Global Adult Tobacco Survey Research Articles

Factors Affecting the Intention to Quit among Women Smokers in Turkey.

Objectives:Tobacco use is an important public health problem that affects adversely the quality of life. A person’s attitude toward quitting tobacco use can be reflected by the desire or intention to quit smoking. The aim of this study was to determine risk factors affecting women’s intention to quit tobacco in Turkey. Methods:In this study, the data obtained from the Global Adult Tobacco Survey (GATS) were used. The GATS is a standard method used in countries to monitor and evaluate the frequency of tobacco use in adults and tobacco control practices. The data used in the study was obtained from the GATS carried out in Turkey in 2008 and 2012. The data related to 1248 women smoking tobacco were used in the analysis. The relationship between women’s intention to quit tobacco use and socio-demographic and economic variables was examined. Results:Men were excluded from the analysis because the focus of the study was women. It was determined that 732 of 1248 women using tobacco intend to quit smoking tobacco. 40.4% of women smoking tobacco are primary school graduates. Women, who were aware of anti-smoking messages and exposed to stimulants that promote smoking, were 36.4% and 27% more likely to intend to stop tobacco use after the next month, respectively. It was observed that women living in a house, where smoking is allowed, are less likely to quit smoking than others (ME = -0.522). This shows the importance of domestic restrictions. Conclusion:Intending to quit is an important preliminary step to quit. Understanding the factors associated with the intention to quit smoking can help tobacco users to stop using it and shape effective policies to increase the quit rates.

Patterns of tobacco and alcohol misuse among presumptive TB Patients in Myanmar: prevalence and sociodemographic associations.

ABSTRACTThis study aimed to assess the prevalence and patterns of tobacco and alcohol use and the associations with socio-demographic variables among presumptive TB patients.A cross-sectional study was conducted among 397 presumptive TB patients in a tertiary hospital in Myanmar. Global Adult Tobacco Survey (GATS) questionnaire and AUDIT-C were used to measure daily tobacco use (single, any or dual use of smoked and smokeless tobacco) and harmful alcohol use, respectively. Multiple and multinomial logistic regression were used to examine the associations with socio-demographic factors.The prevalence of daily use of dual tobacco and any tobacco was 28.2% and 65.7%, respectively. Harmful alcohol use was also high (44.8%). While single use of daily tobacco and harmful alcohol was 28.2% and 7.3%, respectively, concurrent tobacco and alcohol use was 37.5%. While being male and having low education were associated with tobacco use, concurrent tobacco and harmful alcohol use were associated with male gender, low education, and occupation with the government or a company.Due to the high prevalence of tobacco and alcohol misuse, identifying those at risk of tobacco and alcohol misuse and providing integrated care services in a health facility should be considered as a joint activity in national TB and tobacco control programmes.

Tobacco use patterns and predictors among college students in Mangalore, South India: Findings from the Global Adult Tobacco Survey.

INTRODUCTIONTobacco use is a leading cause of death and disability worldwide, particularly in South-East Asia. The tobacco problem in India is probably more complex than in any other country, with a huge consequential burden of tobacco related diseases and deaths. The present study aimed at analyzing the pattern and predictors of tobacco use among college students aged 18–24 years, using the Global Tobacco Surveillance System (GTSS).METHODSA cross-sectional study was conducted among 2063 students, from 30 colleges of Mangalore, South India, who were selected by multistage sampling with probability proportional to size. The tobacco questions used for this study were a validated, recommended subset of key questions from the Global Adult Tobacco Survey (GATS). Data analysis was performed using GATS manuals and SPSS version 24.0.RESULTSA total of 2063 students participated in the study (738 males, 1325 females). Prevalence of tobacco smoking was 4.8%, which included 9.9% males and 2.1% females. Manufactured cigarettes were the most commonly preferred tobacco product among daily smokers. The overall percentage of smokeless tobacco use was 4.8%, which included 7.4% males and 3.3% females. Logistic regression analysis showed that 71.4% of the participants who noticed anticigarette information on television made an attempt to quit smoking. The odds ratio (OR) of quitting was 4.4 times higher compared to those who did not notice any information on television (p=0.002). In addition, noticing health warnings on cigarette packs strongly influenced an individual to quit smoking (OR=30.09).CONCLUSIONSThe study results showed low prevalence of the use of both smoked and smokeless forms of tobacco, current smoking, and chewing tobacco, among the study population. Generating data in this part of the country on tobacco use and developing tobacco control measures at regular intervals are essential to better understand and develop effective intervention programs.

