{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T21:16:35Z","timestamp":1757625395082,"version":"3.44.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"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:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Tobacco use remains a major public health challenge in sub-Saharan Africa, with significant gendered dimensions. Place of residence is an important determinant, as rural and urban contexts shape exposure, access, and consumption patterns. This study investigates rural\u2013urban disparities in tobacco use among women in sub-Saharan Africa, with a focus on quantifying the relative contributions of socioeconomic factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a pooled cross-sectional analysis using nationally representative data from the most recent Demographic and Health Surveys (DHS) of 22 sub-Saharan African countries (2015\u20132022). The study sample included 350,536 women aged 15\u201349 years with complete data on tobacco use and relevant covariates. Tobacco use was defined as self-reported current use of cigarettes or other tobacco products. We employed a multivariate decomposition for non-linear response models to quantify the contributions of group differences in characteristics versus differences in how those characteristics affect an outcome. This technique partitions the observed rural\u2013urban gap in tobacco use into two components: (1) endowment effects (compositional differences in characteristics such as education, household wealth, age, marital status, and employment) and (2) coefficient effects (differences in the influence of these characteristics on tobacco use between rural and urban women). Models adjusted for sampling weights and survey design effects to ensure representativeness.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Compositional differences explained 167.48% of the rural\u2013urban disparity in women\u2019s tobacco use. Educational attainment and wealth index were the most significant contributors, both showing protective effects. If rural women\u2019s education and wealth levels matched those of urban women, tobacco use prevalence would be reduced by 24.99% and 49.84%, respectively. Differences in coefficients accounted for \u221267.48% of the observed gap, with baseline differences in intercepts (\u2212166.17%) driving most of this effect. These findings highlight both structural disadvantages and variations in behavioural responsiveness across residential settings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The study demonstrates that rural\u2013urban disparities in tobacco use among women are primarily shaped by inequalities in education and wealth. Interventions aimed at expanding educational opportunities and addressing poverty in rural communities could substantially reduce tobacco use. Additionally, tailored prevention and cessation strategies targeting women at both the lowest and highest ends of the socioeconomic spectrum are essential to mitigate disparities and advance tobacco control in sub-Saharan Africa.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0331738","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T17:28:56Z","timestamp":1757438936000},"page":"e0331738","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A nonlinear decomposition analysis of the rural-urban disparities in tobacco use among women in sub-Saharan Africa"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3498-2909","authenticated-orcid":true,"given":"Richard Gyan","family":"Aboagye","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bright Opoku","family":"Ahinkorah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene Esi","family":"Donkoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Okyere","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanni","family":"Yaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"pone.0331738.ref001","volume-title":"WHO global report on trends in prevalence of tobacco use 2000\u20132025, third edition","author":"World Health Organization","year":"2019"},{"key":"pone.0331738.ref002","volume-title":"WHO global report on trends in prevalence of tobacco use 2000-2025, fourth edition","author":"World Health Organization","year":"2021"},{"issue":"12","key":"pone.0331738.ref003","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.37820","article-title":"Trends in prevalence of tobacco use by sex and socioeconomic status in 22 sub-Saharan African countries, 2003-2019","volume":"4","author":"CT Sreeramareddy","year":"2021","journal-title":"JAMA Network Open"},{"issue":"1","key":"pone.0331738.ref004","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1136\/tobaccocontrol-2016-053266","article-title":"Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries","volume":"27","author":"CT Sreeramareddy","year":"2018","journal-title":"Tob Control"},{"issue":"8","key":"pone.0331738.