Prevalence of tobacco consumption and the associated factors among the adults in an urban slum: Findings from the WHO STEPwise survey

INTRODUCTION: Despite Pakistan’s stringent tobacco control policy, its effective implementation has always been a challenge, leading to rising tobacco consumption. The aim of the study is to determine the prevalence of tobacco consumption and associated risk factors in the adult population of deprived urban areas. METHODS: A community-based, cross-sectional survey was conducted from February to July 2019, comprising 607 adults residing in the urban squatter settlement of Lahore using a standardized questionnaire, the WHO STEPwise approach. The outcome was current use of tobacco and/or smokeless tobacco daily. Multivariable logistic regression was applied to determine factors associated with smoking and smokeless tobacco consumption. RESULTS: Among 607 participants, about 64% were females, 49.3% were illiterate, 64.9% were currently unemployed, and 47.1% belonged to the low-income group. The prevalence of tobacco smoke was 10.5% (95% CI: 8.07–12.93), and smokeless tobacco consumption was 8.6% (95% CI: 6.38–10.82). Multivariable logistic regression found that smokeless tobacco was more likely among the aged 50–59 years (AOR=4.1; 95% CI: 1.1–13.8) and unemployed (AOR=3.6; 95% CI: 1.1–12.2). Whereas tobacco smoking was more likely among the aged 30–39 years (AOR=5.5; 95% CI: 1.8–16.7), Urdu ethnicity (AOR=2.9; 95% CI: 1.2–7.3), unemployed (AOR=6.6; 95% CI: 2.9–14.9), and never exposed to any media (AOR=3.2; 95% CI: 1.8–17.4). Participants exposed to health warnings were less likely to smoke (AOR=0.02; 95% CI: 0.01–0.05). CONCLUSIONS: This study reports a high prevalence of tobacco consumption among adults and calls for effective policy implementation using a multi-pronged approach, including health professionals and media, to spread awareness about the harmful effects of tobacco and endorsement of health warnings on tobacco packaging.