Background
Methods
Study area
Participants and sampling strategies
Sr. | Districts | Total Kebeles | Population | HHs (/4.8 conversion factor) | No of Selected Kebeles | No of HHs in selected kebeles | PPA of HHs from selected kebeles |
---|---|---|---|---|---|---|---|
1 | Yabello | 23 | 104,743 | 21822 | 7 | 9788 | 140 |
2 | Arero | 21 | 41,583 | 8664 | 7 | 4125 | 59 |
3 | Moyale | 20 | 159,499 | 33228 | 6 | 12952 | 186 |
Total | 64 | 305,825 | 63,714 | 20 | 26,865 | 634 |
Measurement and instrument
Data collection procedures
Statistical analysis
Ethical consideration
Results
Socio-demographic characteristics
Characteristics of respondents | Number | Percent | |
---|---|---|---|
Age category | Mean ± SD age (years) | 42.24 ± 16.2 | |
<25 | 81 | 12.8 | |
25–30 | 99 | 15.6 | |
31–35 | 75 | 11.8 | |
36–40 | 112 | 17.7 | |
41–45 | 62 | 9.8 | |
46–50 | 65 | 10.3 | |
>50 | 140 | 22.1 | |
Sex | Male | 414 | 65.3 |
Female | 220 | 34.7 | |
Religion | Wakefata | 399 | 62.9 |
Muslim | 162 | 25.6 | |
Christian | 73 | 11.5 | |
Ethnicity | Oromo | 630 | 99.4 |
Othersa
| 4 | .6 | |
Educational level | Cannot read and write | 502 | 79.2 |
Read and write but no formal education | 108 | 17.0 | |
At least primary | 24 | 3.8 | |
Current marital status | Single | 41 | 6.5 |
Married | 542 | 85.5 | |
Divorced | 26 | 4.1 | |
Widowed | 25 | 3.9 | |
Occupation | Pastoralist | 490 | 77.3 |
Othersb
| 144 | 22.7 | |
Income category | 0–150 | 269 | 42.4 |
151–650 | 291 | 45.9 | |
651–1400 | 69 | 10.9 | |
1401–2350 | 5 | .8 |
Prevalence of smokeless tobacco use
One of the in-depth interview participants explained as below;“Many people use smokeless tobacco in the villages; both men and women chew tobacco.”
Current smokeless tobacco status | Overall | Male | Female | |||
---|---|---|---|---|---|---|
No | (%) |
N (%) |
N (%) | |||
Current smokeless tobacco user | Daily user | 210 | 33.1 | 131 (20.7) | 79 (12.4) | |
Occasional user | 77 | 12.1 | 46 (7.2) | 31 (4.9) | ||
Occasional user | Occasional user, formerly daily | 25 | 3.9 | 12 (1.9) | 13 (2.0) | |
Occasional user, never daily | 52 | 8.2 | 34 (5.4) | 18 (2.8) | ||
Current non-user of smokeless tobacco | Former daily user | 12 | 1.9 | 6 (0.9) | 6 (0.9) | |
Former occasional user | 12 | 1.9 | 11 (1.7) | 1 (0.2) | ||
Never smokeless user | 323 | 50.9 | 220 (34.7) | 103 (16.2) | ||
For currently daily users: Age at SLT use debut? | <25 years | 146 | 69.5 | 93 (44.3) | 53 (25.2) | |
25–30 year | 17 | 8.1 | 17 (8.1) | 0 (0.0) | ||
>30 year | 11 | 5.2 | 4 (1.9) | 7 (3.3) | ||
I don’t remember | 36 | 17.1 | 17 (8.1) | 19 (9.0) | ||
For currently daily users: How soon after you wake up do you usually use smokeless tobacco for the first time? | Within 5 min | 28 | 13.3 | 22 (10.5) | 6 (2.9) | |
6 to 30 min | 103 | 49.0 | 70 (33.3) | 33 (15.7) | ||
31 to 60 min | 35 | 16.7 | 16 (7.6) | 19 (9.0) | ||
More than 60 min | 44 | 21.0 | 23 (11.0) | 21 (10.0) | ||
For currently daily users: On average, how many times a day do you use the following products? | Chewing tobacco | 2 | 4 | 1.9 | 2 (1.0) | 2 (1.0) |
3 | 11 | 5.2 | 5 (2.4) | 6 (2.9) | ||
4 | 15 | 7.1 | 9 (4.3) | 6 (2.9) | ||
5 | 13 | 6.2 | 7 (3.3) | 6 (2.9) | ||
>5 | 167 | 79.5 | 108 (51.4) | 59 (28.1) | ||
For occasional user: How many times a week do you usually use the following products? | Chewing tobacco | 2 | 8 | 10.4 | 6 (7.8) | 2 (2.6) |
3 | 25 | 32.5 | 18 (23.4) | 7 (9.1) | ||
