Drug and Alcohol Dependence, 26 (19901203Elsevier Scientific Publishers Ireland Ltd.
208
203
The use of tobacco products among Nigerian adults: a general population survey Isidore S. Obot Department
of General and Applied Psychology, (Received
University
of Jos, P.M.B. 2084, Jos 1Nigerial
April 20th. 19901
This study was designed to investigate the incidence of cigarette smoking, cigar/pipe tobacco and snuff use in the Nigerian population. In a sample of 1271 adult heads of household (1137 males, 134 females) the overall prevalence of regular smoking was 22.6%. The proportions of regular cigar/pipe tobacco and snuff users were 17.9% and 9.6% respectively. Among cigarette smokers, 60.6% smoked at least half a pack a day, 11.2% at least one pack a day. Males smoked more than females. The poor, uneducated respondents smoked more than the relatively rich and educated. Smoking was more rampant in the third decade of life than in other age groups. Smokers had a higher incidence of health problems and both nonsmokers and heavy smokers were less aware of the risk of smoking than light smokers. In light of the above it is suggested that health education should be a major component of tobacco and health policy in Nigeria. Key words: tobacco products;
consumption;
Nigeria
respectively. More recent studies of cigarette smoking in Nigeria show both higher and lower proportions depending on the population (Table Il. The highest was reported by Onadeko et al. [6]. In their study 29.5% of male and 20.7% of female post-secondary school students were smokers. Two studies of special populations showed that 15.1% of male hospital patients [3] and 24% of physicians [l] described themselves as cigarette smokers. In a recent large scale general population survey on substance abuse in Southern Nigeria, the proportion of smokers in a sample of 1052 adults was 17.5%. Smoking was much less prevalent among students in the four study centres ranging from a proportion of 0.3 - 5.2% [5]. What may seem like an inconsistent picture of the extent of smoking in Nigeria is a reflection of different methods of data collection and different study populations. A close look at the information from the different studies reveals a number of consistent findings. In fact, studies conducted in Nigeria in the past 15 years permit the following generalizations:
Introduction
While the tobacco plant continues its unimpeded entrenchment as a major economic crop in many African countries, several studies have reported varied proportions of cigarette smokers among students, professionals and the general public [l-6]. In a newspaper article several years ago, the World Health organization Representative in Nigeria put the figure of cigarette smokers in the country at 20 million or 20% of the population [7]. According to this estimate, which was supplied by the Tobacco Advisory Council of Nigeria, one out of every five Nigerians smokes cigarettes. Evidence from various studies in Nigeria seems to support this estimate. One of the earliest studies of smoking in Nigeria was carried out by Elegbeleye and Femi-Pearse [2]. In surveys conducted in Lagos the proportions of regular smokers among male secondary school and medical students were 17.5% and 21.401’0,respectively. Among female students the figures were 2.7% and 2.80/o, 0376-8716/90/$03.50 0 1990 Elsevier Printed and Published in Ireland
Scientific
Publishers
Ireland
Ltd.
204 Table I.
Studies of cigarette smoking in different Nigerian populations.
