East African Journal of Public Health East African Public Health Association ISSN: 0856-8960 Vol. 3, Num. 1, 2006, pp. 24-27

East African Journal of Public Heath, Vol. 3, No. 1, April 2006, pp. 24-27

CIGARETTE SMOKING AND USE OF SMOKELESS TOBACCO IN MOSHI RURAL DISTRICT IN NORTHERN TANZANIA

^1,4Kagoma S. Mnyika, ²Elise Klouman and ³Knut-Inge Klepp

Correspondence to:  Kagoma S Mnyika Muhimbili University College of Health Sciences,  P.O. Box 65015, Dar es Salaam, Tanzania

¹Dept.  of Epidemiology/Biostatistics School of Public Health & Social Sciences Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania,  ²Dept. of General Practice and Community Medicine, University of Oslo, Norway, ³Dept. of Nutrition, University of Oslo, Norway,  ⁴To whom correspondence and request for reprints should be made

Code Number: lp06005

Abstract:

Background: We assessed age and sex differences in cigarette smoking and use of smokeless tobacco over time in a rural population in Tanzania. This paper presents data on tobacco use among men and women 15-36 years old from 1991 to 1997.
Methods: Cross-sectional studies were conducted in 1991, 1993 and 1997 in the Oria rural village situated 30 kilometres south of Moshi town in Kilimanjaro region. Verbal informed consent was obtained from each participant before questionnaire administration. Interviewers were fully trained on how to administer the questionnaire.
Results: The overall prevalence of cigarette smoking in men declined from 36.0% in 1991 to 23.1% in 1997 while for women prevalence declined from 3.0% in 1991 to 1.0% in 1997. Prevalence of cigarette smoking increased significantly with increasing age (p = 0.001). The overall self-reported prevalence of consumption of nasal tobacco snuff was 0.6% and that of oral snuff was 1.9%. There was no significant difference observed on the use of nasal tobacco snuff among men as compared to women (0.5% versus 0.6%). However, significantly more women than men used oral tobacco snuff in this population (3.0 versus 0.5%) (OR =6.31; 95% CI 1.45 to 57.11).
Conclusions: More men than women reported being cigarette smokers while for oral tobacco snuff more women than men used it. Cigarette smoking declined over time and may have been due to economic hardships following floods that hit the village in 1997.

Keywords: Cigarette smoking, smokeless tobacco, Tanzania

Introduction

Cigarette smoking and use of smokeless tobacco in Africa has been on the increase since 1960s (1). Available data suggest that the prevalence of cigarette smoking and use of smokeless tobacco in sub-Saharan African countries is considerable (2-7). Data collected from six districts in Tanzania showed that the overall prevalence of cigarette smoking was higher among men than women (6,8). Cigarette smoking has also been shown to be higher among rural adolescents than among urban adolescents in Tanzania (2-3). Prevalence of cigarette smoking in Dar es Salaam adult population ranges from 27% in males to 5% in females while among primary school adolescents, prevalence proportions range from 13% in males to 5% in females (6-7). Apart from these few studies on cigarette smoking, there is little information on use of smokeless tobacco in Tanzania. Moreover, studies are required to complement the available data on cigarette smoking in Tanzania. In view of this, we investigated the magnitude of cigarette smoking and consumption of smokeless tobacco among persons aged 15-36 years in Oria rural village in Moshi district of Kilimanjaro region in northern Tanzania.

Methods

The present study was conducted in Oria rural village as part of a larger project focusing on measuring the magnitude of sexually transmitted infections (STIs) and HIV/AIDS in a rural population in the Kilimanjaro region (9). Oria village is situated 30 kilometres south of Moshi town within Moshi rural district of Kilimanjaro region in northern Tanzania. The village is composed of several ethnic groups but the main ethnic groups are the Pare, Chagga and Kahe. A large majority of the population of Oria village is engaged in farming while a small proportion of the population is engaged in petty business.

The study was a population-based cross-sectional survey conducted in 1991, 1993 and 1997 in the same population. The whole population of Oria village was eligible for the study in 1991 and 1993 while in the 1997 survey, age eligibility criterion was restricted to individuals in the age group 15-36 years. As the surveys in 1991 and 1993 involved screening for STIs and HIV, a screening centre was established in a convenient location in Oria village where all participants were asked to come for participation in the surveys. However, during 1997 all eligible subjects for the study were recruited through house-to-house registration and interviews took place in their households. The response rates to the interviews in 1991 among the eligible participants were 80% for females and 73% for males while in 1997 the response rates were 80% and 76% for females and males respectively.

In 1991 and 1993, research and ethical clearance was obtained from the Ministry of Health in Tanzania and the Norwegian Committee for Medical Research Ethics. During 1997, the project was cleared by the National Ethical Clearance Committee of the Ministry of Health in Tanzania and the Ethical Clearance Committee of the Muhimbili University College of Health Sciences in Dar es Salaam, Tanzania. In addition, the project was introduced at various levels in Moshi rural district and Oria village through meetings held to inform the local leaders on the purpose of the project.

The survey was conducted using a structured interviewer-administered questionnaire which consisted of pre-coded and open-ended questions. The questionnaire was developed in the English language and translated into Swahili language before it was tested in a pilot study to assess its suitability and acceptability for use in the study population. Before commencement of data collection, the field team was trained on informed consent process and questionnaire administration. Verbal informed consent for participation in the study was sought from each eligible subject. Participants who did not come to the screening centre in 1991 and 1993 surveys were registered as responders. On the other hand during 1997 survey, participants who were absent from home after two consecutive follow-up visits were registered as non-responders. Participants who were away from the village for the duration of the study were excluded from the study and registered as ineligible.

