Factors affecting tobacco smoking in Ethiopia: evidence from the demographic and health surveys

Association between illegal drug use and cigarette smoking among Ethiopian students: A systematic review and meta-analysis

INTRODUCTION

Cigarette smoking is a persistent public health problem as it is a risk factor for many diseases. Previous studies on the role of illegal drug use in cigarette smoking have yielded disparate and inconclusive results, hindering the development of effective intervention strategies to address this issue. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of cigarette smoking and its associated factors, with a specific focus on the influence of illegal drug use among students in Ethiopia.

METHODS

We conducted a comprehensive search of international databases, including PubMed, Cochrane Library, Science Direct, CINAHL, African Journals Online, HINARI, Global Health, and Google and Google Scholar. Grey literature was also identified from various university digital libraries. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA) guidelines. Due to the high heterogeneity among the included studies (I2 = 98.6%; p-value <0.001), we employed a random-effects model with a 95% confidence interval (CI) to estimate the pooled effect using STATA 14 software. The publication bias was assessed using a statistical Egger regression test.

RESULTS

A total of 22 studies involving 18,144 students met the eligibility criteria for this systematic review and meta-analysis. The pooled prevalence of lifetime and current cigarette smoking among students in Ethiopia was 13.8% (95% CI: 9.90-17.82) and 9.61% (95% CI: 7.19-12.03), respectively. Students who used illegal drugs were twenty-three times more likely to smoke cigarettes compared to their counterparts (OR = 23.57, 95% CI: 10.87-51.1). Living in urban settings (OR = 2.9; 95% CI: 1.15-7.28) and the habit of alcohol consumption (OR = 4.79; 95% CI: 1.57-14.64) were also identified as factors associated with cigarette smoking.

CONCLUSIONS

We found that more than one in eight students in Ethiopia have engaged in lifetime cigarette smoking. Notably, students who used illegal drugs exhibited a significantly higher likelihood of cigarette smoking. In light of these findings, it is imperative to implement comprehensive public health interventions that target illegal drug use, cigarette smoking, and alcohol consumption, with a particular emphasis on urban residents.

Tobacco Use and Associated Factors Among Men in Tanzania: Further Analysis of the 2022 Tanzania Demographic and Health Survey Data

Background: Tobacco use is a significant public health challenge, contributing to preventable diseases and premature deaths globally. We aimed to determine the prevalence of tobacco use and associated factors among men in Tanzania. Methods: This was a cross-sectional analysis of data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey. The study population comprised men aged 15-49 years. Weighted logistic regression was performed to identify factors associated with tobacco use. Results: A total of 5763 men with a mean age of 28.6 ± 10 years were included in the analysis. The overall prevalence of tobacco use was 11.1%, with 95% of users consuming smoked products, 17.1% using smokeless products, and 12.1% using both smoked and smokeless products. Older age was associated with increased odds of tobacco use, with odds of tobacco use increasing with each higher age group. Similarly, alcohol consumption was associated with greater odds of tobacco use. On the other hand, having a secondary education or higher, lack of occupation, being the head of the household, and owning a mobile telephone were associated with lower odds of tobacco use. Geographically, men from the Eastern zone and Zanzibar exhibited greater odds of tobacco use, while those from the Southern highlands zone had lower odds. Conclusion: This study revealed a significant prevalence of tobacco use among Tanzanian men and was associated with different individual, interpersonal, and community factors. The findings underscore the need for targeted interventions considering age-specific risk factors and geographical variations.

Smoke-free law compliance and predictive factors in Ethiopia: observational assessment of public places and workplaces

OBJECTIVES

The primary objective of this observational study was to assess the status of public place and workplace compliance with smoke-free provisions in Ethiopia.

METHODS

This study was conducted in four regions of Ethiopia (Oromia; Sidama; Harari; and Southern Nations, Nationalities, and Peoples' Region) from September to October 2021. Data were collected using a standardised smoke-free checklist. Χ2 tests were used to assess the association between categorical variables and the smoke-free status. Multivariable binary logistic regression analysis was used to identify factors associated with the presence of at least one person actively smoking.

RESULTS

Approximately 97% (95% CI 93.1%, 98.8%) of government buildings, 92.5% (95% CI 85.7%, 96.2%) of educational institutions, 89.8% (95% CI 86.3%, 92.5%) of bars, restaurants and cafés, 88.4% (95% CI 82.9%, 92.3%) of food establishments and 84.0% of hotels (95% CI 79.5%, 87.6%) were non-compliant with the tobacco control law. Overall, only 12.3% of sites met the requirements of the current smoke-free law. The multivariable logistic regression models showed that transit facilities (adjusted OR (AOR)=26.66 (95% CI 7.53, 94.41)) and being located in the Harari region (AOR=4.14 (95% CI 2.30, 7.45)) were strongly associated with the presence of active smoking observed during the site visit.

CONCLUSION

This study indicated that public place and workplace non-compliance level was very high in all sites. This calls for more effective implementation of complete smoke-free provisions across all government buildings and institutions in all regions, such as public educational campaigns about the laws and enforcement action for non-compliance. Furthermore, all regional states should adopt Federal Proclamation 1112/2019.

Tobacco use in Haiti: findings from demographic and health survey

INTRODUCTION

Although tobacco has harmful effects on the physical and mental health of individuals, its use remains significant, according to the World Health Organization. To understand this phenomenon, studies have been carried out in many countries around the world, while in Haiti where more than 5,000 people die each year due to tobacco use, little is known about the use of this substance. The aim of this study was to examine the prevalence and the factors associated with tobacco use in Haiti.

METHODS

We used data from the 2016/17 Haitian Demographic Health Survey. Both descriptive and multivariate analyses were conducted using STATA 16.0 software to assess the prevalence and identify factors associated with tobacco use. Results were reported as adjusted odds ratios with 95% confidence intervals. Statistical significance was declared at p < 0.05.

