title: Tobacco use and associated factors among Adults in Uganda: Findings from a nationwide survey.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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].
  
  
  CONCLUSIONS
  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.
authors.affiliation: Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda.
authors.forename: Steven Ndugwa
authors.initials: SN
authors.lastname: Kabwama
authors.affiliation: Mental Health and Substance Abuse, Ministry of Health, Kampala, Uganda.
authors.forename: Sheila
authors.initials: S
authors.lastname: Ndyanabangi
authors.affiliation: Control of Non-Communicable Diseases Desk, Ministry of Health, Kampala, Uganda.
authors.forename: Gerald
authors.initials: G
authors.lastname: Mutungi
authors.affiliation: School of Statistics and Planning, Makerere University College of Business and Management Sciences, Kampala, Uganda.
authors.forename: Ronald
authors.initials: R
authors.lastname: Wesonga
authors.affiliation: St. Francis Hospital, Nsambya, Kampala, Uganda.
authors.forename: Silver K
authors.initials: SK
authors.lastname: Bahendeka
authors.affiliation: Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
keywords: Non-communicable diseases; Sub-Saharan Africa; Tobacco use; Uganda; WHO STEPs methodology