Tobacco Use Patterns among adults aged 18 to 69 years in Tanzania: Results from 2023 STEPS survey

Background: Tobacco smoking remains a leading preventable cause of non-communicable diseases (NCDs) globally, with a growing public health impact in low- and middle-income countries. In Tanzania, nationally representative evidence on tobacco use patterns and associated factors remains limited. Methods: This study analyzed data from the nationally representative Tanzania WHO STEP-wise Survey conducted in 2023. A total of 3,565 adults aged 18–69 years were included using a three-stage stratified sampling design. Data were collected through structured interviews and physical measurements. Current smoking status was self-reported. Weighted analyses were conducted, and modified Poisson regression models were used to identify factors associated with smoking. Results: The overall prevalence of current smoking was 9.9% (95% CI: 7.2–12.6). Smoking was significantly higher among men compared with women (19.8% vs. 0.8%). Prevalence increased with age and was higher among rural residents than among urban residents. Individuals with no formal education had markedly higher smoking prevalence than those with college education. Current alcohol use showed a strong association with smoking, with more than one-quarter of current drinkers reporting smoking. In adjusted analyses, male sex (aPR=20.63), older age, residence in the Southern zone, lower educational attainment, and current alcohol consumption (aPR=4.32) were independently associated with smoking. Conclusion: Tobacco smoking in Tanzania remains concentrated among specific high-risk groups, particularly men, older adults, individuals with low education, and alcohol users. Targeted and integrated tobacco control interventions are urgently needed to reduce future NCD burden.