RESULTS

The prevalence of tobacco use was estimated at 9.8% (95% CI: 9.2-10.4) among men and 1.7% (95% CI: 1.5-1.9) among women. Although the prevalence of tobacco use was low among young people, it increased with age. Respondents aged 35 and above, with no formal education, non-Christians, divorced/separated/widowed, from poorest households, rural areas, "Aire Métropolitaine de Port-au-Prince" region, with high media exposure had a higher likelihood of tobacco use.

CONCLUSION

The low prevalence of tobacco use among Haitian women and youth represents a public policy opportunity to prevent these vulnerable groups from starting smoking. Adult male smokers should also be targeted by appropriate policy to reduce the different health burdens associated with tobacco, both for the smokers and other people they may expose to passive smoking. Government and health sector stakeholders, along with community leaders, should create and enforce awareness strategies and rules to control advertisements that encourage irresponsible and health-risky consumption behaviors.

Magnitude and associated factors of chewing khat during pregnancy in Eastern Ethiopia, 2022: a mixed method cross-sectional study

Introduction

khat (Catha edulis Forsk), is an evergreen flowering tree or shrub widely produced and consumed in East Africa and the Arabian Peninsula. In Ethiopia, it is largely produced, freely marketed and consumed by almost all segments of the population. This is more pronounced in the Eastern part of the country. However, there exists little scientific information on the level and associated factors of khat use among pregnant women in Ethiopia, despite a few available evidences indicated its adverse effect on pregnancy outcomes. Moreover, the perceived reasons for chewing khat during pregnancy were not yet explored qualitatively to triangulate the quantitative findings. Hence, the aim of the present study was to determine the magnitude and associated factors of chewing khat during pregnancy in Eastern Ethiopia, 2022, in a Mixed Method study approach.

Methods

an institution-based cross-sectional study was conducted from August 1st to 14th, 2022 using both quantitative and qualitative methods. Two hundred forty-two pregnant mothers on Antenatal care (ANC) were included in the study. Moreover, 18 purposively selected pregnant mothers on ANC were also considered for qualitative data. Analysis of quantitative data was performed on Statistical Package for the Social Sciences (SPSS) version 27 and thematic framework analysis was performed for qualitative data. Univariable and multivariable logistic regression analysis was performed to identify variables which are significantly associated with khat chewing during pregnancy and to estimate the variable's crude and adjusted odds' ratio with corresponding 95% CI. The statistically significant association was declared at p-value of less than 5.

Results

the overall magnitude of chewing khat during pregnancy in the present study was 27.4% (95% CI: 22.2-33.0). Variables which significantly associated with chewing khat during pregnancy in this study were being >26 years [adjusted odds' ratio (AOR)=2.81 95% CI: 1.19-6.59], being a rural resident (AOR=2.82 95% CI: 1.19-6.69), being illiterate (AOR=4.31 95% CI: 1.02-18.20), participants having chewer husbands (AOR=3.51 95% CI: 1.33-9.24) and respondents having other chewer family members (AOR=3.05 95% CI: 1.19-7.77). In addition, the perceived reasons for chewing khat explored through in-depth interviews were for socialization, to obey tradition, to be happy with friends, husbands and families, to be free from tensioned situations, to be effective in performing daily activities, and due to lack of knowledge of its harm.

Conclusion

in the present study, a relatively higher proportion of mothers chewed khat during their current pregnancy. Being older age, living in rural areas, being illiterate, having khat chewer husbands and other family members were statistically significant variables associated with khat chewing during pregnancy. Moreover, pregnant mothers are practicing chewing of khat in the current study area due to deep-rooted sociocultural issues. Hence, creation of awareness on possible harm of chewing khat during pregnancy especially for those found to be at significantly increased risk of consumption in this study is highly recommended during their antenatal care visits. In addition, creation of awareness out of health institutions, at household and community level, is highly recommended, probably using community volunteers (health development armies) in the present study area. At last, we highly also recommend the local government and religious leaders to work on how to stop the chewing practice especially during pregnancy. For example, the local government and religious leaders can work on averting consideration of chewing by the community as culturally accepted practices.

Gendered Pattern and Predictors of Tobacco use in India: Evidence from the Second Round of Global adult Tobacco Survey

Background

India has completed the second round of the Global Adult Tobacco Survey (GATS) to monitor adult tobacco use and progress in tobacco control efforts. This study assesses the gendered pattern of tobacco use and its predictors in the second rounds of GATS.

Material and Methods

Publicly available GATS-2 (2016-2017) data was analyzed which contains self-reported tobacco use information of ≥15 years Indians (n = 74,037). The independent predictors of "smoking only," "smokeless only," and "dual use" among current male and female tobacco users were assessed using the multinomial regression model.

Results

The burden of "smoking only," "smokeless only," and "dual-use" of tobacco were 8.9% (8.74-9.15), 16.69% (16.42-16.96), and 3.89% (3.75-4.03), respectively, in the second round with wide regional variation as well as male dominance in use. Region, age, education, caste, and religion were significantly and consistently associated with different types of tobacco use in both genders. Other contextual predictors of tobacco use were residence, marital status, occupation, awareness, and wealth index (WI).

Conclusions

Tobacco use predictors and their gendered patterns are contextual. Monitoring the predictors for tobacco use, which may change over time, should be given priority in the national tobacco control program.

Prevalence and risk factors for tobacco, khat, and alcohol consumption among high school students in Ethiopia

BACKGROUND

Tobacco, khat, alcohol, and marijuana are the main risk factors for non-communicable diseases. There are limited studies on substance use in Ethiopia, especially among secondary school students. This study aims to determine the epidemiology of substance use among secondary school students in Ethiopia.