4 | 27 | 35.1 | 13 (16.9) | 14 (18.2) | ||
5 | 5 | 6.5 | 2 (2.6) | 3 (3.9) | ||
>5 | 12 | 15.6 | 7 (9.1) | 5 (6.5) | ||
For currently SLT users: family members using SLT? | Yes | 144 | 50.2 | 88 (30.7) | 56 (19.5) | |
No | 143 | 49.8 | 89 (31.0) | 54 (18.8) | ||
For currently SLT users: close friends smoke or chew tobacco? | Yes | 231 | 80.5 | 148 (51.6) | 83 (28.9) | |
No | 56 | 19.5 | 29 (10.1) | 27 (9.4) | ||
For currently SLT users: In addition to chewing or snuffing or applying SLT, do you smoke cigarette | Yes | 80 | 27.9 | 57 (19.9) | 23 (8.0) | |
No | 207 | 72.1 | 120 (41.8) | 87 (30.3) | ||
For currently SLT users: During the past 12 months, have you tried to stop using smokeless tobacco? | Yes | 52 | 18.1 | 36 (12.5) | 16 (5.6) | |
No | 235 | 81.9 | 141 (49.1) | 94 (32.8) | ||
Noticed anti SLT use information in newspapers or in magazines in the last 30 days | Yes | 21 | 3.3 | 11 (1.7) | 10 (1.6) | |
No | 613 | 96.7 | 403 (63.6) | 210 (33.1) | ||
Noticed anti SLT use information on television or radio in the last 30 days | Yes | 53 | 8.4 | 31 (4.9) | 22 (3.5) | |
No | 581 | 91.6 | 383 (60.4) | 198 (31.2) | ||
Advised by health professionals to stop using smokeless tobacco in past 12 months, | Yes | 92 | 32.1 | 55 (19.2) | 37 (12.9) | |
No | 195 | 67.9 | 122 (42.5) | 73 (25.4) |
Characteristics of respondents | Current smokeless tobacco status | ||
---|---|---|---|
Non users(n = 347) | Users(n = 287) | ||
No (%) | No (%) | ||
Age category | <25 | 48 (59.3) | 33 (40.7) |
25–30 | 55 (55.6) | 44 (44.4) | |
31–35 | 44 (58.7) | 31 (41.3) | |
36–40 | 63 (56.2) | 49 (43.8) | |
41–45 | 39 (62.9) | 23 (37.1) | |
46–50 | 33 (50.8) | 32 (49.2) | |
>50 | 65 (46.4) | 75 (53.6) | |
Sex | Male | 237 (57.2) | 177 (42.8) |
Female | 110 (50) | 110 (50) | |
Religion | Wakefata | 167 (41.9) | 232 (58.1) |
Muslim | 129 (79.6) | 33 (20.4) | |
Christian | 51 (69.9) | 22 (30.1) | |
Ethnicity | Oromo | 346 (54.9) | 284 (45.1) |
Othersa
| 1 (25) | 3 (75) | |
Educational status of mothers | Cannot read and write | 267 (53.2) | 235 (46.8) |
Read and write but no formal education | 66 (61.1) | 42 (38.9) | |
At least primary | 14 (58.3) | 10 (41.7) | |
Current marital status | Single | 22 (53.7) | 19 (46.3) |
Married | 307 (56.6) | 235 (43.4) | |
Divorced | 11 (42.3) | 15 (57.7) | |
Widowed | 7 (28) | 18 (72) | |
Occupation | Pastoralist | 269 (54.9) | 221 (45.1) |
Othersb
| 78 (54.2) | 66 (45.8) | |
Income category | 0–150 | 155 (57.6) | 114 (42.4) |
151–650 | 149 (51.2) | 142 (48.8) | |
651–1400 | 40 (58) | 29 (42) | |
1401–2350 | 3(60) | 2 (40) |
“…tobacco helped me to get relief from pain; even it helps me to forget issues that worry me. If feel alright only after I use tobacco otherwise I feel discomfort”
“…personally, I do not know any heath problem caused by using smokeless tobacco. It may cause discoloration of teeth; of course, this is not a big problem. Rather it serves as painkiller for teeth and head ache”
”..I have been using this tobacco for almost 25 years, until now I did not experience any health problem. There is no disease caused by tobacco use rather it helps to cure pain such as teeth ache” [80 years old male SLT user] A 36 year old SLT user and smoker added that“I think using smokeless tobacco is less harmful than smoking cigarettes. I think cigarettes have ‘something’ that makes people addicted to the cigarettes.”
