{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:14:24Z","timestamp":1788444864022,"version":"build-2803163510"},"reference-count":48,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tobacco use remains a leading preventable risk factor for morbidity and mortality worldwide. Although global evidence indicates a general decline in tobacco use among women, it is unclear to what extent these trends and associated determinants apply to populations in East Africa. Therefore, this study aimed to examine the trends in tobacco use and its associated factors among women aged 15\u201349 across East African countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine trends in tobacco use and identify individual- and community-level factors associated with current tobacco use among women of reproductive age (15\u201349 years) in East Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from Demographic and Health Surveys (DHS) across multiple East African countries. Prevalence trends were assessed over four survey periods (1999\u20132005, 2006\u20132010, 2011\u20132015 and 2016\u20132022). A cross-sectional analysis of the most recent survey wave was used for the multilevel logistic regression models to identify individual-level and community-level factors associated with current tobacco use, including sociodemographic and socioeconomic characteristics (such as age, education, wealth status and marital status) and community-level factors (such as place of residence and contextual community characteristics). Country-specific trends were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 543\u2009013\u2009women of reproductive age from 11 East African countries were included in this analysis. In each DHS survey, most respondents resided in rural areas. Of the pooled sample years, the overall prevalence of current tobacco use was 2.84% (95% CI 2.7% to 2.9%). After a slight increase from 3.74% (1999\u20132005)\u2009to 4.04% (2006\u20132010), the prevalence declined markedly to 1.35% (2011\u20132015)\u2009and then rose to 2.74% (2016\u20132022). Compared with cigarette smoking, the use of other tobacco products has consistently greater fluctuations. Country-specific trends showed a declining prevalence in most countries, although increases or fluctuations were observed in Madagascar and Zambia. In the multilevel analysis, age and education showed the strongest association with tobacco use. Women aged 35\u201349 years had significantly higher odds of tobacco use (adjusted OR (AOR) 2.86, 95%\u2009CI 2.44 to 3.36), and those aged 25\u201334 years (AOR 1.86, 95%\u2009CI 1.62 to 2.15) compared with women aged 15\u201324 years. Women with no formal education were substantially more likely to use tobacco (AOR 4.30, 95%\u2009CI 3.01 to 6.15) than those with higher education levels. Additional factors associated with increased odds included experience of child death (AOR 1.39, 95%\u2009CI 1.27 to 1.52)\u2009and abortion history (AOR 1.21, 95%\u2009CI 1.09 to 1.33). At the community level, urban residence (AOR 1.60, 95%\u2009CI 1.40 to 1.84)\u2009and lower altitudes of &lt;1000\u2009m (AOR 1.40, 95%\u2009CI 1.03 to 1.91) were also significantly associated with tobacco use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tobacco use among women of reproductive age in East Africa remains relatively low but varies substantially across countries and over time. Older age, lack of formal education, reproductive factors and contextual community characteristics were important determinants. Targeted and context-specific tobacco control interventions are therefore required to reduce tobacco use among vulnerable populations in the region.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110431","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:25:35Z","timestamp":1781612735000},"page":"e110431","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Trends and determinants of tobacco use among women of reproductive age in East Africa: a trend and multilevel analysis using demographic and health survey data"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6359-7826","authenticated-orcid":false,"given":"Altaseb Beyene","family":"Kassaw","sequence":"first","affiliation":[{"name":"Department of Biomedical Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7834-8838","authenticated-orcid":false,"given":"Gosa","family":"Mankelkl","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9930-3661","authenticated-orcid":false,"given":"Adisu Meles","family":"Kabtyimer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8849-7177","authenticated-orcid":false,"given":"Halid Worku","family":"Jemil","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7510-3448","authenticated-orcid":false,"given":"Awoke","family":"Keleb","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0993-7676","authenticated-orcid":false,"given":"Anmut Endalkachew","family":"Bezie","sequence":"additional","affiliation":[{"name":"Department of Occupational Health and Safety, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"2026090306270619000_16.6.e110431.1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.4103\/0019-557X.89943","article-title":"Tobacco use: a major risk factor for non communicable diseases in South-East Asia region","volume":"55","author":"Thakur","year":"2011","journal-title":"Indian J Public Health"},{"key":"2026090306270619000_16.6.e110431.2","doi-asserted-by":"crossref","unstructured":"Chugh A , Jain N , Arora M . Prevention and control of tobacco use as a major risk factor for non-communicable diseases (ncds): a lifecourse approach. In: Healthy Lifestyle: From Pediatrics to Geriatrics. Springer, 2022: 173\u201397.","DOI":"10.1007\/978-3-030-85357-0_9"},{"key":"2026090306270619000_16.6.e110431.3","unstructured":"World Health Organization . Tobacco. 