Study
Sample
12
Proportion of current smokers
Elegbeleye and Femi-Pearse (1976) [2]
(a) Secondary school children
1026 Males 947 Females 196 Males 36 Females 1480
17.5% 2.7% 21.4% 2.8% Males 29.5% Females 20.7% 15.1% 0.33% 24% 0.3 - 5.2% (depending on centre) 17.5%
(b) Medical students Onadeko, Awotedu and Onadeko (1983) [6]
Post-secondary
Harries, Chugh and Neumann (1986) [3]
Adult hospital patients
Bandele and Osadiaye (1987) [l] ICAA (1988) [5]
Physicians Secondary school students
820 Males 1526 Females 333 1969
General population
1052
(1) Smoking is an urban activity. As urban populations continue to grow, the proportion of smokers in the country is likely to increase accordingly. (2) The educated smoke more than the uneducated: e.g., medical students and doctors smoke in higher proportions than the general population. (3) Most smokers consume less than 15 cigarettes a day but also engage in risky smoking behaviours, e.g., smoking to the butt, deep inhalation, taking one and a half puffs per minute instead of one. (4) The cigarettes manufactured and/or sold in Nigeria have higher tar contents than cigarettes sold in western countries [8]. (5) Knowledge about the danger of smoking to health is limited. This situation is exacerbated by the general lack of health information and of warnings on the risks of smoking by cigarette manufacturers. (6) Finally, the government continues to place high premium on the financial benefits (in sales and excise tax) from the tobacco and cigarette trade and thereby encourages smoking tacitly. This behaviour overlooks long term health risks in favour of short-term financial benefits. Even though these generalizations are based
students
on research findings and are incontestable to a great extent, a lot more needs to be known about tobacco use in Nigeria. How, for example, are important demographic variables related to cigarette smoking? What is the effect of smoking on the health of Nigerians? What is the extent of consumption of other tobacco products (cigars, snuff) in the general population? The present study was designed to answer these questions. Subjects and methods The study was conducted in three states in the Middlebelt region of Northern Nigeria. The States were Bauchi, Gongola and Plateau, all of which are within the Jos Zone of the Federal Office of Statistics (FOS) and in one of the tobacco growing areas of Nigeria.
Respondents A total of 1271 respondents participated in the study, comprising 1137 (89.5%) males and 134 (10.5%) females. The overrepresentation of males in the sample was due to the priority given to heads of household in the choice of respondents. Almost all respondents (92.5%) were above 20 years of age; more than 50% lived in urban
205
areas; 74.1% were married; 47.2% had no formal education; 30.6% and 27. 4% were civil servants and farmers, respectively. Other occupational categories were businessmen (19.8%), armed forces (1.90/o) and the unemployed (6.5O/ol. A slight majority (51.3%) earned an annual income of less than N3000, reflecting the low educational level of the sample. Procedure Each respondent was reached through a multistage, random selection method using the sampling frame of the Federal Office of Statistics (FOSl. Interviews were conducted individually by trained interviewers drawn from the FOS who were resident in each of the enumeration areas used in the study. Instrument The instrument was part of an 11-page questionnaire on substance abuse. The relevant section consisted of 27 items seeking information on tobacco use, personal data, and health problems. Most of the questions were forced-choice. Results Consumption of tobacco products The proportion of regular cigarette smokers in the sample was 22.6%. Occasional smokers constituted 4.20/o, past smokers 4.7% and those who never smoked (or smoked only experimentally) comprised 68.5% of the sample (Table 111. Among smokers, heavy smoking was more rampant than usually reported. Those who smoke at least a half-pack a day constituted 60.6% of the sample of smokers (n = 3401 and 16.2% of the overall sample. Information was sought on the use of cigar/ pipe-tobacco and snuff. The proportion of respondents who reported smoking cigar or pipe-tobacco “most of the time” was 17.9% and “occasionally” 8.4%. Snuff was consumed “several times/day” by 4.80/o, at least once a day by 2.8%. and at least once a week by 1.1%. In all, 10.2% of the sample had used snuff at least once in the year preceding the study. It is not clear whether cigar/pipe tobacco and
Table II.
Daily consumption
of tobacco cigarettes. 72
More than a pack One pack About half a pack Less than half a pack Only a few cigarettes then
now and
Used to smoke but quit Never (or only experimental) Total
%
72 71 63 81 53
5.6 5.6 5.0 6.4 4.2
60 871
4.7 68.5
1271
100
snuff users also smoked cigarettes and viceversa. No item in the questionnaire addressed the issue of multiple use of tobacco products. Types of cigarettes preferred More than one-third (39.3%) of the smokers expressed a preference for particular brands of cigarettes, 60.7% had no preferred brands. Filter-tipped cigarettes were the choice of 38.5%; 4.9% preferred non-filter cigarettes. The majority of smokers (56.6%) smoked both types. Sex As would be expected a significantly higher proportion of males than females were regular smokers (34.1%~ vs. 9.7%1, x2 = 32.9; P < 0.00001. More males than females smoked heavily: i.e., at least a half-pack/day (17.5% vs. 5.2%). It is noteworthy that the proportion of abstainers among women is as high as 90.3% (Table III).