Characteristics | Current smokeless tobacco status | ||||
---|---|---|---|---|---|
Non users (n = 347) | Users (n = 287) | ||||
N0 | (%) | N0 | (%) | ||
Attitude towards smokeless tobacco use | Unfavorable | 246 | 70.9 | 140 | 48.8 |
Favorable | 101 | 29.1 | 147 | 51.2 | |
Knowledge about SLT health effect | Insufficient knowledge | 212 | 61.1 | 170 | 59.2 |
Sufficient knowledge | 135 | 38.9 | 117 | 40.8 | |
Health risk perception | Poor perception | 188 | 54.2 | 184 | 64.1 |
Good perception | 159 | 45.8 | 103 | 35.9 | |
Social norm | Low social pressure | 228 | 65.7 | 125 | 43.6 |
High social pressure | 119 | 34.3 | 162 | 56.4 |
A 48 year old in depth interview participant stated that“My grand-mother showed me how to prepare and chew tobacco every time I stayed with her. She also said that it would help to avoid headache, mouth and teeth diseases.”“I have chewed tobacco for about ten years, I chew for my pleasure, when I have a tobacco after my food it makes my meal fantastic. My sons are not chewers and they blame me and have asked me not to chew. It makes me nervous with them sometimes and I reply to them that we are in a modern society, I can chew, and if chewing is bad why do the developed countries and people in our country produce smokeless tobacco, if they do not want people to chew?” –65-years –old male SLT user
Factors associated with smokeless tobacco use (Bivariate analyses)
Characteristics of respondents | Current smokeless tobacco status | COR (95% CL) | Adjusted OR (95% CL) | ||
---|---|---|---|---|---|
Non users (n = 347) | Users (n = 287) | ||||
No (%) | No (%) | ||||
Age category | <25 | 48 (13.8) | 33 (11.5) | 1 | |
25–30 | 55 (15.9) | 44 (15.3) | 1.16 (0.64,2.11) | ||
31–35 | 44 (12.7) | 31 (10.8) | 1.03 (0.54,1.94) | ||
36–40 | 63 (18.2) | 49 (17.0) | 1.13 (0.63,2.02) | ||
41–45 | 39 (11.2) | 23 (8.0) | .86 (0.44,1.69) | ||
46–50 | 33 (9.5) | 32 (10.3) | 1.41 (0.73,2.72) | ||
>50 | 65 (18.7) | 75 (26.1) | 1.68 (0.97,2.92) | ||
Sex | Male | 237 (68.3) | 177 (61.7) | 1 | |
Female | 110 (31.7) | 110 (38.3) | 1.34 (0.96, 1.86) | ||
Religion | Wakefata | 167 (48.1) | 232 (80.8) | 1 | 1 |
Muslim | 129 (37.2) | 33 (11.5) | .84 (.12, .28)* | .21 (.13, .33) | |
Christian | 51 (14.7) | 22 (7.7) | .31 (.18, .53)* | .38 (.22, .67) | |
Ethnicity | Oromo | 346 (99.7) | 284 (99.0) | 1 | |
Others*@ | 1 (0.3) | 3 (1.0) | 3.66 (.38, 35.31) | ||
Educational status of mothers | Cannot read and write | 267 (76.9) | 235 (81.9) | 1 | |
Read and write but no formal education | 66 (19.0) | 42 (14.6) | .72 (.47, 1.11) | ||
At least primary | 14 (4.0) | 10 (3.5) | .81 (.35,1.86) | ||
Current marital status | Single | 22 (6.3) | 19 (6.6) | .34 (.12, .98) | |
Married | 307 (88.5) | 235 (81.9) | .30 (.12, 0.72) | ||
Divorced | 11 (3.2) | 15 (5.2) | .53 (.17, 1.71) | ||
Widowed | 7 (2.0) | 18 (6.3) | 1 | ||
Occupation | Pastoralist | 269 (77.5) | 221 (77.0) | 1 | |
Others**$ | 78 (22.5) | 66 (23.0) | 1.03 (.71, 1.50) | ||
Income category | 0–150 | 155 (44.7) | 114 (39.7) | 1 | |
151–650 | 149 (42.9) | 142 (49.5) | 0.91 (0.15, 5.51) | ||
651–1400 | 40 (11.5) | 29 (10.1) | 0.70 (0.12, 4.23) | ||
1401–2350 | 3 (0.9) | 2 (0.7) | 0.92 (0.14, 5.86) | ||
Attitude towards smokeless tobacco use | Unfavorable | 246 (70.9) | 140 (48.8) | 1 | 1 |