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0202467","article-title":"Trends in cigarette demand and supply in Africa","volume":"13","author":"N Vellios","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"pone.0331738.ref006","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12942-023-00342-7","article-title":"Spatial and temporal trends of overweight\/obesity and tobacco use in East Africa: subnational insights into cardiovascular disease risk factors","volume":"22","author":"BC Keino","year":"2023","journal-title":"Int J Health Geogr"},{"key":"pone.0331738.ref007","doi-asserted-by":"crossref","first-page":"113603","DOI":"10.1016\/j.psychres.2020.113603","article-title":"Cognitive function in women with major mental illnesses who use tobacco","volume":"295","author":"B Khobragade","year":"2021","journal-title":"Psychiatry Res"},{"issue":"1","key":"pone.0331738.ref008","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ccm.2019.10.005","article-title":"Lung Cancer in Women: A Modern Epidemic","volume":"41","author":"CR MacRosty","year":"2020","journal-title":"Clin Chest Med"},{"issue":"1","key":"pone.0331738.ref009","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1186\/s12905-022-02014-3","article-title":"Variations in the patterns of tobacco usage among indian females - findings from the global adult tobacco survey India","volume":"22","author":"LD Goyal","year":"2022","journal-title":"BMC Womens Health"},{"issue":"12","key":"pone.0331738.ref010","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1093\/ntr\/ntab131","article-title":"Tobacco use among 1 310 716 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":"R Shukla","year":"2021","journal-title":"Nicotine and Tobacco Research"},{"issue":"10","key":"pone.0331738.ref011","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1253\/circj.CJ-19-0323","article-title":"Effects of tobacco smoking on cardiovascular disease","volume":"83","author":"T Kondo","year":"2019","journal-title":"Circulation Journal"},{"issue":"3","key":"pone.0331738.ref012","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1001\/jama.2020.25019","article-title":"Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force recommendation statement","volume":"325","author":"AH Krist","year":"2021","journal-title":"JAMA"},{"issue":"5","key":"pone.0331738.ref013","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1037\/pha0000342","article-title":"Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control","volume":"28","author":"AN Kurti","year":"2020","journal-title":"Exp Clin Psychopharmacol"},{"key":"pone.0331738.ref014","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/978-3-030-67802-9_2","article-title":"Combatting illicit trade in tobacco products: comparative analysis of law and practice","volume-title":"Combatting illicit trade in tobacco products: in search of optimal enforcement","author":"S Tosza","year":"2022"},{"key":"pone.0331738.ref015","unstructured":"Ulep VG, Dela Cruz NA, Ballesteros AJ, Villanueva AC, Flaminiano CJ. Impact Evaluation of DOH\u2019s Implementation of Articles 6 and 11 of the Framework Convention of Tobacco Control (No. DP 2023-02). 2023."},{"issue":"2","key":"pone.0331738.ref016","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1136\/tobaccocontrol-2021-056540","article-title":"Landscape of tobacco control in sub-Saharan Africa","volume":"31","author":"CO Egbe","year":"2022","journal-title":"Tob Control"},{"issue":"2","key":"pone.0331738.ref017","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5325\/jafrideve.23.2.0133","article-title":"Promoting health, human capital, and gender issues in Africa","volume":"23","author":"L Dunn","year":"2022","journal-title":"Journal of African Development"},{"key":"pone.0331738.ref018","volume-title":"Guide to DHS statistics","author":"TN Croft","year":"2018"},{"key":"pone.0331738.ref019","volume-title":"Demographic and health survey sampling and household listing manual","author":"ICF International","year":"2012"},{"issue":"12","key":"pone.0331738.ref020","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies","volume":"12","author":"E Von Elm","year":"2014","journal-title":"International Journal of Surgery"},{"issue":"1","key":"pone.0331738.ref021","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1186\/s12889-019-7200-8","article-title":"Factors affecting tobacco smoking in Ethiopia: evidence from the demographic and health surveys","volume":"19","author":"H Guliani","year":"2019","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0331738.ref022","article-title":"Socio-economic and demographic determinants of tobacco use in Kenya: findings from the Kenya Demographic and Health Survey 2014","volume":"30","author":"P Magati","year":"2018","journal-title":"Pan African Medical Journal"},{"issue":"6","key":"pone.0331738.ref023","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-057607","article-title":"Prevalence of and factors associated with tobacco smoking in the Gambia: a national cross-sectional study","volume":"12","author":"M Shariful Islam","year":"2022","journal-title":"BMJ Open"},{"key":"pone.0331738.ref024","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1186\/s12889-015-2433-7","article-title":"Burden