Age
The highest proportion of smokers was found among those in their 30s. In this age group 27.5% were regular smokers of cigarettes. This was followed by respondents in their teens (23.2%), 40s (22.7%). 50s (22.2%) and 20s (17.9%). Also the least proportions of heavy smokers were found in the 20 - 39 and less than 20 age groups (11.9%) and the highest in the 30 - 39 and older age-groups.
206 Table III.
Distribution
Variables
of smokers n’
by different
Quantity
variables
of cigarettes
f%). smoked each day
At least one pack
About a half-pack
Less than 10 sticks
Infrequent occasional
Used to smoke
Never smoked
Age lyead < 20 20-29 30-39 40-49 50andabove
73 491 459 145 81
10.9 7.7 13.9 13.1 12.3
2.7 4.2 6.9 4.1 3.7
9.6 6.0 6.7 5.5 6.2
2.7 5.5 2.8 4.8 2.5
4.1 6.8 3.5 3.4 0
69.9 69.8 66.1 69.0 75.3
Education None Primary Post-primary Higher education
543 239 342 147
10.3 14.7 10.5 10.8
4.8 7.5 4.7 2.0
7.2 6.7 5.8 4.1
2.8 5.0 4.9 6.1
3.3 5.4 5.2 7.5
71.6 60.6 68.8 69.4
Income N 5000
619 261 102
12.6 10.7 12.8
5.9 5.3 3.9
7.7 6.9 2.9
3.5 3.9 6.8
4.8 3.4 2.9
65.4 69.7 70.6
Male Female
1137 134
12.0 1.8
5.5 3.4
6.9 1.5
4.5 1.5
5.1 1.5
65.9 90.3
h - Different
ns were used in calculating
Sex
the proportions
because
Education Respondents with only primary education had the highest proportion of regular smokers (28.9%) and those with the highest level of education had the lowest (16.9%). In fact respondents with primary education or less generally smoked more than those with at least a postprimary education. Income This variable provided a more consistent picture of the extent of smoking than other variables. smoking decreased with Regular increasing income from 29.9% in the lowest group to 19.6% in the highest income group. The high proportion of regular smokers among the lowest income group supports the earlier finding of a higher prevalence of smoking among the least educated, assuming that education and income are positively correlated.
of missing
information.
Smoking and health x2-Analyses were conducted to determine whether smokers experienced certain health problems more than non-smokers. Smokers had more cases of cancer (p < 0.0005); ulcers (P < 0.001); stroke P < 0.011; nervous condition P < 0.00001); kidney problem (P < 0.0011; liver problem P < 0.051; and blood circulation problem @’ < 0.000011 than non-smokers. There was no significant difference between the two groups in cases of hypertension and accidents. Awareness of the health consequences of smoking Are smokers aware of the health hazards of smoking? In order to answer this question a x2 analysis was conducted on responses by nonsmokers, light smokers (less than a half-pack/ day) and heavy smokers (at least a half-pack/ day). The analysis showed that light smokers
207
were more aware of the risks involved in smoking than both non-smokers and heavy smokers (x2 = 77.3; P < 0.0001). Surprisingly, a high proportion of non-smokers were unaware of the potential harm of smoking. Sixty-three percent either did not know or were not sure that smoking was harmful to health. Discussion The overall percentage of regular smokers in this study was 22.6%. Previous studies of adult populations [3,5] have generally shown lower prevalence. But at least two recent studies among physicians [l] and male post-secondary school students [6] have reported higher prevalence. Males in this study smoked much more than females (24.4% vs. 6.7%). Since males accounted for nearly ninety percent of the sample, generalizations about the extent of smoking in the population studied should be limited to males only. It is worthy of note that even though the proportion of smokers was not extremely high, smoking at least half a pack/day seemed to be the norm among smokers. In fact, 50% of male smokers consumed at least one pack of cigarettes/day. Considering that respondents with little income smoked more than others the impact of smoking on family income may be appreciable. In a review of information on smoking and health in