METHODS

This cross-sectional study was conducted in March 2020 in four large regions of Ethiopia and the capital Addis Ababa. We collected data from 3,355 grade 9 and grade 10 students in 36 randomly selected high schools. Data were collected on tobacco, khat, alcohol and other substances. Mixed effect logistic regression models were fitted to determine the predictors of cigarette smoking.

RESULTS

157 (4.7%) of the participants ever smoked cigarettes and 81 (2.4%) were current smokers. 106 (3.2%) ever used smokeless tobacco, 1,342 (41.8%) had ever drunk alcohol, 290 (8.7%) ever used khat, 137 (4.8%) chewed khat regularly and 76 (2.3%) ever used marijuana. There was a significant regional variation in substance use patterns; cigarette and khat use was the highest in southern regions, whereas alcohol use was highest in the northern areas. Availability of cigarette and khat shops within a 100-meter radius of the school compound was reported by 1,229 (37.5%) and 816 (25%) students, respectively. Three hundred fifty-four (10.9%) students had ever seen someone smoking a cigarette in the school compound. Ever use of smokeless tobacco (Adjusted Odds Ratio (AOR) = 9.4, 95%CI: 4.9-17.9), ever use of shisha (AOR = 8, 95% CI: 3.9-16.3), ever use of khat (AOR = 4.1, 95%CI: 2.5-6.8), ever use of alcohol (AOR = 2.3, 95%CI: 1.4-3.7), having a friend who smoked a cigarette (AOR = 2, 95%CI: 1.2-3.5), and ever seen someone smoking a cigarette in the school compound (AOR = 1.9, 95%CI: 1.1-3.4) were associated with ever use of cigarettes.

CONCLUSION

Substance use prevalence in Ethiopia has regional variations and prevention strategies should be tailored to the needs of the regions. Although this study reported a lower prevalence of cigarette smoking, students could access cigarettes and khat in nearby school areas. The existing tobacco control laws that prohibit selling tobacco products to children and adolescents under 21 years of age and ban establishing tobacco shops close to school compounds should be enforced.

Nearly One-Fourth of Eastern Ethiopian Adolescents are Current Psychoactive Substance Users: A School-Based Cross-Sectional Study

Introduction

Psychoactive substance use is a growing health problem in both developing and developed countries. Despite adolescents being at high risk of practicing risky behaviors including substance use, there is no adequate information on the problem in the Harari Region, in the Eastern part of Ethiopia. Hence, the present study aimed to identify the burden of current substance use in high school adolescent students of Harari Region, Ethiopia, from 10th April to 10th May 2022.

Methods

A school-based cross-sectional study was employed on a total of 1498 randomly selected adolescent students. Poisson regression was used for the assessment of substance use over the last three months among adolescent students. The substance use burden was reported by IRR (incidence rate ratio) at a 95% Confidence interval. The final model fitness was checked using Akaike information criterion (AIC) and Bayesian information criterion (BIC) reports. The variables that had less than 0.05 P-value were declared to be statistically significant.

Results

The overall psychoactive substance use was 373 (24.9%, 95% Confidence Interval (CI); 22.8-27.1%). The substances included khat (21.6%, 95% CI; 18.6-23.6%), alcohol drinking (1.8%; 95% CI; 1.3-2.6%), and smoking (1.2%, 95% CI; 0.75-1.9%). Being male (IRR (Incidence Rate ratio) = 1.21, 95% CI; 1.11-1.38), availability of the substance (IRR (Incidence Rate ratio) = 2.02, 95%; 1.53-2.66), having substance user friends (IRR=1.60: 95% CI: 1.30-2.01), and being at a younger age (IRR = 1.21; 95% CI: 1.02-1.44) increased the psychoactive substance use rate in the adolescents.

Conclusion and Recommendation

One out of four adolescents was a current psychoactive substance user. Being male, substance availability, having substance-user friends, and being at younger age increased the psychoactive substance use rate in school adolescents in Eastern Ethiopia. The intervention that involves the schools' community, students' families, and executive bodies should be strengthened to overcome the substance use-related burdens among high school adolescent students.

Prevalence of dysmenorrhea and associated risk factors among university students in Zimbabwe

BACKGROUND

Dysmenorrhea is an often incapacitating condition that is characterized by painful menstruation and general body malaise. In Zimbabwe, this condition is understudied, and its associated risk factors are poorly understood.

OBJECTIVES

To investigate the prevalence and associated risk factors of dysmenorrhea among female students at Midlands State University in Zimbabwe.

DESIGN

This is a cross-sectional study that employed simple random sampling technique to obtain data from 382 students using pretested and self-administered questionnaires.

METHODS

Data were analyzed using STATA version 16. Associations between dysmenorrhea, menstrual, sociodemographic, and lifestyle characteristics were measured using chi-square test and logistic regression model.

RESULTS

The prevalence of dysmenorrhea was 75.9%, with 28.6% of sufferers describing their pain as severe. Dysmenorrhea significantly affected the school/daily activities of respondents (χ2 = 18.22, p < 0.001). Family history (χ2 = 4.28, p = 0.04), age of menarche (χ2 = 14.8, p < 0.001), regularity of menstrual cycle (χ2 = 18.1, p < 0.001), and parity (χ2 = 8.8, p = 0.03) were associated with the prevalence of dysmenorrhea. The risk of developing dysmenorrhea almost doubled with positive family history (prevalence odds ratio = 1.68 (95% confidence interval: 1.03 to 2.75, p = 0.040)); increased with decrease in age of menarche (prevalence odds ratio = 0.19 (95% confidence interval: 0.10 to 0.45, p < 0.001)) and decreased with increase in parity (prevalence odds ratio = 0.15 (95% confidence interval: 0.03 to 0.82, p = 0.029)). However, the risk was low among those with irregular menstrual cycles (prevalence odds ratio = 0.14 (95% confidence interval: 0.10 to 0.33, p < 0.001)). Physical exercise, smoking, alcohol, and coffee consumption were not associated with the prevalence of dysmenorrhea (p > 0.05).