Beyond Educating the Masses: The Role of Public Health Communication in Addressing Socioeconomic- and Residence-based Disparities in Tobacco Risk Perception

ABSTRACT Public health communication has long been a key component of tobacco control efforts. However, little is known whether and how such an effort could address disparities in tobacco risk perceptions among population subgroups. In this study, using data from the Global Adult Tobacco Survey of Ethiopia, we examined if tobacco risk perceptions varied across socioeconomic and urban vs. rural population subgroups, and whether and how exposure to anti-smoking message was associated with disparities in risk perceptions across socioeconomic and urban-rural subgroups. The results indicated that health risk perceptions of smoking and secondhand smoke exposure were significantly lower among rural, less educated and less affluent population subgroups. Controlling for age, gender, education, wealth, place of residence, and pro-smoking message exposure, anti-smoking message exposure was associated with greater risk perceptions of smoking. Moreover, anti-smoking message exposure moderated the associations of place of residence and education with risk perceptions of smoking and secondhand smoke exposure, respectively. The probability of risk perception of smoking associated with anti-smoking message exposure was higher among the rural populace compared to urbanites. Similarly, the probability of risk perception of secondhand smoke exposure associated with anti-smoking message exposure was the highest among individuals without formal education compared to those with primary, secondary, and college-level education. The findings suggest that efforts should be made to make sure adequate anti-smoking message exposure among less educated and rural audiences so as to reduce disparities in tobacco risk perceptions.

Correlates of Chronic Kidney Disease in India

Chronic kidney disease (CKD) is one of the major non-communicable diseases in India, yet there is a lack of nationally representative studies. The present study aimed to correlate certain demographic factors like tobacco use, alcohol use, the use of clean fuel, economic condition, obesity, and diabetes with CKD burden. National Family Health Survey 4 (2015–2016), Global Adult Tobacco Survey 2: India 2016–2017, and India: Health of the Nation’s States were used as data sources. Spearman correlation coefficient, scatter plot, and multivariate linear regression were used for analysis, considering state as a unit. Obesity and diabetes were significantly correlated with CKD burden (r = 0.452, p = 0.012 and r = 0.789, p = 0.000, respectively). Even after multivariate regression, they were found significant predictors for CKD burden. For reducing the burden of CKD, emphasis should be given to early diagnosis and management of diabetes and lifestyle modification.

The potential and barriers in the expansion and utilization of a text message-based tobacco cessation service among tobacco users in India

AbstractBackgroundThere is growing recognition of the role of the mCessation service (MCS) in promoting tobacco cessation in India.ObjectiveTo examine the potential for expanding the utilization of the MCS for tobacco cessation in India after assessing the dimensions related to literacy, mobile phone access, intention to quit, and advice to quit from the second round of the Global Adult Tobacco Survey.MethodsA cross-sectional analysis of the data collected during the second round of the nationally-representative Global Adult Tobacco Survey (GATS) (2016–17) was conducted.ResultsCurrent tobacco smokers, smokeless tobacco, and dual users compromised 10.7%, 21.4%, and 3.4% of the survey participants, respectively. Quit attempts were reported by 36.3% of the existing tobacco smokers, of whom nearly 72% tried to quit without any assistance, while only 0.3% used the MCS. However, the potential expansion of the MCS was likely among 11.2% tobacco users with an existing intention to quit, being literate, Hindi-speakers and having cell-phone access.ConclusionsThe utilization of the MCS can be considerably expanded among tobacco users in India by enabling multilingual usage and incorporation as standard care practice to allow the opportunistic promotion of tobacco cessation by healthcare providers at their health clinics.

