Tobacco use and associated factors among Adults in Uganda: Findings from a nationwide survey
More details
Hide details
Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
Mental Health and Substance Abuse, Ministry of Health, Kampala, Uganda
Control of Non-Communicable Diseases Desk, Ministry of Health, Kampala, Uganda
School of Statistics and Planning, Makerere University College of Business and Management Sciences, Kampala, Uganda
St. Francis Hospital, Kampala, Uganda
Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
Steven Ndugwa Kabwama   

Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
Publication date: 2016-08-11
Tobacco Induced Diseases 2016;14(August):27
Tobacco use and the exposure to tobacco smoke is one of the most preventable causes of death and disability globally. The risk is even higher among daily tobacco users. The World Health Organization (WHO) has recommended that surveillance of major risk factors for Non Communicable Diseases (NCDs) such as tobacco use is imperative to predict the future burden of NCDs, identify interventions to reduce future burden and monitor emerging patterns and trends. In 2014 the first Uganda nation-wide NCD risk factor survey was carried out to estimate the prevalence of major NCD risk factors. We analyzed data from this survey to estimate the prevalence of daily tobacco use and associated risk factors.

A nationally representative sample was drawn stratified by the four regions of the country. The WHO’s STEPwise tool was used to collect data on demographic and behavioral characteristics including tobacco use, physical and biochemical measurements. Tobacco use was divided into three categories; daily tobacco use, daily smoked tobacco use and daily smokeless tobacco use. Weighted logistic regression analysis was used to identify factors associated with daily tobacco use.

Of the 3983 participants, 9.2 % (366) were daily tobacco users, 7.4 % (294) were daily smoked tobacco users and 2.9 % (115) were daily smokeless tobacco users. Male participants were more likely to be daily tobacco users compared with female participants AOR 5.51 [3.81–7.95]. Compared with participants aged 18–29 years, those aged 30–49 years were more likely to be daily tobacco users AOR 2.47 [1.54–3.94] as were those aged 50–69 years AOR 2.82 [1.68–4.74]. Compared with participants without any education, those with primary education were less likely to be daily tobacco users AOR 0.43 [0.29–0.65], as were those with secondary education AOR 0.21 [0.14–0.33] and those with university level of education AOR 0.23 [0.11–0.48]. Compared with participants in the central region, those in the eastern region were more likely to be daily tobacco users AOR 2.14 [1.33–3.45] as were those in the northern region AOR 4.31 [2.79–6.45] and those in the western region AOR 1.87 [1.18–2.97]. Participants who were underweight were more likely to be daily tobacco users compared with people with normal BMI AOR 2.19 [1.48–3.24].

In agreement with previous surveys on tobacco use, there is a high prevalence of tobacco use in Uganda with almost 1 in every 10 Ugandans using tobacco products daily. Being older, male, having no formal education, residing in the east, north and western regions and having low BMI were significantly associated with daily tobacco use. This information provides a useful benchmark to the National Tobacco Control Program for the designing of public health interventions for the control and prevention of tobacco use in Uganda.