CONCLUSION

Dysmenorrhea is common among female students at Midlands State University, and it significantly affects their academic activities. Family history, regular menstrual cycle, nulliparity, and lower age of menarche were risk factors. More awareness is recommended including studies on impact and management strategies.

Geographical variation and correlates of substance use among married men in Ethiopia: spatial and multilevel analysis from Ethiopian Demographic and Health Survey 2016

OBJECTIVE

The use of substances has become one of the world's most serious public health and socioeconomic issues. Most nations in sub-Saharan Africa, including Ethiopia, are undergoing significant economic transitions, creating a favourable environment for socially destructive substance use. This study aimed to determine the geographical variation, prevalence and correlates of substance use among ever-married men in Ethiopia.

DESIGN

A community-based cross-sectional survey was undertaken from 18 January 2016 to 27 June 2016.

DATA SOURCE

Data were used from the 2016 Ethiopian Demographic and Health Survey (EDHS).

DATA EXTRACTION AND ANALYSIS

Data from the 2016 EDHS was used, and a total of 7793 ever-married men were involved in the analysis. The spatial autocorrelation statistic (Global Moran's I) was used to determine whether substance use was dispersed, clustered or randomly distributed. A multilevel logistic regression model was used to identify the correlates with substance use, and statistical significance was declared at p<0.05 and 95% CI.

RESULTS

Of all ever-married men, 72.5% (95% CI 71.5% to 73.4%) were currently using at least one of the three substances (alcohol, cigarettes and chat). The highest hotspot areas of substance use were observed in Ahmara and Tigray regions. The age (adjusted OR, AOR 1.80; 95% CI 1.32 to 2.45), educational status (AOR 0.64; 95% CI 0.51 to 0.82), occupation (AOR 1.36; 95% CI 1.05 to 1.76), watching television (AOR 1.50; 95% CI 1.25 to 1.81) and living in the city (AOR 2.25; 95% CI to 1.36 to 3.74) were individual and community-level correlates found to have a statistically significant association with substance use.

CONCLUSION

In this study, nearly three-fourths of married men used one of the three substances. Given these findings, it is critical to reducing the problem by improving modifiable individual-level variables such as educational status and reducing substance advertising.

[Prevalence and factors associated with smoking among adults living in the Moungali district of Brazzaville in 2021]

Introduction

tobacco epidemic is a real public health problem in the world and in Africa. The purpose of this study was to estimate the prevalence and identify factors associated with smoking among adults living in the Moungali district.

Methods

we conducted a cross-sectional analytical study of 800 adults. Two-stage random sampling was used to select subjects in the Moungali district, Brazzaville, in September 2021. Binary logistic regression using the ascending stepwise method allowed identification of the associated factors. The adjustment of the model was verified by the Hosmer Lomeshow test. Data were collected via the Kobo collect V1.30.1 app. and analyzed with the Stata 15.0 software.

Results

smoking prevalence was 4.63%, 95% CI [3.37-6.31]. Males (AOR=8.36 95% CI [3.74-18.72], p-value < 0.0001), alcohol consumption (AOR=2.6 95% CI [1.11-6.11], p-value = 0.028), and professional activity (formal or informal sector) (AOR=3.91 95% CI [1.16-13.11], p-value = 0.027) were factors significantly associated with smoking.

Conclusion

this study highlights that smoking is a stronger risk factor in men than in women. In addition, alcohol consumption and professional activity in the formal or informal sector are also factors associated with active smoking. Preventive actions focusing on these factors are necessary to effectively fight smoking in adults.

Prevalence of and factors associated with tobacco smoking in the Gambia: a national cross-sectional study

OBJECTIVES

To examine the prevalence of and risk factors associated with tobacco smoking in the Gambia.

DESIGN

A nationwide cross-sectional study.

SETTING

The Gambia.

PARTICIPANTS

The study participants were both women and men aged between 15 and 49 years old. We included 16,066 men and women in our final analysis.

DATA ANALYSIS

We analysed data from the Gambia Demographic and Health Survey (DHS), 2019-2020. DHS collected nationally stratified data from local government areas and rural-urban areas. The outcome variable was the prevalence of tobacco smoking. Descriptive analysis, prevalence and logistic regression methods were used to analyse data to identify the potential determinants of tobacco smoking.

RESULTS

The response rate was 93%. The prevalence of current tobacco smoking was 9.92% in the Gambia in 2019-2020, of which, 81% of the consumers smoked tobacco daily. Men (19.3%) smoked tobacco much higher than women (0.65%) (p<0.001). People aged 40-49 years, with lower education, and manual workers were the most prevalent group of smoking in the Gambia (p<0.001).Men were 33 times more likely to smoke tobacco than women. The chance of consuming smoked tobacco increased with the increase of age (adjusted OR (AOR) 9.08, 95% CI 5.08 to 16.22 among adults aged 40-49 years, p<0.001). The strength of association was the highest among primary educated individuals (AOR 5.35, 95% CI 3.35 to 8.54).Manual workers (AOR 2.73) and people from the poorest households (AOR 1.86) were the risk groups for smoking. However, place of residency and region were insignificantly associated with smoking in the Gambia.

CONCLUSIONS

Men, older people, manual workers, individuals with lower education and lower wealth status were the vulnerable groups to tobacco smoking in the Gambia. Government should intensify awareness programmes on the harmful effects of smoking, and introduce proper cessation support services among tobacco smoking users prioritising these risk groups.

Prevalence of Clinical Cardiovascular Disease Risk Factors Among HIV Infected Patients on Anti-Retroviral Treatment in a Tertiary Hospital in Ethiopia

Background

Anti-retroviral treatment has improved mortality of human immunodeficiency virus (HIV) infected patients, which is offset by an increasing burden of cardiovascular diseases (CVD). Data regarding prevalence of cardiovascular disease risk factors in HIV infected patients in Ethiopia are very scarce. The aim of this study was to determine the prevalence of CVD risks and associated factors in patients with HIV.