Nigeria, Lucas and Erinosho [9] found that the prevalence of smoking was highest in the third decade of life. This was confirmed in this study: smoking (in particular heavy smoking) was more rampant in the 30 - 39 age group than all other groups. It is consoling that younger respondents smoked in less numbers even though the nature of the sample made it impossible to establish the extent of smoking among teenagers. Contrary to generally held beliefs the educated did not smoke more than the uneducated. Respondents with little or no formal education smoked more than those with primary school education and above. Since most of the educated respondents in the sample were civil ser-
vants it is possible that the policy of nonsmoking in offices may be having some beneficial effect. In fact the highest proportions of occasional smokers and those who have quit smoking were in this group. Probably because of the low educational and income levels of the sample there was no overriding preference for either particular brands or filter-tipped cigarettes. Most smokers tended to consume whatever cigarette was available. Smoking was related to health problems because cigarette smokers had a higher prevalence of most health problems than non-smokers. But it is not possible to state with certainty that smoking was responsible for these disorders especially since alcohol consumption is also associated with some of them. [lo]. Actually a correlation analysis showed a positive relationship between smoking and drinking. Moreover, some of the generally recognized smoking-related illnessess were not included in the list of disorders. The level of awareness of the health risk from smoking was low especially among heavy smokers and non-smokers. It is possible that non-smokers misunderstood the question on awareness and interpreted it to refer to their having any smoking related problems, and it is also likely that the relatively high awareness among light smokers was moderated by another factor, e.g, education. Whatever is the case, a tobacco policy in Nigeria (which is long overdue) must include a health education component not only for school children but for the general public. Such a policy should also include the risks involved in the use of other tobacco products - cigar, pipe tobacco, snuff. Except for the findings in this study no other information on the use of these products in Nigeria exist. It is suggested that in future research this broad perspective on tobacco use should be maintained in order to understand the extent of use and effects of different tobacco products. Acknowledgement This research Research Grant
was supported by No. SRGC/86-87/006
Senate of the
208
University of Jos. I am indebted to Fred Tamen for his assistance in coding and data analysis.
6
References Bandele, E.O. and Osadiaye, J.A. J. Natl. Med. Assoc. (Nigeria) ‘79,430 - 432. Elegbeleye, 0.0. and Femi-Pearse, D. Brit. J. Prev. Sot. Med. 30,60-70. Harries, A.D., Chugh, K.S. and Neumann, T. J. Trop. Med. Hyg. 89,3741. D’Hondt, W. and Vandewiele, M. Journal of Youth and Adolescence 12,333 - 353. International Council for Alcoholism and Addictions. Report of a Research on Substance Abuse in Some Urban
and Rural
Areas
in Nigeria.
Lausanne.
7 8 9
10
Onadeko, B.O., Awotedu, A.A. and Onadeko, M.O. Smoking patterns of students in higher institutions of learning in Nigeria. In Forbes, W.F., Frecker, R.C. and Nostbaken, D. (Eds.1 Proceedings of the Fifth World Conference on Smoking and Health, Volume I. Ottawa: Canadian Council on Smoking and Health. Brew-Graves, S.H. (19861 Tobacco: The underrated killer. The Guardian, 11 February, p. 7. Awotedu, A.A., Higenbottam, T.W. and Onadeko, B.O. (1983) J. Epidemiol. Commun. Health 37.218-220. Lucas, A.O. and Erinocho-Francis, A.O. Smoking and Health in Nigeria. Report of WHO Expert Committee on Smoking and its Effect on Health. Wld. Hlth. Org. Techn. Dep. Ser. No. 568 Geneva 1975. Obot, IS. and Neighbors, H.V. Nig. J. Basic. Appl. Psychol. 1, ll- 22.