Estimating illicit cigarette consumption using a tax-gap approach, India.

ObjectiveTo estimate the magnitude of illicit cigarette consumption in India using a tax-gap approach.MethodsIn the tax-gap analysis, illicit cigarette consumption in India was defined as the difference between total and legal consumption. Data on total cigarette consumption came from two national Global Adult Tobacco Surveys carried out from 2009 to 2010 and from 2016 to 2017. Legal consumption was derived from Government of India data on domestic cigarette production and trade.FindingsEstimated total cigarette consumption was 104.8 billion sticks in 2009 to 2010 and 94.2 billion sticks in 2016 to 2017, a decrease of 10.6 billion sticks, or of 10%, over the time period. Legal cigarette consumption fell from 99.4 to 88.5 billion sticks over the same period, a drop of 11%. Estimated illicit cigarette consumption was, therefore, 5.4 billion sticks in 2009 to 2010 and 5.6 billion sticks in 2016 to 2017, and accounted for 5.1% and 6.0% of the market in these periods, respectively. Consequently, only about 1 in 20 cigarettes consumed in India was illicit. Between 2016 and 2017, the estimated equivalent retail sales value of illicit cigarettes was 49 billion Indian rupees (753 million United States dollars, US$) and the estimated tax revenue foregone was 25 billion Indian rupees (US$ 390 million).ConclusionIllicit cigarette consumption is relatively modest in India by global standards. Nonetheless, India should strengthen its capacity to control the illicit tobacco market as part of a comprehensive tobacco control strategy, while also continuing to implement traditional demand reduction measures, such as tobacco taxation.

Identifying stages of smoke and smokeless tobacco cessation among adults in India: an application of transtheoretical model

ABSTRACT Introduction In this paper, we used the transtheoretical model of stages of change to study the addictive behavior of smokers, which is a continuum of stages, namely pre-contemplation, contemplation, and preparation, and classify the tobacco users in these three stages to study the differentials and factors determining these stages. Data and Methodology This study used the data from the Global Adult Tobacco Survey (GATS)-2 conducted in 2016–17 in India. Multinomial logistic regression was used to predict the probabilities for different stages according to socio-demographic factors and factors related to tobacco use such as nicotine dependency, information about dangers about tobacco use, etc. Results Among 9499 smoking tobacco users, 44.73% of users are in the pre-contemplation stage, 46.83% in contemplation, and only 8.43% in the preparation stage. The probability of a smoker to be in the preparation stage for quitting after knowing the dangers of smoking is 0.11. Conclusion We found a significant association between the stages of smoke and smokeless tobacco cessation and socio-demographic characteristics and the factors related to smoke and smokeless tobacco use. Contemplation is a major driver of tobacco cessation. These stages may help tobacco control program implementation more effectively and efficiently.

Tütün Yasağının Genişletilmesinin Sigara Kullanma Olasılığı Üzerine Etkileri

Dünya genelinde hükümetler tütün ile ilişkili hast alıkları ortadan kaldırmak için tütün kullanımına karşı bir dizi önlemler alarak mücadele etmektedirler. Türkiye, Dünya Sağlık Örgütü’nün ilk global umumi sağlık antlaşmasını imzaladıktan sonra tütün salgın hastalığına karşı acilen bir dizi karşıt politikayı hayata geçirmiştir. Sigara tüketiminin azaltılması bağlamında yeni bir kanıt sunmak adına Türkiye için yapılan Küresel Yetişkin Tütün Anketleri 2008 ve 2012 verisetlerine Lineer Olasılık Modellerini uygulayarak tütün karşıtı politikanın etkilerini inceledik. 2009 ve 2010 yılları arasında uygulamaya konulan tütün karşıtı iki önemli politikanın sigara kullanıcısı olma olasılığı üzerinde istatistiksel olarak anlamlı ve negatif bir etkisi görülmektedir. Konuya cinsiyet perspektifinden yaklaştığımızda; bu politika her iki cinsiyetin de sigara kullanıcıları olma olasılıklarını düşürmektedir fakat bu etki yetişkin erkekler için daha fazladır. Eğitimin kadın ve erkek üzerindeki etkisi farklılaşmakta; eğitimli kadınların sigara içme olasılıkları daha yüksek iken yetişkin erkekler için bu durum tam tersidir. Politika yapıcılar tütün tüketimine önlem almak ve sigara salgınını durdurmak için bu çalışmanın sonuçlarını dikkatle incelemeli ve cinsiyet farklılıklarını dikkate alan bir takım politikalar geliştirmelidirler.