2025. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tobacco"},{"key":"2026090306270619000_16.6.e110431.4","doi-asserted-by":"publisher","DOI":"10.1111\/dar.14040"},{"key":"2026090306270619000_16.6.e110431.5","unstructured":"World Health Organization . WHO report on the global tobacco epidemic 2021: addressing new and emerging products, 2021. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240032095?utm_source=chatgpt.com"},{"key":"2026090306270619000_16.6.e110431.6","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1159\/000369441","article-title":"The WHO Framework Convention on Tobacco Control","volume":"42","author":"Brundtland","year":"2015","journal-title":"The Tobacco Epidemic"},{"key":"2026090306270619000_16.6.e110431.7","doi-asserted-by":"publisher","DOI":"10.1136\/tc-2024-058717"},{"key":"2026090306270619000_16.6.e110431.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2016.02.017"},{"key":"2026090306270619000_16.6.e110431.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-19478-7","article-title":"Compliance with tobacco advertising and promotion laws at points-of-sale in Ethiopia: an observational study in 10 cities","volume":"24","author":"Deressa","year":"2024","journal-title":"BMC Public Health"},{"key":"2026090306270619000_16.6.e110431.10","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1093\/ntr\/ntab131","article-title":"Tobacco Use Among 1\u2009310\u2009716 Women of Reproductive age (15\u201349 Years) in 42 Low- and Middle-Income Countries: Secondary Data Analysis From the 2010-2016 Demographic and Health Surveys","volume":"23","author":"Shukla","year":"2021","journal-title":"Nicotine Tob Res"},{"key":"2026090306270619000_16.6.e110431.11","doi-asserted-by":"publisher","DOI":"10.3109\/00016341003605719"},{"key":"2026090306270619000_16.6.e110431.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12967-015-0690-y","article-title":"Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review","volume":"13","author":"Banderali","year":"2015","journal-title":"J Transl Med"},{"key":"2026090306270619000_16.6.e110431.13","unstructured":"United Nations Statistics Division U . Standard country or area codes for statistical use (M49). n.d. Available: https:\/\/unstats.un.org\/unsd\/methodology\/m49"},{"key":"2026090306270619000_16.6.e110431.14","unstructured":"Croft, Trevor N., Aileen M. J. Marshall, Courtney K. Allen, et al . Guide to DHS Statistics: DHS-7 (Version 2), 2018. Available: https:\/\/preview.dhsprogram.com\/pubs\/pdf\/DHSG1\/Guide_to_DHS_Statistics_DHS-7_v2.pdf"},{"key":"2026090306270619000_16.6.e110431.15","unstructured":"Esri . Data classification methods\u2014ArcGIS Pro, 2024. Available: https:\/\/pro.arcgis.com\/en\/pro-app\/latest\/help\/mapping\/layer-properties\/data-classification-methods.htm"},{"key":"2026090306270619000_16.6.e110431.16","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2004.029454"},{"key":"2026090306270619000_16.6.e110431.17","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7532"},{"key":"2026090306270619000_16.6.e110431.18","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1177\/1536867X0300300102","article-title":"Intra-class Correlation in Random-effects Models for Binary Data","volume":"3","author":"Rodr\u00edguez","year":"2003","journal-title":"Stata J"},{"key":"2026090306270619000_16.6.e110431.19","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2009.088310"},{"key":"2026090306270619000_16.6.e110431.20","doi-asserted-by":"crossref","unstructured":"Zuur AF , Ieno EN , Walker N , et al . 2009. Zero-truncated and zero-inflated models for count data. mixed effects models and extensions in ecology with R. 2009.261\u201393. doi:10.1007\/978-0-387-87458-6_11","DOI":"10.1007\/978-0-387-87458-6_11"},{"key":"2026090306270619000_16.6.e110431.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-014-0243-x","article-title":"Prevalence, distribution, and social determinants of tobacco use in 30 sub-Saharan African countries","volume":"12","author":"Sreeramareddy","year":"2014","journal-title":"BMC Med"},{"key":"2026090306270619000_16.6.e110431.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12199-020-00924-y","article-title":"National, regional, and global prevalence of cigarette smoking among women\/females in the general population: a systematic review and meta-analysis","volume":"26","author":"Jafari","year":"2021","journal-title":"Environ Health Prev Med"},{"key":"2026090306270619000_16.6.e110431.23","unstructured":"Dalmau R . Women and tobacco, a gender perspective. EJ Cardiol Prac 2021."},{"key":"2026090306270619000_16.6.e110431.24","unstructured":"World Health Organisation . WHO celebrates 10 years of tobacco control in the african region 2015. 2015 Available: https:\/\/www.afro.who.int\/news\/who-celebrates-10-years-tobacco-control-african-region?utm_source=chatgpt.com"},{"key":"2026090306270619000_16.6.e110431.25","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2019-054940"},{"key":"2026090306270619000_16.6.e110431.26","unstructured":"World health organization . WHO global report on trends in prevalence of tobacco smoking 2000\u20132025. 2018."},{"key":"2026090306270619000_16.6.e110431.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-018-6058-5","article-title":"Tobacco use and its determinants in the 2015 Kenya WHO STEPS survey","volume":"18","author":"Ngaruiya","year":"2018","journal-title":"BMC Public Health"},{"key":"2026090306270619000_16.6.e110431.