of waterpipe smoking and chewing tobacco use among women of reproductive age group using data from the 2012-13 Pakistan Demographic and Health Survey","volume":"15","author":"MT Khan","year":"2015","journal-title":"BMC Public Health"},{"key":"pone.0331738.ref025","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1186\/s12889-015-1820-4","article-title":"Tobacco use and associated factors among adults in Ethiopia: further analysis of the 2011 Ethiopian Demographic and Health Survey","volume":"15","author":"Y Lakew","year":"2015","journal-title":"BMC Public Health"},{"issue":"4","key":"pone.0331738.ref026","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1177\/1536867X1201100404","article-title":"Mvdcmp: Multivariate Decomposition for Nonlinear Response Models","volume":"11","author":"DA Powers","year":"2011","journal-title":"The Stata Journal"},{"issue":"9","key":"pone.0331738.ref027","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":"S Yaya","year":"2020","journal-title":"The Journal of Maternal-Fetal & Neonatal Medicine"},{"issue":"5","key":"pone.0331738.ref028","article-title":"Rural-urban differences in changes and effects of Tobacco 21 in youth e-cigarette use","volume":"147","author":"H Dai","year":"2021","journal-title":"Pediatrics"},{"issue":"10","key":"pone.0331738.ref029","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.2105\/AJPH.2017.303967","article-title":"Rural versus urban use of traditional and emerging tobacco products in the United States, 2013\u20132014","volume":"107","author":"ME Roberts","year":"2017","journal-title":"American Journal of Public Health"},{"key":"pone.0331738.ref030","doi-asserted-by":"crossref","DOI":"10.1155\/2023\/4292647","article-title":"Tobacco Use and Cessation among a Nationally Representative Sample of Men in India, 2019\u20132021","volume":"2023","author":"SK Singh","year":"2023","journal-title":"Journal of Smoking Cessation"},{"issue":"21","key":"pone.0331738.ref031","doi-asserted-by":"crossref","first-page":"17661","DOI":"10.1007\/s12144-022-02777-w","article-title":"Impact of social norms on Chinese college students\u2019 tobacco use","volume":"42","author":"L Zhou","year":"2023","journal-title":"Current Psychology"},{"issue":"9","key":"pone.0331738.ref032","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1080\/00220388.2015.1046445","article-title":"Rural livelihood diversification in sub-Saharan Africa: a literature review","volume":"51","author":"S Alobo Loison","year":"2015","journal-title":"The Journal of Development Studies"},{"issue":"8","key":"pone.0331738.ref033","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1093\/ntr\/ntad056","article-title":"Causal Effect of Education on Tobacco Use in Low-and-Middle-Income Countries","volume":"25","author":"MU \u00d6zmen","year":"2023","journal-title":"Nicotine and Tobacco Research"},{"key":"pone.0331738.ref034","volume-title":"Empower women: facing the challenge of tobacco use in Europe","author":"World Health Organization","year":"2015"},{"key":"pone.0331738.ref035","doi-asserted-by":"crossref","first-page":"243","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":"CT Sreeramareddy","year":"2014","journal-title":"BMC Med"},{"issue":"1","key":"pone.0331738.ref036","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1186\/s12889-021-11084-1","article-title":"Prevalence and socio-demographic correlates of tobacco and alcohol use in four sub-Saharan African countries: a cross-sectional study of middle-aged adults","volume":"21","author":"PR Boua","year":"2021","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0331738.ref037","article-title":"Psychological overinvolvement, emotional distress, and daily affect following marital dissolution","volume":"5","author":"KJ Bourassa","year":"2019","journal-title":"Collabra: Psychology"},{"key":"pone.0331738.ref038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-017-4579-y","article-title":"Association of adult tobacco use with household food access insecurity: results from Nepal demographic and health survey, 2011","volume":"18","author":"CT Sreeramareddy","year":"2018","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0331738.ref039","article-title":"Tobacco use and mass media utilization in sub-Saharan Africa","volume":"10","author":"TNO Achia","year":"2015","journal-title":"PLoS One"},{"key":"pone.0331738.ref040","doi-asserted-by":"crossref","first-page":"106850","DOI":"10.1016\/j.addbeh.2021.106850","article-title":"Digital marketing of smokeless tobacco: A longitudinal analysis of exposure and initiation among young adults","volume":"117","author":"SL Clendennen","year":"2021","journal-title":"Addict Behav"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331738","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T17:29:06Z","timestamp":1757438946000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331738"}},"subtitle":[],"editor":[{"given":"Mohammad Rifat","family":"Haider","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331738","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]}}}