Economic Costs of Diseases and Deaths Attributable to Tobacco Use in India, 2017–2018

About 28.6% of Indian adults use tobacco. This study estimates the economic burden of deaths and diseases attributable to smoking and smokeless tobacco (SLT) use for persons aged ≥35 years. The National Sample Survey data on healthcare expenditures, the Global Adult Tobacco Survey data on tobacco use prevalence, and relative risks of all-cause mortality from tobacco use were used to estimate the economic burden of diseases and deaths attributable to tobacco use in India, using a prevalence-based attributable-risk approach. Costs are estimated under the following heads: (1) direct medical and nonmedical expenditures; (2) indirect morbidity costs; and (3) indirect mortality costs of premature deaths. Total economic costs attributable to tobacco use from all diseases and deaths in India in the year 2017-2018 for persons 35 years or older amount to INR 1773.4 billion (US $27.5 billion), of which 22% is direct and 78% is indirect cost. Men bear 91% of the total costs. Smoking contributed 74% and SLT use contributed 26% of the costs. The economic costs of tobacco use amount to approximately 1.04% of India's gross domestic product (GDP), while the excise tax revenue from tobacco in the previous year was only 12.2% of its economic costs. The direct medical costs alone amount to 5.3% of total health expenditure. The enormous costs imposed on the nation's health care system due to tobacco use could potentially stress the public health care system and strain the economy and it warrants massive scaling up of tobacco control efforts in India. The study finds that the economic burden from tobacco constitutes more than 1% of India's GDP, and the direct health expenditures on treating tobacco-related diseases alone accounts for 5.3% of the total private and public health expenditures in India in a year. It shows that, for every INR 100 that is received as excise taxes from tobacco products, INR 816 of costs is imposed on society through its consumption. It establishes that tobacco consumption is a major resource drain on the national exchequer, and its effective regulation through comprehensive fiscal and non-fiscal policies is highly warranted.

Smoking and Mental Illness: Prevalence, Patterns and Correlates of Smoking and Smoking Cessation among Psychiatric Patients.

This study aims to understand (a) the prevalence and correlates of smoking in a psychiatric population, (b) factors that encourage smoking cessation, and (c) awareness towards cessation programmes. This study captured data (n = 380) through a modified version of the Global Adult Tobacco Survey (GATS). A descriptive analysis of the data was performed. The prevalence of smoking was 39.5% (n = 150) and 52.3% of the smokers were dependent on nicotine. More than half of the smokers had made at least one attempt to quit in the past 12 months and 56% reported no immediate plans to quit smoking. The awareness towards institutional smoking cessation programmes was fair (44%), with 49.7% of smokers having indicated that they were willing to use the service upon referral. Smokers endorsed that increasing the cost of cigarettes, restricting availability, and increasing knowledge of health harms could encourage smoking cessation. Past smokers reported that self-determination/willpower followed by substitution of smoking with other types of foods and drinks were factors that helped them achieve successful cessation. Given that the readiness to quit and awareness towards cessation programmes are low among the smokers, concerted efforts through educational programmes and policy changes are crucial to achieve successful cessation.

