Tobacco product use and passive smoking in Afghanistan: A cross-sectional epidemiological study of prevalence and determinants

INTRODUCTION Tobacco use poses a major public health challenge globally, with low-and middle-income countries, including Afghanistan, bearing a significant portion of the burden.Despite its known contribution to morbidity and mortality, comprehensive data on the prevalence, patterns, and determinants of tobacco use in Afghanistan remain limited.This study aims to address this gap by providing evidence on smoking, smokeless tobacco use, and passive smoking among Afghan adults.METHODS This is a secondary data analysis of the 2018 Afghanistan World Health Organization STEPwise approach to NCD risk factor surveillance (STEPs), nationally representative, cross-sectional survey.The study included adults aged ≥18 years who were permanent residents of the selected households and consented to participate.Data were collected using structured, interviewer-administered questionnaires based on self-reported data.Descriptive statistics and logistic regression models were employed to determine the prevalence and predictors of smoking (any form, including cigarettes, pipes, shisha, etc.), smokeless tobacco use, and passive smoking.RESULTS Among 3955 participants, the prevalence of current smoking was 8.9%, smokeless tobacco use 14.9%, and passive smoking 44.7%.Males were significantly more likely to smoke (AOR=5.0;95% CI: 3.4-7.4)and use smokeless tobacco (AOR=23.0;95% CI: 14.0-36.8)compared to females.Smoking prevalence peaked in the 35-44 years age group, while smokeless tobacco use was highest among individuals aged ≥55 years.Individuals with no education showed higher odds of using smokeless tobacco compared to educated individuals.Passive smoking was more common among urban residents (AOR=1.4;95% CI: 1.2-1.6),whereas individuals with monthly income ≥50000 AFN showed lower odds (AOR=0.7;95% CI: 0.6-0.9).Regionally, the Western region exhibited the highest odds of smoking (AOR=2.3;95% CI: 1.5-3.7),whereas the Southern region had the highest prevalence of smokeless tobacco use.CONCLUSIONS This study highlights the burden of tobacco use and passive smoking in Afghanistan and provides evidence of the sociodemographic and regional distribution of tobacco products in the country.These findings highlight important associations; however, further longitudinal studies are required to understand better the determinants and trends of tobacco use in the Afghan population.