title: Influence of socioeconomic position and gender on current cigarette smoking among people living with HIV in sub-Saharan Africa: disentangling context from composition.
abstract: Smoking is still gaining ground in Sub-Saharan Africa, especially among socially disadvantaged groups. People living with HIV represent a subgroup with a significantly elevated prevalence of cigarette smoking. The objective of the study was to examine the influence of individual-, neighbourhood- and country-level socioeconomic position on current cigarette smoking among people living with HIV in Sub-Saharan Africa.
  
  
  
  We applied multivariable multilevel logistic regression analysis on Demographic and Health Survey data collected between 2003 and 2012 in sub-Saharan Africa. We identified 31,270 individual living with HIV (Level 1) nested within 7,054 neighbourhoods (Level 2) from 19 countries (Level 3).
  
  
  
  After adjustment for individual-, neighbourhood- and country-level factors, respondents, the following significant independent risk factors for increasing odds of being a current cigarette smokers among people living with HIV: male gender (odds ratio [OR] = 62.49; 95 % credible interval [CrI] 45.93 to 78.28), from the poorer households (OR = 1.62, 95 % CrI 1.38 to 1.90); living in urban areas (OR = 1.24, 95 % CrI 1.09 to 1.41), from neighbourhoods with low poverty rate (OR = 1.25, 95 % CrI 1.09 to 1.43), illiteracy rate (OR = 1.28, 95 % CrI 1.14 to 1.42), low unemployment rate (OR = 1.11, 95 % crI 1.01 to 1.43); and from countries with low socio-economic deprivation (OR = 1.53, 95 CrI 1.08 to 1.96). About 3.4 % and 39.4 % variation in cigarette smoking behaviour among people living with HIV is conditioned by differences between neighbourhoods and countries.
  
  
  
  Gender, education and socioeconomic context are independently associated with current cigarette smoking among people living with HIV in sub-Saharan Africa.
authors.affiliation: Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden. olalekan.uthman@ki.se.|Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK. olalekan.uthman@ki.se.|Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK. olalekan.uthman@ki.se.
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
authors.affiliation: Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anna Mia
authors.initials: AM
authors.lastname: Ekström
authors.affiliation: Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden.|Centre for Epidemiology and Social Medicine, Health Care Services, Stockholm County Council, Stockholm, Sweden.
authors.forename: Tahereh T
authors.initials: TT
authors.lastname: Moradi
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D003710:Demography; D005260:Female; D015658:HIV Infections; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D055815:Young Adult