Predictors of cigarette and shisha use in Nima and Osu communities, Accra, Ghana: A cross-sectional study

Abstract

INTRODUCTION Tobacco use in any form leads to mortality and morbidity of millions of people every year, not only tobacco users but also non-users by inhaling secondhand tobacco smoke. The objective of this study was to assess predictors of cigarette and shisha use in urban and urban slum communities in Accra, Ghana. METHODS A cross-sectional study design was employed, using a quantitative data collection technique over two months, May to June 2017. Logistic regression was used to study the association between demographic characteristics of respondents and cigarette/shisha use, and data were analyzed in STATA. RESULTS The study included 389 respondents from urban (135) and urban slum (254) communities in the capital Accra. The prevalence of ever smoking cigarettes, shisha and electronic cigarettes was 24.9% (95% CI: 20.8–29.5), 34.6% (95% CI: 30.0–39.6) and 15.1% (95% CI: 11.3–19.8), respectively. For current smokers, 13.1% (95% CI: 10.1–16.9) smoked cigarettes, 10.3% (95% CI: 7.6–13.7) smoked shisha, and 19.5% (95% CI: 15.9–23.8) smoked either cigarettes or shisha. Respondents aged 26–35 years (OR=2.22; 95% CI: 1.08–4.56, p=0.029) and those with no employment (OR=2.30; 95% CI: 1.19–4.44, p=0.013) had higher odds of cigarette/shisha use compared to those aged 18–25 years and the employed, respectively. CONCLUSIONS The provision of adequate resources and continued engagement of relevant stakeholders, can strengthen smoke-free law implementation in Ghana and protect citizens from the harmful effects of tobacco use. INTRODUCTION Tobacco remains the single most preventable risk factor that acts against present and future generations, having devastating health, social, environmental and economic consequences through its consumption and exposure1. It is one of the main public health problems killing over 8 million people, with 9 in 10 as a result of direct tobacco use, and 1 in 10 due to exposure to tobacco smoke2. It is a challenge to public health as 8 in 10 of 1.3 billion adult smokers are located in lowand middle-income countries including Ghana. This high level of tobacco consumption and exposure leads to high tobacco-related morbidity and mortality as a result of high level tobacco addiction3 and poverty within the immediate families of the tobacco users due to the diversion of household money from buying basic needs, such as food and shelter, to tobacco purchases4. Tobacco addiction and continuous use also lead to increased healthcare costs as a result of increased tobacco-related disease5. It is well documented that tobacco and tobacco products have no safe level of exposure. Cigarettes are the most commonly used6 tobacco product followed by other types such as waterpipe tobacco (shisha), smokeless tobacco products, cigars, cigarillos, roll-your-own tobacco, pipe tobacco, bidis, and kreteks7. Waterpipe tobacco smoking (hookah, shisha, narghile) use is on the rise and has received attention from public health researchers and practitioners due to its fastgrowing use by and appeal to some populations8,9. This high demand for waterpipe (shisha) use, especially by youth can be attributed to the deceptive and aggressive marketing strategies of the tobacco industry, falsely presented as safer form of cigarette smoking6,9. Studies have confirmed that most shisha smokers are unaware of the harmful health AFFILIATION 1 Vision for Alternative Development (VALD), Accra, Ghana 2 Department of Adult Education and Human Resources Studies, Wisconsin International University College,Accra, Ghana 3 Research and Development Division, Ghana Health Service, Ministry of Health, Accra, Ghana 4 Global Statistical Institute, Techiman, Ghana 5 Kintampo Health Research Centre, Ghana Health Service, Ministry of Health, Kintampo, Ghana 6 Animal Biology and Conservation Science Department, University of Ghana, Accra, Ghana 7 Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana 8 School of Continuing and Distance Education, University of Ghana Learning Centres, University of Ghana, Accra, Ghana CORRESPONDENCE TO Divine D. Logo. Research and Development Division, Ghana Health Service, Ministry of Health, P.O. Box MB 190, Ministries, Accra, Ghana. Email: divine.logo@ghsmail.org ORCID ID:https://orcid.org/0000-0001-7742-933X