Methods

A cross-sectional study was conducted on 333 patients with HIV infection, using a modified World Health Organization’s stepwise approach to surveillance questionnaire. Anthropometric and blood pressure measurement was done along with biochemical studies. Cardiovascular risk was estimated using Framingham risk score. Multivariate logistic regression was used to examine the association between cardiovascular risks and associated factors, with a p-value of <0.05 considered statistically significant.

Results

The mean age of the participants was 45 years, and 69.2% were females. Most (80.9%) of the participants had viral load below 50 copies/mL and the mean CD4 count was 579 cells/mm³. Dyslipidemia was the most common risk factor identified in 69.4%, followed by abnormal fasting blood glucose (≥100 mg/dL) in 36.8%. Hypertension was diagnosed in 23.8%, while 22.8% and 11.1% had metabolic syndrome and obesity, respectively. Framingham risk score was low in 95.9%. Male gender, increasing age, high body mass index and previous ART regimen being tenofovir disoproxil fumarate, lamivudine and nevirapine increased CVD risk factors.

Conclusion

Traditional cardiovascular risk factors were high in the population studied. There is a need to raise awareness about the risk factors, and patients should have timely follow-up and care.

The potential distributional health and financial benefits of increased tobacco taxes in Ethiopia: Findings from a modeling study

Ethiopia raised taxes on tobacco products in early 2020, increasing the overall price of the typical pack of cigarettes by about 67%. We quantify the potential impacts of Ethiopia's tobacco tax hike on various outcomes-life years, tax revenues, cigarette expenditures and catastrophic health expenditures (CHE). Using parameters like price elasticity of demand for cigarettes and smoking prevalence in Ethiopia from the existing literature and secondary data sources, we model the potential implications of the reform at the population level and for different wealth quintiles. We focus only on men since a small proportion of Ethiopian women smoke. Results indicate that Ethiopia's tax hike could induce a significant proportion of current smokers to quit smoking and thereby save almost eight million years of life in the current population. The reform is also likely to increase tax revenues by USD26 million in the first year after its introduction. The richest quintile will bear the greatest share of this higher tax burden and the poorest will bear the least. Additionally, deaths due to the main diseases associated with smoking will fall. This is expected to avert up to 173,000 CHE cases due to the out-of-pocket costs that would have been incurred in obtaining medical treatment. This analysis highlights that cigarette tax hikes in countries that have low smoking prevalence can reduce smoking even further, and thereby protect against the future health and financial costs of smoking. Importantly, the effects of these policies can be progressive across the income spectrum.

'They have a right to participate as a stakeholder': Article 5.3 implementation and government interactions with the tobacco industry in Ethiopia

INTRODUCTION

This paper explores implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control in Ethiopia. The analysis highlights how operationalising key requirements of Article 5.3, such as minimising policy engagement with the tobacco industry, has been mediated by path-dependent processes of stakeholder consultation and collaboration that have persisted following privatisation of Ethiopia's state-owned tobacco monopoly.

METHODS

We conducted semistructured interviews with key officials (n=21) working in tobacco control policy, with high levels of access secured across ministries and agencies beyond health.

RESULTS

We found contrasting levels of awareness of Article 5.3 across government sectors, with extremely limited awareness in departments beyond health. The data also highlight competing ideas about conflict of interest, in which recognition of a fundamental conflict of interest with the tobacco industry is largely confined to health actors. Beyond limited cross-sectoral awareness and understanding of Article 5.3, gaps in implementation are exacerbated by assumptions and practices around stakeholder consultation, in which attempts to minimise policy interactions with the tobacco industry are mediated by institutionally embedded processes that presume active engagement. The results also highlight a continuation of the close relationship between the Ethiopian government and tobacco monopoly following its privatisation.

CONCLUSION

The Ethiopian government's recent achievements in tobacco control legislation require that policymakers are actively supported in reconciling perceived tensions and requirements for stakeholder consultation. Effective tobacco control governance would be further enhanced by enabling government agencies to more clearly identify which interactions with the tobacco industry are strictly necessary under Article 5.3 guideline recommendations.

The Magnitude of NCD Risk Factors in Ethiopia: Meta-Analysis and Systematic Review of Evidence

Background: Non-communicable Diseases (NCDs) and their risk factors are the leading contributors to morbidity and mortality globally, particularly in low- and middle-income countries including Ethiopia. To date, there has been no synthesis of the literature on the relative prevalence of NCD risk factors in Ethiopia. Methodology: We conducted a systematic review and meta-analysis of primary studies reporting on the prevalence of NCD risk factors in Ethiopia published in English from 2012 to July 2020. Pre-tested NCD search terms were applied to Medline, Embase, Scopus, CINAHL, and Global Health. Three reviewers screened and appraised the quality of the identified papers. Data extraction was conducted using a pilot tested proforma. Meta-analysis was conducted using Stata 16 and pooled prevalence estimated with associated 95% confidence intervals. Clinically heterogeneous studies that did not fulfil the eligibility criteria for meta-analysis were narratively synthesised. I² was used to assess statistical heterogeneity. Results: 47 studies fulfilled the inclusion criteria and contributed 68 NCD risk factor prevalence estimates. Hypertension was the most frequently examined NCD risk factor, with a pooled prevalence of 21% (n = 27 studies). The pooled prevalence percentages for overweight and obesity were 19.2% and 10.3%, respectively (n = 7 studies each), with a combined prevalence of 26.8% (n = 1 study). It was not possible to pool the prevalence of alcohol consumption, smoking, metabolic disorders, or fruit consumption because of heterogeneity across studies. The prevalence of alcohol use, as reported from the included individual studies, ranged from 12.4% to 13.5% (n = 7 studies). More than 90% of participants met the WHO-recommended level of physical activity (n = 5 studies). The prevalence of smoking was highly variable, ranging between 0.8% and 38.6%, as was the prevalence of heavy alcohol drinking (12.4% to 21.1%, n = 6 studies) and metabolic syndrome (4.8% to 9.6%, n = 5 studies). Fruit consumption ranged from 1.5% up to the recommended level, but varied across geographic areas (n = 3 studies). Conclusion and recommendations: The prevalence of NCD risk factors in Ethiopia is relatively high. National NCD risk factor surveillance is required to inform the prioritisation of policies and interventions to reduce the NCD burden in Ethiopia.

