Aboagye Richard Gyan, Ahinkorah Bright Opoku, Donkoh Irene Esi, Okyere Joshua, Yaya Sanni
School of Population Health, University of New South Wales, Sydney, Australia.
Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
PLoS One. 2025 Sep 9;20(9):e0331738. doi: 10.1371/journal.pone.0331738. eCollection 2025.
Tobacco use remains a major public health challenge in sub-Saharan Africa, with significant gendered dimensions. Place of residence is an important determinant, as rural and urban contexts shape exposure, access, and consumption patterns. This study investigates rural-urban disparities in tobacco use among women in sub-Saharan Africa, with a focus on quantifying the relative contributions of socioeconomic factors.
We conducted a pooled cross-sectional analysis using nationally representative data from the most recent Demographic and Health Surveys (DHS) of 22 sub-Saharan African countries (2015-2022). The study sample included 350,536 women aged 15-49 years with complete data on tobacco use and relevant covariates. Tobacco use was defined as self-reported current use of cigarettes or other tobacco products. We employed a multivariate decomposition for non-linear response models to quantify the contributions of group differences in characteristics versus differences in how those characteristics affect an outcome. This technique partitions the observed rural-urban gap in tobacco use into two components: (1) endowment effects (compositional differences in characteristics such as education, household wealth, age, marital status, and employment) and (2) coefficient effects (differences in the influence of these characteristics on tobacco use between rural and urban women). Models adjusted for sampling weights and survey design effects to ensure representativeness.
Compositional differences explained 167.48% of the rural-urban disparity in women's tobacco use. Educational attainment and wealth index were the most significant contributors, both showing protective effects. If rural women's education and wealth levels matched those of urban women, tobacco use prevalence would be reduced by 24.99% and 49.84%, respectively. Differences in coefficients accounted for -67.48% of the observed gap, with baseline differences in intercepts (-166.17%) driving most of this effect. These findings highlight both structural disadvantages and variations in behavioural responsiveness across residential settings.
The study demonstrates that rural-urban disparities in tobacco use among women are primarily shaped by inequalities in education and wealth. Interventions aimed at expanding educational opportunities and addressing poverty in rural communities could substantially reduce tobacco use. Additionally, tailored prevention and cessation strategies targeting women at both the lowest and highest ends of the socioeconomic spectrum are essential to mitigate disparities and advance tobacco control in sub-Saharan Africa.
在撒哈拉以南非洲，烟草使用仍然是一项重大的公共卫生挑战，且存在显著的性别差异。居住地点是一个重要的决定因素，因为农村和城市环境塑造了接触、获取和消费模式。本研究调查了撒哈拉以南非洲女性烟草使用的城乡差异，重点是量化社会经济因素的相对贡献。
我们使用来自22个撒哈拉以南非洲国家（2015 - 2022年）最新的人口与健康调查（DHS）的具有全国代表性的数据进行了汇总横断面分析。研究样本包括350536名年龄在15 - 49岁之间、拥有关于烟草使用及相关协变量完整数据的女性。烟草使用被定义为自我报告当前使用香烟或其他烟草制品。我们对非线性响应模型采用多元分解来量化特征组差异以及这些特征影响结果方式的差异所起的作用。该技术将观察到的烟草使用城乡差距分为两个部分：（1）禀赋效应（教育、家庭财富、年龄、婚姻状况和就业等特征的构成差异）和（2）系数效应（这些特征对农村和城市女性烟草使用影响的差异）。模型对抽样权重和调查设计效应进行了调整，以确保代表性。
构成差异解释了女性烟草使用城乡差距的167.48%。教育程度和财富指数是最主要的贡献因素，两者均显示出保护作用。如果农村女性的教育和财富水平与城市女性相当，烟草使用 prevalence 将分别降低24.99%和49.84%。系数差异占观察到差距的 - 67.48%，截距的基线差异（ - 166.17%）驱动了大部分这种效应。这些发现凸显了结构劣势以及不同居住环境中行为反应的差异。
该研究表明，女性烟草使用的城乡差异主要由教育和财富不平等所塑造。旨在扩大农村社区教育机会和解决贫困问题的干预措施可以大幅减少烟草使用。此外，针对社会经济谱两端女性的量身定制的预防和戒烟策略对于减轻差异和推进撒哈拉以南非洲的烟草控制至关重要。
