Socioeconomic and demographic patterning of concurrent tobacco smoking and alcohol consumption among men in Malawi: evidence from the 2024 Malawi demographic and health survey

Background Tobacco smoking and alcohol consumption are major behavioural risk factors for non-communicable diseases that frequently co-occur, yet in Malawi they have typically been studied separately. This study examined the prevalence and socioeconomic correlates of concurrent (dual) tobacco smoking and alcohol consumption among Malawian men. Methods This study used a cross-sectional secondary analysis of the 2024 Malawi Demographic and Health Survey among men aged 15–54 years in the national survey domains ( N = 8,583, after excluding 330 men in the Dzaleka refugee camp sample from 8,913 interviewed; no missing data). Dual use was current tobacco smoking together with current alcohol consumption. Survey-weighted logistic, modified Poisson and multinomial regression estimated prevalence and associated factors. Education and household wealth were adjusted for each other, employment and the other covariates in a single mutually adjusted model. Sensitivity analyses used continuous covariates, heavier drinking and any tobacco use. Results Prevalence was 12.1% (95% CI: 11.2–12.9) for smoking, 22.7% (21.4–24.0) for alcohol consumption and 7.3% (6.6–8.1) for dual use, about 2.7 times the 2.7% expected if the behaviours were independent. Dual use rose to a plateau around ages 40–44 years (adjusted odds ratio [AOR] = 15.78, 95% CI: 8.13–30.62; adjusted prevalence ratio [aPR] = 12.68, 6.90–23.30, versus ages 15–19). Odds were lower among men in the richest than the poorest households (AOR = 0.42, 0.27–0.65) and among men with higher education than none (AOR = 0.40, 0.20–0.78), and higher among employed men (AOR = 1.63, 1.19–2.23). Currently married or cohabiting men had higher crude but lower adjusted odds than never-married men (AOR = 0.53, 0.35–0.78); the age-stratified association was higher at ages 15–24 years but lower from age 25 years. Previously married or separated men had higher odds (AOR = 2.04, 1.23–3.37). Wealth and education patterns resembled those for smoking only rather than alcohol consumption only. Conclusions Dual use is unevenly distributed; it is more common among older and employed men and men in the poorest households and less common among men with higher education. These are adjusted associations from cross-sectional data. Integrating tobacco and alcohol screening and cessation support within existing primary healthcare and non-communicable disease platforms may help address co-occurring use among groups with a higher prevalence.