Tobacco use is a significant public health problem in Sub Sahara Africa, and various demographic factors influence its prevalence. Understanding the prevalence and factors associated with tobacco use can inform targeted interventions. Hence, this study aimed to identify determinants of tobacco use among men aged 15 to 59 in SSA countries from 2016 to 2024 using a multilevel mixed-effect logistic regression analysis. This study used data from Demographics and Health Surveys, a cross sectional survey conducted in 28 countries across SSA between 2016 and 2024. This analysis included a total weighted sample of 210,056 men aged between 15 and 59 years. A multilevel logistic regression model was used to identify factors associated with tobacco use among men. The measure of association between explanatory variables and outcome was reported using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The study revealed that the prevalence of tobacco use was 14.45% in SSA. Moreover, spatial clustering of tobacco use was detected in Lesotho, South Africa, Madagascar, Democratic Republic of the Congo, Mauritania, Sierra Leone, Gabon, and Zambia. In the multilevel multivariable model, tobacco use among men was significantly associated with factors at the individual and community levels. Older men had higher odds of use, with those aged 25–34 (AOR = 2.34; 95% CI: 2.21, 2.48), 35–44 (AOR = 3.03; 95% CI: 2.84, 3.23), and 45 years and above (AOR = 3.20; 95% CI: 3.00, 3.42) more likely to use tobacco compared with men aged 15–24. Lower education (no education: AOR = 1.89; 95% CI: 1.71, 2.08; primary: AOR = 2.03; 95% CI: 1.85, 2.22; secondary: AOR = 1.65; 95% CI: 1.51, 1.80), being unmarried (AOR = 1.57; 95% CI: 1.50, 1.65), early age at first sex (15–19 years: AOR = 6.40; 95% CI: 5.82, 7.04; 20–24 years: AOR = 4.32; 95% CI: 3.91, 4.78; 25 years and above: AOR = 4.12; 95% CI: 3.69, 4.59), and not exposed to media (AOR = 1.10; 95% CI: 1.05, 1.15) or internet use (AOR = 1.26; 95% CI: 1.20, 1.32) were also associated with higher tobacco use. At the household and occupational levels, men from poor (AOR = 1.67; 95% CI: 1.57, 1.76) and middle income households (AOR = 1.22; 95% CI: 1.15, 1.29), and those working in agriculture (AOR = 1.49; 95% CI: 1.39, 1.60), manual labor (AOR = 1.75; 95% CI: 1.63, 1.88), or professional occupations (AOR = 1.32; 95% CI: 1.22, 1.42) were more likely to use tobacco. Community and contextual factors, including urban residence (AOR = 1.12; 95% CI: 1.06, 1.20), regional differences (East Africa: AOR = 1.38; 95% CI: 1.28, 1.48; Southern Africa: AOR = 3.75; 95% CI: 3.43, 4.10), and country income level (low income: AOR = 1.39; 95% CI: 1.29, 1.49; upper middle income: AOR = 1.63; 95% CI: 1.42, 1.87), further associated with tobacco use. The prevalence of tobacco use among men in SSA was 14.45%, indicating a substantial public health burden. Moreover, spatial clustering of tobacco use was detected in Lesotho, South Africa, Madagascar, Democratic Republic of the Congo, Mauritania, Sierra Leone, Gabon, and Zambia. The findings show that tobacco use is influenced by a complex interplay of individual, household, and community level determinants. Higher odds of tobacco use were observed among older men, those with lower educational attainment, unmarried individuals, and men reporting early sexual debut. Limited exposure to media and internet use further increased the likelihood of tobacco use. In addition, socioeconomic and occupational factors played a significant role, with men from poor and middle income households and those engaged in agricultural, manual, and professional occupations being more likely to use tobacco. At the contextual level, urban residence, regional disparities particularly in East and Southern Africa, and country income classifications were also significantly associated with tobacco use. From a policy perspective, the most actionable priorities lie in addressing information gaps, socioeconomic vulnerability, and regulatory environments. Expanding access to targeted health communication through mass media and digital platforms is critical, especially for populations with limited education and access to information. Integrating tobacco control interventions into occupational settings such as agriculture and manual labor sectors offers a strategic entry point to reach high risk groups. At the same time, strengthening and enforcing comprehensive tobacco control policies, including taxation, advertising restrictions, and smoke free regulations, is essential, particularly in high burden regions and countries. Overall, effective reduction of tobacco use among men in SSA will require a focused and context specific approach that prioritizes disadvantaged populations, improves access to health information, and reinforces policy level interventions. Coordinated efforts that align public health messaging with structural and regulatory actions are likely to yield the greatest impact.
Yohannes et al. (Thu,) studied this question.