At the end of the interview, all participants were given chance to ask questions and any person found suffering from an STI or any other minor ailment was offered treatment immediately by the field teams. Participants suffering from major or complicated ailments were referred to Mawenzi Regional Hospital or KCMC hospital using project transport facilities.

Data management and analysis

All questionnaire forms were checked for missing and out of range data as well as for illogical and inconsistent data on daily basis. Open-ended questions were coded before data entry. Data entry and statistical analyses were performed using the statistical package for social sciences (SPSS Inc, Chicago, IL, USA) (10). Associations between cigarette smoking and socio-demographic characteristics were analysed using chi-squared (χ²) statistics for contingency tables. P-values were considered significant if less or equal to 0.05 (P ≤ 0.05). All p-values presented are two-sided. However, associations between use of smokeless tobacco and socio-demographic characteristics were analysed using logistic regression analyses and statistical significance was assessed using 95% confidence intervals for odds ratios (OR).

Results

Table 1 presents the socio-demographic profile of the study population. With the exception of the age distribution (higher proportion in 1997 for 15-19 age group), the composition of the study population remained relatively comparable from the first cross-sectional study in 1991 to the study conducted in 1997. Proportionately, more women participated in the study than did the men.

Table 2 presents prevalence proportions of cigarette smoking according to socio-demographic characteristics. The prevalence of cigarette smoking was significantly higher among men as compared to women and declined over the years from 36.0% in 1991 to 23.1% in 1997 in men and from 3.0% in 1991 to 1.0% in 1997 in women. Prevalence of cigarette smoking among male adolescents is evident and ranged from 8.5% in 1991 to 3.1% in 1997. Prevalence of cigarette smoking increased significantly with increasing age. Roman Catholics were more likely to be cigarette smokers than others and the difference was statistically significant during the survey of 1993. Persons with more schooling were more likely to report cigarette smoking than others and the difference was statistically significant for 1997 data.

Comparing school adolescents with out-of-school adolescents (15-19 years) in 1997 data, we found cigarette smoking to be more prevalent among out-of-school adolescents than school adolescents (12.5% versus 0.9%; p = 0.001). However, when we adjusted for age considering the fact that the out-of-school participants were older than school adolescents (17.5 years versus 15.6 years; p=0.001), the difference in the prevalence of cigarette smoking became non-significant (results not shown in Table).

Table 3 presents prevalence proportions of use of smokeless tobacco during the survey conducted in 1997. The overall prevalence of use of nasal tobacco snuff for both sexes combined was 0.6% while that of oral tobacco snuff was 1.9%. There was no significant difference observed on the use of nasal tobacco snuff among males as compared to females. However, the prevalence of use of oral tobacco snuff was significantly higher among women as compared with men. Being older than 19 years of age was not significantly associated with increased use of smokeless tobacco in this population.

(Table 4 )

Discussion

Validity of results

The study was conducted in Oria village which has a heterogeneous population in terms of ethnic groups but very homogeneous with respect to socio-economic status. Although methodological differences during the surveys could affect the comparability of the results of the 1997 survey with data from previous surveys of 1991 and 1993, this was highly unlikely as house-to-house interviews were used with same confidentiality as previous surveys. Moreover, during 1997 more persons participated in the study than in 1993 which suggest that people were more willing to participate in the study. We did not expect any impact on the validity of data by implementing the study at three different occasions with varying time intervals because we used a trained field team to collect data. In addition to lack of anti-cigarette smoking campaigns, the habit of cigarette smoking and use of smokeless tobacco have no stigma in the Tanzanian context. Consequently, under-reporting of cigarette smoking and use of smokeless tobacco habits was highly unlikely in this population. Therefore, the data presented in this paper may reflect the true estimates of the prevalence proportions of cigarette smoking and use of smokeless tobacco in Oria rural village.

The data presented suggest that the prevalence of cigarette smoking was significantly higher among men than among women. The sex differences in the prevalence of cigarette smoking are consistent with other published reports from Tanzania and other countries in sub-Saharan Africa (7,11-14). It is most likely that the observed sex differences in the prevalence of cigarette smoking may be attributed to the phases in the development of cigarette smoking (15-16). It is said that in phase one of cigarette smoking there are more men smoking cigarettes as compared to women while in phase two men stop smoking but more women start to smoke and in phase three smoking is equally common in both sexes because women also start quitting cigarette smoking (15-16). Therefore cigarette smoking in Oria rural village may be in phase one in the development process of cigarette smoking. The observations of this study are also consistent with earlier studies conducted in six districts on mainland Tanzania which showed that the prevalence of cigarette smoking was consistently higher among men than in women (2-4,8). Hence it may be inferred that Tanzania may still be in phase one in the development process of cigarette smoking.

Furthermore, the overall prevalence of cigarette smoking declined over time from 1991 to 1997. It is not clear if the observed decline in cigarette smoking was occasioned by economic hardships in Oria village. In 1997 there was El-Nino rains that resulted in devastating floods of Oria village and this might have had significant economic repercussions on the population. However, the dramatic decline in cigarette smoking may not be explained solely by economic hardships. The decline in the prevalence of cigarette smoking over the years may indicate that some people may actually have stopped cigarette smoking. Therefore, there may be a need for further studies to establish if the decline in cigarette smoking was real or temporary remission due to economic hardships. Nonetheless, the observations suggest that most smokers in this population may not be hard-core smokers who find it difficult to quit smoking. It is likely that cigarette smoking cessation may have been triggered by economic hardships that prevailed in the village suggesting that people in Oria rural village are not addicted and therefore anti-smoking intervention measures might work.

Acknowledgements

We thank the Moshi District Medical Officer and the research field team for data collection in Oria village. The project was supported by research grants from the Norwegian Agency for Development Co-operation (NORAD) and the Norwegian Council for Higher Education’s Programme for Development Research and Education (NUFU).

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