Prevalence and predictors of nicotine dependence among adult smokers in 4 African countries, 2016-2021
1
CDC Foundation, Atlanta, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Understanding population-level nicotine dependence can provide insights into future tobacco-related morbidity and mortality. This study assessed the prevalence and predictors of nicotine dependence among smokers in four African countries.
METHODS:
We analyzed cross-sectional Global Adult Tobacco Survey data collected between 2016-2021 in four African countries. Nicotine dependence was assessed among daily cigarette smokers utilizing Heavy Smoking Index (HSI) measure: time to first cigarette after waking and cigarettes smoked per day. HSI scores were categorized as low (0-1) or medium-high dependence (2-6). Weighted country-level multivariate regression analyses were conducted to calculate the adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) of having medium-high nicotine dependence, accounting for covariates.
RESULTS:
The prevalence of medium-high nicotine dependence among daily cigarette smokers ranged from 60.4% (95%CI: 53.6-66.8; Botswana) to 68.4% (95%CI: 63.6-72.7; South Africa). Individuals aged 25–44 years in Ethiopia had significantly lower odds of medium-high nicotine dependence versus those aged 45+ years (aOR=0.20; 95% CI: 0.10–0.80). Respondents in Botswana with low (aOR=0.10; 95%CI: 0.00–0.40) or medium wealth index (aOR=0.24; 95%CI: 0.10–0.90) had lower odds of medium-high nicotine dependence versus those in the highest wealth group. In Ethiopia, single tobacco product users had lower odds of medium-high nicotine dependence (aOR=0.05; 95%CI: 0.00–0.20) versus multiple product users. Having smoke-free home rules was associated with higher odds of medium-high nicotine dependence in Botswana (aOR=3.84; 95%CI: 1.10–12.90) and South Africa (aOR=4.48; 95%CI: 2.40–8.30) versus households without smoke-free rules.
CONCLUSIONS:
Results show that medium-high nicotine dependence was prevalent (>60%) in all four countries assessed. Significant predictors varied by country and were observed across age groups, wealth index, household smoking rules and poly tobacco use status. The results underscore the need for targeted and expanded access to cessation services to reduce dependence and advance tobacco control efforts.
Understanding population-level nicotine dependence can provide insights into future tobacco-related morbidity and mortality. This study assessed the prevalence and predictors of nicotine dependence among smokers in four African countries.
METHODS:
We analyzed cross-sectional Global Adult Tobacco Survey data collected between 2016-2021 in four African countries. Nicotine dependence was assessed among daily cigarette smokers utilizing Heavy Smoking Index (HSI) measure: time to first cigarette after waking and cigarettes smoked per day. HSI scores were categorized as low (0-1) or medium-high dependence (2-6). Weighted country-level multivariate regression analyses were conducted to calculate the adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) of having medium-high nicotine dependence, accounting for covariates.
RESULTS:
The prevalence of medium-high nicotine dependence among daily cigarette smokers ranged from 60.4% (95%CI: 53.6-66.8; Botswana) to 68.4% (95%CI: 63.6-72.7; South Africa). Individuals aged 25–44 years in Ethiopia had significantly lower odds of medium-high nicotine dependence versus those aged 45+ years (aOR=0.20; 95% CI: 0.10–0.80). Respondents in Botswana with low (aOR=0.10; 95%CI: 0.00–0.40) or medium wealth index (aOR=0.24; 95%CI: 0.10–0.90) had lower odds of medium-high nicotine dependence versus those in the highest wealth group. In Ethiopia, single tobacco product users had lower odds of medium-high nicotine dependence (aOR=0.05; 95%CI: 0.00–0.20) versus multiple product users. Having smoke-free home rules was associated with higher odds of medium-high nicotine dependence in Botswana (aOR=3.84; 95%CI: 1.10–12.90) and South Africa (aOR=4.48; 95%CI: 2.40–8.30) versus households without smoke-free rules.
CONCLUSIONS:
Results show that medium-high nicotine dependence was prevalent (>60%) in all four countries assessed. Significant predictors varied by country and were observed across age groups, wealth index, household smoking rules and poly tobacco use status. The results underscore the need for targeted and expanded access to cessation services to reduce dependence and advance tobacco control efforts.
| eISSN: | 2654-1459 |
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