"If I don't smoke shisha, I won't be able to sleep": lived experiences of high school students in Ethiopia

Background

Shisha smoking predisposes the users to cardiovascular diseases, cancer, and infections, such as tuberculosis, hepatitis, and herpes. In Ethiopia, there is little data on the adolescents' shisha smoking experience. This study aimed to explore the lived experience of high school students and inform ongoing and future prevention and control interventions.

Methods

This study was conducted in Addis Ababa and Adama cities in Ethiopia. Twenty-five secondary school students aged 15-22 years who had shisha smoking experience participated in this study. A topic guide was used to facilitate the in-depth interviews (IDIs) and a digital audio recorder recorded the interviews. Interviews varied between 40-90 minutes and were conducted in private open-air spaces where only the interviewee and researcher were present. Each transcript was coded using Atlas.ti version 8 software. The analytical approach was iterative, with interview transcripts analyzed at the time of coding and re-analyzed after a preliminary result was drafted to search for additional themes.

Results

Students described two key factors that influenced their decision to initiate shisha smoking: peer influence and perceiving it as a means to release stress. After initiating shisha use students maintained the behaviour because of: peer influence, khat chewing, enjoyment of shisha smoking, having prolonged leisure time, and accessibility to shisha. Students regretted the impact shisha use had on their lives, such as conflict with their families, poor academic performance, and spending money on shisha smoking. Female students were also concerned about reproductive health risks related to shisha use.

Conclusions

Peer influence played a major role both in initiating and maintaining shisha use. However, students admitted concern over the impact of shisha smoking on academic performance and their relationship with their families. Since shisha use is associated with khat chewing; shisha smoking control programs cannot be successful without controlling khat. Especially young girls had worries about their reproductive health risks associated with shisha use. This suggests that targeted awareness raising programs highlighting the dangers of shisha use for both health and safety; especially for young women is required.

Tobacco use prevalence and its determinate factor in Ethiopia- finding of the 2016 Ethiopian GATS

BACKGROUND

Tobacco, one of the risk factors for non-communicable diseases, kills 8 million people each year. Like other sub-Saharan countries, Ethiopia faces the potential challenge of a tobacco epidemic. However, there is no organized data on the prevalence of tobacco use in the country. Therefore, this study aims to determine adult tobacco use in Ethiopia.

METHODS

The study was conducted using the WHO and CDC GATS survey methods. Complex survey analysis was used to obtain prevalence and population estimates with 95% confidence intervals. Bivariate regression analyses were employed to examine factors related to tobacco use.

RESULTS

The overall tobacco use percentage was 5.0% [95% CI (3.5, 6.9)], of which 65.8% [95% CI (53.4, 76.3)] only smoked tobacco products; 22.5% [95% CI (15.7, 31.2)] used smokeless tobacco only; and 11.8% [95% CI (6.5, 20.4)] used both smoked and smokeless tobacco products. In 2016, more men adults (8.1%) used tobacco than women did (1.8%). Eight out of eleven states have a higher smoking rate than the national average (3.7%). Gender, employment, age, religion, and marital status are closely linked to current tobacco use (p-value< 0.05). Men adults who are employed, married, and mostly from Muslim society are more likely to use tobacco.

CONCLUSION

The prevalence of tobacco use is still low in Ethiopia. However, the percentage of female smokers is increasing, and regional governments such as Afar and Gambella have a relatively high prevalence. This calls for the full implementation of tobacco control laws following the WHO MPOWER packages. A tailored tobacco control intervention targeting women, younger age groups, and regions with a high proportion of tobacco use are recommended.

Cigarette smoking prevalence and associated factors among college students, Amhara, Ethiopia

INTRODUCTION

tobacco is the only legal drug that kills many of its users when used exactly as intended by the manufacturers. It is estimated that of the 1.1 billion smokers worldwide, nearly 80% of them live in low and middle-income countries. This trend increases in college and university students with most smokers starting to smoke during adolescent. The aim of this study is to assess cigarette smoking prevalence and associated factors among a select group of college of teachers´ education students.

METHODS

a cross-sectional study was conducted. Multistage sampling was used to select 605 study participants from across the eight departments of the Injibara College of Teachers´ Education. Each subject was selected by simple random sampling technique after proportional allocation to each class. EpiData version 4.2 was used for data entry and Stata version 14 was used for data cleaning and analysis. Variables with p-value < 0.2 in bi-variable analysis were selected for multi-variable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported to show the strength of association.

RESULTS

the current prevalence of cigarette smoking is 6.8% amongst the Injibara College of Teachers´ Education students. Males [AOR: 2.84 (95% CI: 1.13, 7.14)], divorced marital status [AOR: 7.27 (95% CI: 1.23, 42.85)], food source in hostel [AOR: 11.62 (95% CI 3.23, 41.71)] and exposure to family/other smokers [AOR: 6.17 (95% CI: 2.17, 16.06)] were statistically significant factors for cigarette smoking.

CONCLUSION

the prevalence of cigarette smoking was relatively low. Male, marital status, source of food, and exposure to family/other smokers were identified associated factors. Policy makers and health regulatory body are strongly encouraged to consider this evidence and the associated factors for smoking in their efforts to develop and implement tobacco control laws.