Impact of Health Warning Labels on Cigarette Packs in India: Findings from the Global Adult Tobacco Survey 2016–17

Two rounds of Global Adult Tobacco Survey (GATS) were conducted in 2009-10 and 2016-17 in India. These two surveys provide national comparable data on tobacco usage and its related aspects in India. This study used the data from GATS 2016-17 to examine the salience and impact of cigarette pack pictorial health warnings (PHWs) on quit intention among current cigarette smokers in India. The nationally representative survey interviewed 74, 037 respondents aged ≥15 years with an overall response rate of 92.9% using a multi-stage sampling method. Results of multivariate analysis showed that the strongest predictor for quit intention because of health warnings was “ever made a quit attempt in the past 12 months” and buying cigarette packs instead of loose cigarettes. Compared to GATS 2009-10, GATS 2016-17 observed an increase in salience of cigarette health warnings by 16% and increase in the impact of PHWs on quit intention by 50%. PHWs have a significant impact on intention to quit among cigarette smokers in India with a rising trend. The efforts of Government of India in terms of periodic introduction of new PHWs and increase in the size of warning labels to 85% of the cigarette packs is laudable. The study results support ban on loose cigarettes and warrants stricter implementation of the act prohibiting sale of loose cigarettes.

Smoke-free workplaces are associated with smoke-free homes in India: evidence for action.

India enacted a smoke-free law in 2003. It is believed that smoke-free workplaces will lead to more smoking in private places such as homes. The national Global Adult Tobacco Survey (GATS 2) India 2016-2017 collects information on the self-reported prevalence of SHS exposure in homes and workplaces. The present study utilised the GATS 2 dataset to establish the association between working in a smoke-free workplace and living in a smoke-free home. 70.1% of respondents who worked indoors reported smoke-free workplace; 64.5% of respondents reported that they live in a smoke-free home. Respondents who reported that their workplace was smoke-free were significantly more likely to live in smoke-free homes compared with those who are exposed to SHS at the workplace (69.5% vs 45.5%, AOR = 1.8, 95% CI 1.5-2.1). Males, urban residents, family with fewer members, non-smokers and non-smokeless tobacco users were significantly more likely to live in a smoke-free home. Significant differences were also observed with respect to religion, caste, region and education levels. Our results provide conclusive evidence to support that smoke-free workplaces influence smoke-free homes in India. Thus, it highlights the importance of accelerating the implementation of existing national tobacco control legislation on smoke-free public places.

Secondhand Tobacco Smoke Exposure in Indoor Workplaces in Viet Nam and Associated Factors: Findings from Two Rounds of Global Adult Tobacco Surveys (GATS) 2010 and 2015.

This paper explores changes in the level of secondhand smoke (SHS) exposure at indoor workplaces between 2010 and 2015 in Viet Nam and the association between the exposure and various demographic factors, using data from Viet Nam's Global Adult Tobacco Surveys (GATS) 2010 and 2015. Data was pooled from the two GATS surveys and analysed using descriptive and Poisson regression analyses. There was a highly statistically significant reduction in the level of SHS exposure at indoor workplaces from 55.9% to 42.6% (p.

Secondhand Smoke Exposure among Nonsmokers in China.

China signed the World Health Organization Framework Convention on Tobacco Control and conducted a series of activities to protect people from secondhand smoke exposure. This paper explores the changes in prevalence of secondhand smoke exposure among nonsmokers between 2010 and 2015. Data from the 2010 Global Adult Tobacco Survey and 2015 National Adult Tobacco Survey were used in this study. Due to the complex sample design for these surveys, data were weighted and analyzed using the SAS 9.3 complex survey data analysis procedure. The Chi-square test was used for comparison among different groups. From 2010 to 2015, secondhand smoke exposure among nonsmokers decreased in restaurants, government buildings, health-care facilities, schools, and public transportation in China (p<0.05). The relative change was most significant for schools (52.1%), followed by public transportation (49.4%) and government buildings (42.2%). The percentage of secondhand smoke exposure reported in workplaces declined from 55.2% to 45.3%. Secondhand smoke exposure at home reduced from 58.3% to 46.7%. People's awareness that secondhand smoke could cause heart disease in adults, lung illness in children, and lung cancer in adults increased from 24.6% to 36.0%. Additionally, support for smoke-free policies is high among the Chinese population. Even for restaurants, where support for smoke-free policies was lowest, 75.1% of nonsmokers and 55.3% of smokers supported smoke-free policies. Secondhand smoke exposure declined from 2010 to 2015 in China but remains a serious problem. Public awareness about the hazards of secondhand smoke is increasing and Chinese people support smoke-free laws.