Riala K, Alaräisänen A, Taanila A, Hakko H, Timonen M, Räsänen P. Regular daily smoking among 14-year-old adolescents increases the subsequent risk for suicide: the Northern Finland 1966 Birth Cohort Study. J Clin Psychiatry. 2007;68(5):1,478–780.
Bhat VM, Cole JW, Sorkin JD, Wozniak MA, Malarcher AM, Giles WH, et al. Dose-response relationship between cigarette smoking and risk of ischemic stroke in young women. Stroke. 2008;39(9):2439–43.
Craig WY, Palomaki GE, Haddow JE. Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data. BMJ. 1989;298(6676):784–8.
Castellsague X, Munoz N, Destefani E, Victora CG, Castelletto R, Rolon PA, Quintana MJ, et al. Independent and Joint effects of tobacco smoking and alcohol drinking on the risk of esophageal cancer in men and women. Int J Cancer. 1999;82:657–64.
Alwan A. Global status report on noncommunicable diseases 2010: World Health Organization; 2011. Available from [Accessed 18 Sep 2015].
Ministry of Health, Uganda. Tobacco related morbidity and mortality at Uganda Cancer Institute. Kampala: Uganda Cancer Institute; 2013.
World Health Organization. STEPwise approach to surveillance (STEPS) 2015. Available from: [Accessed 22 Sep 2015].
Uganda Bureau of Statistics (UBOS) and ICF International Inc. Uganda Demographic Health Survey 2011. Kampala Uganda: UBOS and Calverton. Maryland: ICF International Inc; 2012.
Uganda Bureau of Statistics. National Population and Housing Census 2014 Revised Edition. Kampala: 2014. Available from [Accessed 12 Jan 2016].
Uganda Bureau of Statistics and ICF International Inc. Uganda Demographic and Health Survey, 2006: Uganda Bureau of Statistics and Calverton. Maryland: ICF International Inc; 2007.
Uganda Bureau of Statistics (UBOS) and ICF International Inc. Uganda Demographic and Health Survey 2000-2001. Kampala Uganda: UBOS and Calverton. Maryland: ICF International Inc; 2001.
Ministry of Health Uganda, Uganda Bureau of Statitstics, World Health Organisation Regional office for Africa, CDC Foundation, Centers for Disease Control. Global Adult Tobacco Survey: Executive Summary 2013 Uganda 2014 [cited 5th August 2015]. Available from: http://global.tobaccofreekids.....
Guwatudde D, Mutungi G, Wesonga R, Kajjura R, Kasule H, Muwonge J, et al. The Epidemiology of Hypertension in Uganda: Findings from the National Non-Communicable Diseases Risk Factor Survey. PLoS One. 2015;10(9):e0138991.
Guwatudde D, Kirunda BE, Wesonga R, Mutungi G, Kajjura R, Kasule H, et al. Physical Activity Levels Among Adults in Uganda: Findings from a Countrywide Cross-Sectional Survey. J Phys Act Health. 2016; doi:10.1123/jpah.2015-0631.
Whitworth J, International Society of hypertension Writing Group. 2003 World health Organization (WhO)/International Society of hypertension (ISh) statement on management of hypertension. J Hypertens. 2003;21(11):1983–92.
Longo M. Democratic Republic of Congo (Ville de Kinshasa) STEPS Survey 2005 Factsheet. 2005. Available from [Accessed 4 Dec 2015].
Tesfaye F. Ethiopia (Butajira) STEPS Survey 2003 Fact sheet. 2003. Available from [Accessed 7 Sep 2015].
Ministry of Health Zambia, World Health Organization Country Office. Prevalence rates of the common non communicable disease risk factors in Lusaka district, Zambia 2008. 2008. Available from [Accessed 7 Sep 2015].
Mayige M. Tanzania STEPS Survey 2012 Fact Sheet. 2012. Available from [Accessed 7 Sep 2015].
Damasceno AA. Mozambique STEPS Survey 2005 Factsheet. 2005. Available from [Accessed 4 Dec 2015].
Jha P, Chaloupka FJ. The economics of global tobacco control. BMJ. 2000;321(7257):358.
Mpabulungi L, Muula A. Tobacco use among high school students in a remote district of Arua, Uganda. Rural Remote Health. 2006;6:609.
Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology. 2003;8(4):419–31.
Foulds J, Ramstrom L, Burke M, Fagerström K. Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tob Control. 2003;12(4):349–59.
Phillips CV, Wang C, Guenzel B. You might as well smoke; the misleading and harmful public message about smokeless tobacco. BMC Public Health. 2005;5(1):31.
Mahalik JR, Burns SM, Syzdek M. Masculinity and perceived normative health behaviors as predictors of men’s health behaviors. Soc Sci Med. 2007;64(11):2201–9.
