Elsevier

Drug and Alcohol Dependence

Volume 84, Issue 1, 1 September 2006, Pages 14-27
Drug and Alcohol Dependence

Review
A systematic literature review of tobacco use among adults 15 years and older in sub-Saharan Africa

https://doi.org/10.1016/j.drugalcdep.2005.12.008Get rights and content

Abstract

Background

Given that developing countries (and particularly women in these countries) are at increasing risk for tobacco use, the need for hard data to accurately monitor tobacco use in developing countries is needed. The purpose of this review is to synthesize the available prevalence data on current tobacco use among adults in sub-Saharan Africa (SSA).

Methods

Several databases were systematically searched for articles published in peer-reviewed journals at any time during the last century to mid-2005. The search resulted in the retrieval of 54 articles in which the current use of tobacco, cigarettes, cigars and snuff were reported. They were conducted in 14 of the 48 SSA countries.

Results

Cross-country comparisons revealed that the prevalence, and intensity (frequency and/or quantity) of tobacco use was higher among males compared to females across all countries. Certain racially classified social groups in South Africa were at increased risk for tobacco use. Males aged between 30 and 49 years used tobacco at higher rates than those younger or older than this age range. Among females, prevalence rates of smoked tobacco use increased steadily with age. There was no clear pattern regarding socio-economic status (SES) or urban/rural differences. The onset of tobacco use mostly occurs in late adolescence or early adulthood.

Conclusions

While in many SSA countries the prevalence of tobacco use among adults is relatively low compared to developed and other developing countries, prevention, interventions and policies should work towards reducing these levels by targeting the at risk populations identified from this review.

Section snippets

Background

Approximately 1 billion men and 250 million women, aged 15 years and older, in the world smoke tobacco (Action on Smoking and Health, 2004). Of these, 50% of the men and 9% of the women live in developing countries. These statistics, together with evidence of the decline in tobacco use in developed nations such as the United Kingdom, United States, Canada, Japan, Australia and New Zealand, led the authors of the World Health Organisation's Tobacco Atlas to conclude that the tobacco epidemic is

Review methodology

The review comprises articles that were published in peer-reviewed journals at any time during the last century up to mid-2005. All articles report prevalence data, patterns and initiation of tobacco use among sub-Saharan African adult populations. Following lower age limits for adults versus youth from the Tobacco Atlas (Mackay and Eriksen, 2002), studies were included in which the samples’ lower age limit was 15 years. Articles about tobacco-related medical conditions were excluded. Despite

Results and discussion

The search resulted in the retrieval of 55 articles that met the inclusion criteria. These studies were undertaken in the following sub-Saharan African countries: Benin (n = 1), Chad (n = 1), The Gambia (n = 1), Ghana (n = 1), Ivory Coast (n = 1), Kenya (n = 3), Malawi (n = 2), Nigeria (n = 10), Senegal (n = 7), South Africa (n = 24), Tanzania (n = 1), Uganda (n = 2), Zambia (n = 1) and Zimbabwe (n = 1).

Concluding comments

Despite the variation in the information and inconsistency of reporting across studies and countries, this review has revealed that males generally, and certain ethnic and/or RCSGs are at increased risk for tobacco use in SSA. Furthermore, most studies revealed initiation of tobacco use during late adolescence or early adulthood. However, there is no clear pattern regarding SES or urban/rural differences which in our view may reflect the lack of detailed research on these topics.

Given the small

Acknowledgements

The authors would like to acknowledge the assistance of Kimya McCray, Selima Taylor and Todné Thomas. The authors would also like to acknowledge the Minority International Research Training Program of the Fogarty International Center (5T37 TWOO113-04), the National Institutes of Drug Abuse (P50 DA10075), and the Fogarty International Center of the National Institutes of Health, International Tobacco and Health Research and Capacity Building Program (IROI TWO5955-02) for their research grant

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