Tobacco control and household tobacco consumption: A tale of two educational groups.

Since the ratification of the World Health Organization Framework Convention on Tobacco Control in 2004, Pakistan has made modest but continued progress in implementing various tobacco control measures. By 2014, substantial progress was achieved in areas of monitoring, mass media antitobacco campaigns, and advertising bans. However, the findings from the 2014 Global Adult Tobacco Survey of Pakistan show significant differences in antitobacco campaign exposure among individuals of different educational attainment. Given this large variation in noticing antitobacco information, this paper analyzes how heterogeneity in treatment exposure may differentially impact tobacco‐use prevalence across household groups. Household‐level tobacco‐use prevalence in 2014 was, respectively, 56% and 48% for the low‐ and high‐education households. The gap in tobacco‐use prevalence between the two educational groups further widens post 2014. We find that, on average, individuals with higher than primary education are 14 percentage points and 6 percentage points more likely to notice anticigarette and antismokeless tobacco information in 2014, respectively. Subsequently, in 2016, high‐education households experienced a 3.6 percentage point higher reduction in tobacco‐use prevalence compared to the low‐education households. These findings motivate policies to enhance the outreach of tobacco control measures across different educational groups.

Trends and patterns of second-hand smoke exposure amongst the non-smokers in India-A secondary data analysis from the Global Adult Tobacco Survey (GATS) I & II.

The primary objective of the present study was to compare the prevalence and patterns of second-hand smoke (SHS) exposure in the home, workplace, public places, and at all three places amongst the non-smoker respondents between the two rounds of Global Adult Tobacco Survey (GATS) in India. The secondary objectives were to assess the differences in various factors associated with SHS exposure among non-smokers. This secondary data analysis incorporated data generated from the previous two rounds of the cross-sectional, nationally representative GATS India, which covered 69,296 and 74,037 individuals aged 15 years and above. Exposure to the SHS at home, workplace, and public places amongst the non-smokers were the primary outcome variables. Standard definitions of the surveys were used. The overall weighted prevalence of exposure to SHS amongst the non-smokers inside the home and public places reduced. In contrast, the prevalence in the workplace increased marginally in round II compared to I. The proportion of adults who were exposed to SHS at all three places did not change much in two rounds of surveys. A decrease in the knowledge of the respondents exposed to SHS at home and public places was observed about the harmful effects of smoking in round II. Age, gender, occupation, place, and region of respondents were found to be significant determinants of SHS exposure at all the three places on multinomial logistic regression analysis. The study calls for focused interventions in India and stringent implementation of anti-tobacco legislation, especially in the workplaces for reducing the exposure to SHS amongst the non-smokers and to produce encouraging and motivating results by next round of the survey.

Use of Betel Quid in India from 2009 to 2017: An Epidemiological Analysis of the Global Adult Tobacco Survey (GATS)

Background: Betel quid chewing is a deep-rooted practice in India and neighboring countries, which has migrated to other parts of the world. Betel leaf acts as a carrier for areca nut and most often, smokeless tobacco, both of which are carcinogenic, making betel quid a harmful product. Objectives: The first objective was to compare the prevalence of “use of betel quid with tobacco” from GATS-1 to GATS-2. The second was to study the association of “use of betel quid with and without tobacco” with different socio-economic groups (wealth quintiles) according to select background characteristics. Methods: This study used data from the Global Adult Tobacco Surveys (GATS), 2009–10 and 2016–17. Logistic regression with adjustment of co-variates (age, gender, residence and education) was used to study association of use of betel quid with different socio-economic groups. Results: Highest reduction (40 percent) was seen in “use of betel quid with tobacco” among male youth (15–24 years) over the two rounds of GATS. No change was seen in this form of use among females. The odds of “use of betel quid with tobacco” had a positive gradient with decreasing wealth quintiles. “Use of betel quid without tobacco” showed highest odds among participants with moderate levels of education. Conclusion: Health promotion interventions around harmful effects of “betel quid with and without tobacco” are needed for all genders from poorer populations with low education. Stress needs to be laid on universal population-level public health awareness campaigns about the carcinogenic properties of areca nut in betel quid.

