Prevalence and Factors Associated with Tobacco Smoking in a National Representative Sample of Zambian Adults: Data from the 2017 STEPS – NCDs Survey

BACKGROUND: There has been a reduction in tobacco smoking worldwide except in developing countries. Africa has the lowest prevalence of tobacco use in the world, however, the rising trends amidst the WHO FCTC implementation are worrisome as it is likely to increase the tobacco public health impact in the next decade. The study investigated factors associated with tobacco smoking among adults in Zambia. METHODS: We used secondary data extracted from the 2017 STEPS – NCDs Survey. Logistic regression was used to obtain unadjusted (UOR) and adjusted odds ratios (AOR) at 95% confidence interval (CI). RESULTS: Of the 4,301 adults who participated, 11.0% were current tobacco smokers (25.7% men and 2.27% women). Of these 75.6% and 11.9% drunk alcohol and had mental health problems, respectively. In multivariable analysis, factors significantly associated with increased odds of current tobacco smoking were older age groups of 45-59 years (AOR = 1.69; 95% CI: 1.17-2.43, p = 0.005) and 60-69 years (AOR = 2.22; 95% CI: 1.25-3.93, p = 0.006), alcohol consumption (AOR = 5.93; 95% CI: 4.44-7.91, p < 0.001), mental health problems (AOR = 2.08; 95% CI: 1.34-3.22, p = 0.001). On the other hand, female gender (AOR = 0.07; 95% CI: 0.05-0.10, p < 0.001), being diabetic (AOR = 0.52; 95% CI: 0.15-0.46, p = 0.026), education attainment; primary, secondary, and higher education (AOR = 0.65; 95% CI: 0.47-0.91, p = 0.012, AOR = 0.40; 95% CI: 0.29-0.55, p < 0.001 and AOR = 0.26; 95% CI: 0.15-0.46, p < 0.001), respectively, had reduced odds of tobacco smoking. CONCLUSIONS: Our findings underscore the high prevalence of tobacco smoking particularly in uneducated males who consume alcohol and have mental health problems. The mental health problems and alcohol consumption in this population need to be addressed in concert with smoking cessation strategies.