Social Determinants of Health and Tobacco Use in Seven Sub-Saharan African Countries: Evidence from the Global Adult Tobacco Survey

Abstract

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. Using nationally representative data from Global Adult Tobacco Surveys (GATS) conducted in seven SSA countries (2012-2018), this study explores the impact of the social determinants of health on 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 impact of these determinants on current tobacco use in each country and for the combined dataset. The pooled data analysis was further stratified by tobacco product category and sex. We found significant homogenous impacts of the social determinants on 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 less social support (not married or non-religious). 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. Our findings reveal significant impacts of social determinants on tobacco use in SSA, although this association is stronger for SLT use than for smoking.

Note:
Funding Information: The current study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of Interests: The authors declare that no competing interests exist.

Keywords: social determinants of health, Tobacco Smoking, Smokeless Tobacco, Sub-Saharan Africa, SSA