A study on tobacco use in women with major mental illnesses- schizophrenia, bipolar disorder and recurrent depression

About 14.2% of women in the general Indian population and 4.8% in Delhi use tobacco but its use among women with Major Mental Illness (MMI) in developing countries has not been adequately studied. We assessed tobacco use in women with MMI in a tertiary care psychiatry outpatient department through a cross-sectional, observational study, with sample size of at least n= 77 each for schizophrenia-SZ, bipolar disorder-BD and Recurrent Depressive Disorder-RDD. Fagerstrom Test for Nicotine Dependence (FTND) both for smoke and smokeless tobacco were applied along with a subset of questions from Global Adult Tobacco Survey 2016. After diagnosis and referral by the treating psychiatrist and written informed consent, in our total sample of 321 women participants, lifetime use of tobacco was reported by 14.64%. Of all those who had ever used tobacco, 12.14% used it currently as well. As for diagnosis, those with BD (16.25%) used tobacco most frequently followed by SZ (14.18%) and RDD (6%). The FTND score was higher for schizophrenia indicating greater dependence. Tobacco use among women with MMI was thrice as common as women in general population of Delhi State, with smoke and smokeless tobacco use being equally prevalent, a grave cause for concern and intervention.

Caffeine, alcohol, khat, and tobacco use during pregnancy in Butajira, South Central Ethiopia.

The use of excessive caffeine and consumption of alcohol, cigarette, and khat during pregnancy can result in adverse health effects on the fetus. The World Health Organization (WHO) recommends a daily caffeine intake not exceeding 300 mg. Likewise, pregnant women are recommended to avoid alcohol, khat and tobacco use. However, the prevalence's of the use of substances among pregnant women were not well studied in developing countries such as Ethiopia. Therefore, the study aimed to estimate the prevalence of caffeine and alcohol consumption, khat chewing, and tobacco use during pregnancy and identify key factors associated with excess caffeine consumption. We conducted a community based cross-sectional study and used a random sampling technique to recruit 352 pregnant women. We adapted a questionnaire from Caffeine Consumption Questionnaire-Revised (CCQ-R), Alcohol Use Disorder Identification Test (AUDIT), Global Adult Tobacco Survey (GATS), and Ethiopian Demographic Health Survey 2016 for caffeine, alcohol consumption, tobacco use, and khat chewing assessment, respectively. We conducted non-consecutive two days 24-hour recall to determine the habitual intake of caffeine from caffeinated beverages and foods. Prevalence with 95% confidence interval was estimated for excess caffeine intake per day, alcohol consumption, khat chewing, and passive tobacco smoking. We ran a multivariable binary logistic regression model to identify factors associated with excess caffeine intake. Almost all pregnant women (98.2%) consumed caffeine as estimated using the 2 days 24-hour average. The median daily caffeine intake was 170.5 mg and ranged from 0.00 mg to 549.8 mg per day. In addition, 17.6% (95% CI: 13.9%, 22.0%) of them had a daily caffeine consumption of 300 mg and above exceeding the WHO recommended daily caffeine intake during pregnancy. The prevalence of alcohol consumption and Khat chewing were 10.0% (95% CI: 7.2%, 13.7%) and 35.8% (95% CI: 30.8, 41.0%) respectively. None of the pregnant women were active tobacco smokers. However, 23.2% (95% CI: 19.0, 28.0%) were passive tobacco smokers. We found that pregnant women in the richest wealth quintile (AOR = 3.66; 95% CI: 1.13, 11.88), and the first trimester of pregnancy (AOR = 4.04; 95% CI: 1.26, 13.05) had higher odds of consuming excessive caffeine. The study showed a considerable magnitude of substance use among pregnant women in the study area. Given this findings, we recommend, programs and services focusing on pregnant women to consider addressing substance use.