Grunberg NE, Winders SE, Wewers ME. Gender differences in tobacco use. Health Psychol. 1991;10(2):143.
Sorensen G, Gupta PC, Pednekar MS. Social Disparities in Tobacco Use in Mumbai, India: the roles of occupation, education, and gender. Am J Pub Health. 2005;95(6):1003–8.
Okidi JA, McKay A. Poverty dynamics in Uganda: 1992 to 2000. Economic Policy Research Centre Makerere, Kampala and School of Economics University of Nottingham. 2003. Available at SSRN: [Accessed 7 Dec 2015].
Najjumba-Mulindwa I. Chronic poverty among the elderly in Uganda: perceptions, experiences and policy issues. Conference ‘Staying Poor: Chronic Poverty and Development Policy’. Oxford, UK: University of Manchester; 2003.
Davey Smith G, Hart C, Hole D, MacKinnon P, Gillis C, Watt G, et al. Education and occupational social class: which is the more important indicator of mortality risk? J Epidemiol Community Health. 1998;52(3):153–60.
Stead M, MacAskill S, MacKintosh A-M, Reece J, Eadie D. “It’s as if you’re locked in”: qualitative explanations for area effects on smoking in disadvantaged communities. Health Place. 2001;7(4):333–43.
Yach D, Bettcher D. Globalisation of tobacco industry influence and new global responses. Tob Control. 2000;9(2):206–16.
Albanes D, Jones DY, Micozzi MS, Mattson ME. Associations between smoking and body weight in the US population: analysis of NHANES II. Am J Pub Health. 1987;77(4):439–44.
Shimokata H, Muller DC, Andres R. Studies in the distribution of body fat: III. Effects of cigarette smoking. JAMA. 1989;261(8):1169–73.
Potter BK, Pederson LL, Chan SS, Aubut J-AL, Koval JJ. Does a relationship exist between body weight, concerns about weight, and smoking among adolescents? An integration of the literature with an emphasis on gender. Nicotine Tob Res. 2004;6(3):397–425.
Chiolero A, Faeh D, Paccaud F, Cornuz J. Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr. 2008;87(4):801–9.
Preston A. Cigarette smoking-nutritional implications. Prog Food Nutr Sci. 1990;15(4):183–217.
The complications of treating chronic obstructive pulmonary disease in low income countries of sub-Saharan Africa
Frederik A. van Gemert, Bruce J. Kirenga, Tewodros Haile Gebremariam, George Nyale, Corina de Jong, Thys van der Molen
Expert Review of Respiratory Medicine
Burden of cumulative risk factors associated with non-communicable diseases among adults in Uganda: evidence from a national baseline survey
Ronald Wesonga, David Guwatudde, Silver K. Bahendeka, Gerald Mutungi, Fabian Nabugoomu, James Muwonge
International Journal for Equity in Health
The prevalence and trends of waterpipe tobacco smoking: A systematic review
Mohammed Jawad, Rana Charide, Reem Waziry, Andrea Darzi, Rami A. Ballout, Elie A. Akl, Lion Shahab
Cutaneous malignancies in HIV
Aileen Y. Chang, Phil Doiron, Toby Maurer
Current Opinion in HIV and AIDS
Smoking cessation after engagement in HIV care in rural Uganda
Julian A. Mitton, Crystal M. North, Daniel Muyanja, Samson Okello, Dagmar Vořechovská, Bernard Kakuhikire, Alexander C. Tsai, Mark J. Siedner
Perceptions about the harmfulness of tobacco among adults in Uganda: Findings from the 2013 Global Adult Tobacco Survey
Steven Kabwama, Daniel Kadobera, Sheila Ndyanabangi
Tobacco Induced Diseases
Determinantes de saúde mental e abuso de substâncias psicoativas associadas ao tabagismo. Estudo de caso controle
Thiago Amorim, Roselma Lucchese, Neta Silva, Jaqueline Santos, Ivânia Vera, Núbia Paula, Naiane Simões, Luiz Monteiro
Ciência & Saúde Coletiva
Smokeless tobacco use: its prevalence and relationships with dental symptoms, nutritional status and blood pressure among rural women in Burkina Faso
Jeoffray Diendéré, Augustin Zeba, Léon Nikièma, Ahmed Kaboré, Paul Savadogo, Somnoma Tougma, Halidou Tinto, Arouna Ouédraogo
BMC Public Health
Cardiovascular risk factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis
Geofrey Musinguzi, Rawlance Ndejjo, Isaac Ssinabulya, Hilde Bastiaens, Marwijk van, Rhoda Wanyenze
BMC Cardiovascular Disorders
Cancer Risk Studies and Priority Areas for Cancer Risk Appraisal in Uganda
Alfred Jatho, Binh Tran, Jansen Cambia, Miisa Nanyingi, Noleb Mugisha
Annals of Global Health