{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T19:20:52Z","timestamp":1771615252183,"version":"3.50.1"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Alcohol and tobacco use are leading modifiable risk factors for non-communicable diseases (NCDs) worldwide. In sub-Saharan Africa, including Uganda, these behaviors are increasingly common but often analyzed separately, limiting understanding of their shared determinants. This study used nationally representative data from the 2014 Uganda WHO STEPS survey to examine individual and joint predictors of current alcohol and tobacco use among adults aged 18\u201369. Using separate and joint logistic regression models, we assessed associations with demographic, socioeconomic, and health-related factors, applying a shared random effect in the joint model to account for within-individual correlation. The joint model provided better fit (AIC\u2009=\u20096850.13) than the combined separate models (AIC\u2009=\u20096890.73), suggesting a shared latent structure influences both outcomes. Female sex and higher educational attainment were consistently associated with lower odds of substance use, while older age and being separated, divorced, or widowed were linked to higher odds. Smoking-specific interactions showed stronger effects in older and underweight individuals and regional differences were more pronounced for smoking than alcohol. These findings highlight the presence of shared and distinct determinants underlying alcohol and tobacco use in Uganda. While the results suggest potential value in considering these behaviors jointly, further research is needed to evaluate whether integrated intervention strategies are effective in reducing co-occurring substance use.<\/jats:p>","DOI":"10.1371\/journal.pone.0327941","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T18:32:17Z","timestamp":1771612337000},"page":"e0327941","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Joint modeling of alcohol and tobacco use among adults in Uganda"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6004-8397","authenticated-orcid":true,"given":"Grace","family":"Kakaire","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edna Chepkemoi","family":"Chumoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"pone.0327941.ref001","article-title":"Tobacco exposure and alcohol drinking prevalence and associations with hypertension in rural southwest China: A cross-sectional study","volume":"22","author":"G Li","year":"2024","journal-title":"Tob Induc Dis"},{"issue":"1","key":"pone.0327941.ref002","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1186\/s12889-022-12718-8","article-title":"Alcohol consumption and associated factors among middle-aged and older adults: results from China Health and Retirement Longitudinal Study","volume":"22","author":"Q Wang","year":"2022","journal-title":"BMC Public Health"},{"key":"pone.0327941.ref003","doi-asserted-by":"crossref","first-page":"106776","DOI":"10.1016\/j.addbeh.2020.106776","article-title":"Emotion regulation and experiential avoidance moderate the association between posttraumatic symptoms and alcohol use disorder among Israeli combat veterans","volume":"115","author":"D Feingold","year":"2021","journal-title":"Addict Behav"},{"key":"pone.0327941.ref004","volume-title":"WHO framework convention on tobacco control: guidelines for implementation of article 5.3, articles 8 to 14","author":"World Health O","year":"2013"},{"key":"pone.0327941.ref005","volume-title":"Global status report on alcohol and health 2018","author":"World Health O","year":"2019"},{"key":"pone.0327941.ref006","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.maturitas.2020.10.011","article-title":"Associations between sedentary behavior and happiness: An analysis of influential factors among middle-aged and older adults from six low- and middle-income countries","volume":"143","author":"M Felez-Nobrega","year":"2021","journal-title":"Maturitas"},{"issue":"3","key":"pone.0327941.ref007","doi-asserted-by":"crossref","first-page":"706","DOI":"10.3390\/nu12030706","article-title":"Fruit and Vegetable Consumption and Sarcopenia among Older Adults in Low- and Middle-Income Countries","volume":"12","author":"A Koyanagi","year":"2020","journal-title":"Nutrients"},{"key":"pone.0327941.ref008","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ypmed.2016.07.013","article-title":"Sex\/gender differences in smoking cessation: A review","volume":"92","author":"PH Smith","year":"2016","journal-title":"Prev Med"},{"key":"pone.0327941.ref009","first-page":"21","article-title":"Pattern and determinants of alcohol and tobacco co-use and its relationship with smoking cessation in Hong Kong","volume":"7","author":"RKS Ho","year":"2021","journal-title":"Tob Prev Cessat"},{"issue":"7","key":"pone.0327941.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0102149","article-title":"Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies","volume":"9","author":"C Violan","year":"2014","journal-title":"PLoS One"},{"key":"pone.0327941.ref011","doi-asserted-by":"crossref","unstructured":"Jackson KM, Sher KJ, Schulenberg JE. 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