Favorable | 101 (29.1) | 147 (51.2) | 2.56 (1.84, 3.55)* | 2.12 (1.48, 3.04) | |
Knowledge about SLT health effect | Insufficient knowledge | 212 (61.1) | 170 (59.2) | 1 | |
Sufficient knowledge | 135 (38.9) | 117 (40.8) | 1.08 (.79, 1.49)* | ||
Health risk perception | Poor perception | 188 (54.2) | 184 (64.1) | 1 | 1 |
Good perception | 159 (45.8) | 103 (35.9) | .66 (.48, .91)* | .49 (.34, .70) | |
Social norm | Low social pressure | 228 (65.7) | 125 (43.6) | 1 | 1 |
High social pressure | 119 (34.3) | 162 (56.4) | 2.48 (1.80, 3.43)* | 1.73 (1.21, 2.47) |
Factors associated with smokeless tobacco use (Multiple variable analyses)
Discussion
“Although I don’t like chewing tobacco, I feel it’s normal. As you see it is very common in our community, it’s normal for people to chew tobacco.” [−−43-year-old health care provider]
“Chewing is our traditional habit that we follow when we grow old; it can help to avoid mouth and teeth diseases.” –56 years old male SLT user“I think chewing helps us care for our teeth, I’ve tried to chew tobacco but I always got dizzy, then I stopped. I sometimes put a small amount of tobacco to crush with my teeth when I have toothache.” --41-year-old female SLT user“When I was young my father asked me to buy smokeless tobacco for him. Every time I bought smokeless tobacco I lit them for him and I sometimes put the smokeless tobacco in my mouth, I did this repeatedly. I liked smokeless tobacco and I saved some money to buy smokeless tobacco for myself and hide them from people in my family and my village. I would find secret places to chew tobacco, later after getting married and having children I dared to chew tobacco in public.” --64-year-old male SLT user
“Using smokeless tobacco became a habit a long time ago. In our society, people serve chewable tobacco to guests; for instance, chewable tobaccos are served in wedding ceremonies, new baby born and traditional ceremonies.” – 30 –years-old health care provider“I think chewing tobacco is a normal habit, it is commonly accepted in our traditional instructions for women to symbol of respect to welcome or greet guests who come to their house. When men visit to their house, women serve them smokeless tobacco. So to be perfect men a long time ago, men chewed.” --56-year-old man SLT user
“I hate using smokeless tobacco because the tobacco smell makes me sick, like having nausea and headache.” --36-yearold-male non-SLT user“I don’t like using smokeless tobacco because it makes chewers sick and dirty, my uncle who is a chewer coughs every day, it resembles like had tuberculosis and his body is full of tobacco smells, he always spits his saliva.” --41-year-old male non-SLT user
“I have chewed tobacco for many years, but I did not have any sickness. I saw the older generation, my grandmother, my mother, they chew tobacco, and they did not have any disease, in fact their teeth stayed very strong until they passed away.” --50-year-old male SLT user“Chewing tobacco would cause no harm as it does not have smoke, it just stays in the mouth and then they spit it out.” --43-year-old female- SLT user
“I think that there is no benefit from chewing tobacco, but people just do it as habit, they saw others do it so they follow them, and then it becomes their habit.” --35-years-old male SLT user