge, and irreligiousness. For smokeless tobacco (SLT) use, the trends were similar and stronger for all determinants except sex. Among women only, the odds of smoking and SLT use respectively increased and decreased with greater wealth. Conclusions Tobacco use is significantly associated with socioeconomic deprivation in SSA (stronger for SLT use than for smoking). These findings highlight opportunities for targeted interventions within SSA.