Bioinsecticide Production from Cigarette Wastes

Tobacco, one of the most significant nonfood crops, is critical to agriculture worldwide. The tobacco processing business creates a significant amount of hazardous tobacco waste containing nicotine, and only a tiny portion of it gets recycled. Nicotine, the primary component of tobacco products such as cigarettes, is an alkaloid and can be used as an insecticide. This research aims to extract nicotine from discarded cigarette butts and utilize it as an insecticide. Extraction, emulsification, and efficiency testing on cabbage aphids are all part of the procedure. The initial extraction tests used a solvent combination of ethanol and methanol in various ratios, with a 3 : 1 ratio yielding the best results. Temperature (30–60°C), extraction length (4–6 hrs), and sodium hydroxide concentration (1–3 M) are the independent variables studied for extraction parameters, and the optimal conditions are determined using Design-Expert, response surface approach central composite design (RSM-CCD). In addition, artificial neural network (ANN) studies with MATLAB were used to accurately forecast extraction yield. The extracted product was evaluated using a gas chromatography–mass spectrometry (GC-MS) and a UV/visible spectrophotometer. The ideal crude extract yield and nicotine content were 17.75 and 3.26%, respectively, at the optimal conditions of temperature 60°C, time 4 hrs, and NaOH concentration 2.83 M with desirability of 0.832. The nicotine extracted was emulsified by combining the crude extract with a combination of palm oil and surfactants. Density, viscosity, pH, flash point, and surface tension of the emulsified concentration were measured and reported as 1.01 ± 0.01 g/ml, 585.33 ± 2.52 mPa s, 9.37 ± 0.03, 87.96 C, and 34.10 mN/m, respectively. On the cabbage aphid, the emulsified concentrated extract performed best at a ratio of 1 : 100 (emulsified concentrated to solvent).

Tobacco Use Among Reproductive Age Women in Ethiopia: Evidence from the National Health Survey

Purpose

To assess the prevalence and determinants of current tobacco use among reproductive-age women in Ethiopia.

Methods

A cross-sectional study was conducted by utilizing secondary data taken from the Ethiopian Demographic Health Survey of 2016. Descriptive statistics and logistic regressions were used to analyze the data. The odds ratio with a 95% confidence interval was considered to interpret associations and a significant association was stated at a p-value < 0.05.

Results

The overall magnitude of current tobacco use was 1.4% (n= 217). Majority of them 59.91% (n= 130) smoke cigarettes and followed by smoking gaya 43.32% (n= 94). Higher prevalence was found among participants from Gambella 44.24% (n= 96), Benishangul.59% (n= 36) and afar regions 13.36% (n= 29). Age group of 25–34 years [AOR = 2.78; 95% CI: 1.69, 4.57)], age group of ≥ 35 years [AOR = 4.24; 95% CI: 2.54, 7.07)], followers of protestant religion [AOR = 2.36; 95% CI: 4.17, 9.42], Islamic religion [AOR = 3.92; 95% CI: 2.16, 7.11], and traditional religion [AOR = 16.23; 95% CI: 8.33, 31.61], being in poorest wealth index [AOR = 15.78; 95% CI: 7.38, 33.70], poorer wealth index [AOR = 5.85; 95% CI: 2.64, 12.97], middle wealth index [AOR = 3.61; 95% CI: 1.57, 8.29], and richer wealth index [AOR = 2.48; 95% CI: 1.10, 5.85], who were never in union [AOR = 0.31; 95% CI: 0.14, 0.67], ever drinking alcohol [AOR = 5.44; 95% CI: 3.71, 7.95] and ever chewing khat [AOR = 7.59; 95% CI: 4.99, 11.55] were factors associated with current tobacco use.

Conclusion

Women used tobacco in different forms, and its distribution varies across Ethiopian regional states. The concerned body needs to give attention to the identified associated factors and regions with higher tobacco use.

Tobacco use and associated factors among adults reside in Arba Minch health and demographic surveillance site, southern Ethiopia: a cross-sectional study

BACKGROUND

Tobacco use is one of the world-leading preventable killers. There was a varied prevalence of tobacco use and cigarette smoking across different areas. The aim of the study was to assess the prevalence and factors associated with current tobacco use among adults residing in Arba Minch health and demographic surveillance site (HDSS).

METHODS

A community-based cross-sectional study was conducted among adults residing in Arba Minch HDSS in 2017. The estimated sample size was 3368 individuals which were selected by simple random sampling techniques using Arba Minch HDSS dataset. Data collection tools were obtained from the WHO STEPwise. Current use of tobacco, which defined as the current use of smoked and/or smokeless tobacco, was considered as the dependent variable. A binary logistic regression model was used to identify candidate variables for the multivariable logistic regression model. An adjusted odds ratio (AOR) at a p-value of less than 0.05 was used to determine a statistically significant association between independent and dependent variables.

RESULT

The prevalence of tobacco use among adults was 20.2% (95% CI: 18.9-21.6%). The current use of smoked and smokeless tobacco were 17.1% (95%CI: 15.8-18.4%) and 9.7% (95%CI: 8.8-10.8%), respectively. The current use of tobacco was significantly associated with sex (female [AOR 0.54; 95%CI: 0.42-0.68] compared to men), age group (35-44 [AOR 1.57; 95%CI: 1.14-2.17], 45-54 [AOR 1.99; 95%CI: 1.45-2.74], and 55-64 [AOR 3.26; 95%CI: 2.37-4.48] years old compared to 25-35 years old), physical activity (moderate physical activity level [AOR 0.65; 95%CI: 0.44-0.96] compared with low) and residency (highland [AOR 4.39; 95% CI: 3.21-6.01] compared with at lowlander). Also, heavy alcohol consumption (AOR 3.97; 95% CI: 3.07-5.12), and Khat chewing (AOR 3.07(95%CI: 1.64-5.77) were also associated with the use of tobacco among the study participants.