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0132401","article-title":"A Systematic Review of Tobacco Smoking Prevalence and Description of Tobacco Control Strategies in Sub-Saharan African Countries; 2007 to 2014","volume":"10","author":"Brathwaite","year":"2007","journal-title":"PLoS One"},{"key":"2026090306270619000_16.6.e110431.29","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2015-052250"},{"key":"2026090306270619000_16.6.e110431.30","unstructured":"Bandara S . Understanding Political Economic Conditions That> Impact World Health Organization Framework Convention of Tobacco Control (WHO FCTC)> Implementation in the African. Region: McGill University (Canada), 2024."},{"key":"2026090306270619000_16.6.e110431.31","unstructured":"on Smoking O . Factors influencing tobacco use among women. In: Women and Smoking: A Report of the Surgeon General: Centers for Disease Control and Prevention (US). 2001."},{"key":"2026090306270619000_16.6.e110431.32","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-18840-z","article-title":"Smokeless tobacco consumption among women of reproductive age: a systematic review and meta-analysis","volume":"24","author":"Itumalla","year":"2024","journal-title":"BMC Public Health"},{"key":"2026090306270619000_16.6.e110431.33","doi-asserted-by":"crossref","DOI":"10.1186\/s13011-023-00530-5","article-title":"Determinants of cigarette smoking and smoking frequency among women of reproductive age in Nigeria: evidence from a nationwide cross-sectional survey","volume":"18","author":"Ogbuabor","year":"2023","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"2026090306270619000_16.6.e110431.34","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsp141"},{"key":"2026090306270619000_16.6.e110431.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2010.04.003"},{"key":"2026090306270619000_16.6.e110431.36","doi-asserted-by":"crossref","first-page":"109300","DOI":"10.1016\/j.drugalcdep.2022.109300","article-title":"Prevalence and socio-structural determinants of tobacco exposure in young women: Data from the Healthy Trajectories Initiative (HeLTI) study in urban Soweto, South Africa","volume":"232","author":"Soepnel","year":"2022","journal-title":"Drug Alcohol Depend"},{"key":"2026090306270619000_16.6.e110431.37","doi-asserted-by":"crossref","first-page":"065","DOI":"10.1055\/s-0039-1694071","article-title":"Smoking and Tobacco Use: Ill Effects on Reproductive, Maternal, Newborn, Child Health, and Adolescent (RMNCHA) Program\u2014A Review","volume":"55","author":"Mittal","year":"2019","journal-title":"Ann Natl Acad Med Sci"},{"key":"2026090306270619000_16.6.e110431.38","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0184235","article-title":"Relationship between the number of family members and stress by gender: Cross-sectional analysis of the fifth Korea National Health and Nutrition Examination Survey","volume":"12","author":"Noh","year":"2017","journal-title":"PLoS One"},{"key":"2026090306270619000_16.6.e110431.39","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph22060825","article-title":"Barriers and Facilitators of Tobacco Cessation Interventions at the Population and Healthcare System Levels: A Systematic Literature Review","volume":"22","author":"Sultana","year":"2025","journal-title":"Int J Environ Res Public Health"},{"key":"2026090306270619000_16.6.e110431.40","doi-asserted-by":"crossref","unstructured":"Hsu R , Tong ST . Disparities in Smoking Cessation Treatment Among Immigrants and Potential Barriers to Care. J Racial Ethn Health Disparities 2025. doi:10.1007\/s40615-025-02443-4","DOI":"10.1007\/s40615-025-02443-4"},{"key":"2026090306270619000_16.6.e110431.41","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.25019"},{"key":"2026090306270619000_16.6.e110431.42","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-8-200904210-00009"},{"key":"2026090306270619000_16.6.e110431.43","doi-asserted-by":"crossref","DOI":"10.1093\/heapro\/daae036","article-title":"Barriers to smoking interventions in community healthcare settings: a scoping review","volume":"39","author":"Coleman","year":"2024","journal-title":"Health Promot Int"},{"key":"2026090306270619000_16.6.e110431.44","doi-asserted-by":"crossref","DOI":"10.18332\/tid\/173088","article-title":"International and national frameworks, guidelines, recommendations, and strategies for maternal tobacco prevention and cessation: A scoping review protocol","volume":"21","author":"Nagdeo","year":"2023","journal-title":"Tob Induc Dis"},{"key":"2026090306270619000_16.6.e110431.45","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2023"},{"key":"2026090306270619000_16.6.e110431.46","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1080\/14767058.2018.1520835","article-title":"Exposure to tobacco use in pregnancy and its determinants among sub-Saharan Africa women: analysis of pooled cross-sectional surveys","volume":"33","author":"Yaya","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2026090306270619000_16.6.e110431.47","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-7826-6","article-title":"Tobacco use and associated risk factors in Burkina Faso: results from a population-based cross-sectional survey","volume":"19","author":"Bonnech\u00e8re","year":"2019","journal-title":"BMC Public Health"},{"key":"2026090306270619000_16.6.e110431.48","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2011-050280"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-110431","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:28:18Z","timestamp":1788442098000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-110431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":48,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjopen-2025-110431"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-110431","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}