CONCLUSION

Nearly one in five adults used tobacco currently in the study area, which is more than the national reports. Interventions for the reduction of tobacco use need to give due attention to men, older adults, uneducated, poor, and highlanders.

Predictors of hookah smoking frequency among women in the South of Iran: A cross-sectional study

The prevalence of hookah smoking has grown over the past decades in Iran especially in the south of the country. This study aimed to determine the behavioral and socio-demographic predictors of the hookah smoking frequency among women in southern Iran. This research was conducted on 400 women hookah smokers selected through multi-stage sampling method. Data were collected from October 2018 to September 2019 using a questionnaire guided by literature. Ordinal logistic regression analysis was run to determine the influential behavioral and socio-demographic predictors involved in the frequency of hookah smoking. Variables with a P-value of less than 0.05 in the final fitting model were associated with the outcome variable (frequency of hookah smoking per day1 = once a day, 2 = twice a day, 3 = three times a day, 4 = more than three times a day). We found that the longer duration of hookah smoking, family usage of hookah smoking, beginning to smoke hookah with peers, absence of either parent in family (single-parent families and a lack of prior intention to cease smoking), ever-married women and low socio-economic status (SES) predicted the frequency of hookah smoking. To prevent the behavior and make effective interventions to reduce hookah smoking, policy-makers should stay focused on factors other than internal motivations. Focus on the companies surrounding women smokers, quitting the habit of hookah smoking and effective interventions to decrease one's intention to smoke hookah can help reduce such unhealthy behaviors.

Prevalence and factors associated with tobacco use among men in India: findings from a nationally representative data

BACKGROUND

Tobacco consumption causes almost 638,000 premature deaths per year in India. This study sought to examine the prevalence and determinants of tobacco use among men in India.

METHODS

We analyzed data from the fourth round of the National Family Health Survey in India. These nationally representative cross-sectional sample data were collected from January 20, 2015, to December 4, 2016. A total of 112,122 men aged 15-54 years were included in this study. Primary outcomes were tobacco use categorized into smoking, smokeless, any tobacco, and both smoked and smokeless tobacco use. Complex survey design and sampling weights were applied in both the descriptive analyses and logistic regression models. We present the findings using odds ratios.

RESULTS

The prevalence of tobacco use among men in India for the studied period was 45.5% (95% CI 44.9-46.1), smoking was 24.6% (95% CI 24.1-25.1), smokeless tobacco use was 29.1% (95% CI 28.6-29.6), and both smoked and smokeless tobacco use was 8.4% (95% CI 8.1-8.7). The prevalence of tobacco use among men was higher among the elderly, separated/divorced/widowed individuals, those with lower education and wealth status, alcohol consumers, manual workers, and residents of the northeast region. Multivariate analysis showed that age, lower education, occupation, region, alcohol consumption, separated/divorced/widowed status, and economic status were substantially associated with tobacco use among Indian men.

CONCLUSIONS

Innovative and cost-effective strategies targeting high-risk groups are crucial to curbing the tobacco epidemic in India. Anti-smoking campaigns should also focus on mitigating alcohol abuse. Reducing tobacco marketing and implementing formal education about the dangers of tobacco use, progressive taxing, packaging, and labeling of tobacco products and price strategies should be harmonized in legal provisions.

Smoking Intensity and Associated Factors among Male Smokers in Ethiopia: Further Analysis of 2016 Ethiopian Demographic and Health Survey

Background

Smoking invariably has health, social, economic, and environmental consequences in Ethiopia. Reducing and quitting cigarette smoking improves individual health and increases available household funds for food, education, and better economic productivity. Therefore, this study is aimed at assessing cigarette smoking intensity and associated factors among male smokers in Ethiopia.

Methods

The data were extracted from the 2016 national cross-sectional Ethiopian Demographic and Health Survey. Our study used data from the standardized and adapted men's questionnaire. The study included a total of 391 (weighted) smokers who at least smoked one manufactured cigarette per day. The data were collected using a two-stage cluster design which includes selection of enumeration areas and then selection of households. The number of manufactured cigarettes smokers smoked per day was used to measure smoking intensity. Descriptive statistics were used to summarize the study findings. Bivariable and multivariable truncated negative binomial Poisson regression models were employed to determine smoking intensity.

Results

The finding showed that on average men smoked weighted nine cigarettes per day. One in every five of the smokers (21.2%) smoked 10 cigarettes per day. Smokers living in rural areas (IRR = 0.43, 95% CI: 0.244, 0.756), currently married (IRR = 0.64, 95% CI: 0.46, 0.91), formerly married (IRR = 0.54, 95% CI: 0.30, 0.96), richer men (IRR = 0.63, 95% CI: 0.43, 0.90), and richest men (IRR = 0.49, 95% CI: 0.28, 0.87) were associated with lower smoking intensity. Smokers in the Somali (IRR = 2.80, 95% CI: 1.29, 6.11), Harari (IRR = 3.46, 95% CI: 1.14, 10.51), and Dire Dawa (IRR = 3.09, 95% CI: 1.23, 7.80) regions; older age (IRR = 1.77, 95% CI: 1.31, 2.40); affiliated with Protestant religion (IRR = 1.81, 95% CI: 1.12, 2.92); poorer men (IRR = 1.64, 95% CI: 1.19, 2.27); watched television (IRR = 1.18, 95% CI: 1.04, 1.35); drunk alcohol (IRR = 1.37, 95% CI: 1.03, 1.82); and completed primary (IRR = 1.15, 95% CI: 1.01, 0.317) and higher education (IRR = 2.96, 95% CI: 1.88, 4.67) were positively associated with smoking intensity.

Conclusion

Male smokers in Ethiopia smoked intensively with an average of nine manufactured cigarettes per day. Tobacco control interventions should target the following: Eastern Ethiopia regions, older aged, affiliated with Protestant religion, poorer men, watched television, drunk alcohol, and primary and higher educational level.