208
203
The use of tobacco products among Nigerian adults: a general population survey Isidore S. Obot Department
of General and Applied Psychology, (Received
University
of Jos, P.M.B. 2084, Jos 1Nigerial
April 20th. 19901
This study was designed to investigate the incidence of cigarette smoking, cigar/pipe tobacco and snuff use in the Nigerian population. In a sample of 1271 adult heads of household (1137 males, 134 females) the overall prevalence of regular smoking was 22.6%. The proportions of regular cigar/pipe tobacco and snuff users were 17.9% and 9.6% respectively. Among cigarette smokers, 60.6% smoked at least half a pack a day, 11.2% at least one pack a day. Males smoked more than females. The poor, uneducated respondents smoked more than the relatively rich and educated. Smoking was more rampant in the third decade of life than in other age groups. Smokers had a higher incidence of health problems and both nonsmokers and heavy smokers were less aware of the risk of smoking than light smokers. In light of the above it is suggested that health education should be a major component of tobacco and health policy in Nigeria. Key words: tobacco products;
consumption;
Nigeria
respectively. More recent studies of cigarette smoking in Nigeria show both higher and lower proportions depending on the population (Table Il. The highest was reported by Onadeko et al. [6]. In their study 29.5% of male and 20.7% of female post-secondary school students were smokers. Two studies of special populations showed that 15.1% of male hospital patients [3] and 24% of physicians [l] described themselves as cigarette smokers. In a recent large scale general population survey on substance abuse in Southern Nigeria, the proportion of smokers in a sample of 1052 adults was 17.5%. Smoking was much less prevalent among students in the four study centres ranging from a proportion of 0.3 - 5.2% [5]. What may seem like an inconsistent picture of the extent of smoking in Nigeria is a reflection of different methods of data collection and different study populations. A close look at the information from the different studies reveals a number of consistent findings. In fact, studies conducted in Nigeria in the past 15 years permit the following generalizations:
Introduction
While the tobacco plant continues its unimpeded entrenchment as a major economic crop in many African countries, several studies have reported varied proportions of cigarette smokers among students, professionals and the general public [l-6]. In a newspaper article several years ago, the World Health organization Representative in Nigeria put the figure of cigarette smokers in the country at 20 million or 20% of the population [7]. According to this estimate, which was supplied by the Tobacco Advisory Council of Nigeria, one out of every five Nigerians smokes cigarettes. Evidence from various studies in Nigeria seems to support this estimate. One of the earliest studies of smoking in Nigeria was carried out by Elegbeleye and Femi-Pearse [2]. In surveys conducted in Lagos the proportions of regular smokers among male secondary school and medical students were 17.5% and 21.401’0,respectively. Among female students the figures were 2.7% and 2.80/o, 0376-8716/90/$03.50 0 1990 Elsevier Printed and Published in Ireland
Scientific
Publishers
Ireland
Ltd.
204 Table I.
Studies of cigarette smoking in different Nigerian populations.
Study
Sample
12
Proportion of current smokers
Elegbeleye and Femi-Pearse (1976) [2]
(a) Secondary school children
1026 Males 947 Females 196 Males 36 Females 1480
17.5% 2.7% 21.4% 2.8% Males 29.5% Females 20.7% 15.1% 0.33% 24% 0.3 - 5.2% (depending on centre) 17.5%
(b) Medical students Onadeko, Awotedu and Onadeko (1983) [6]
Post-secondary
Harries, Chugh and Neumann (1986) [3]
Adult hospital patients
Bandele and Osadiaye (1987) [l] ICAA (1988) [5]
Physicians Secondary school students
820 Males 1526 Females 333 1969
General population
1052
(1) Smoking is an urban activity. As urban populations continue to grow, the proportion of smokers in the country is likely to increase accordingly. (2) The educated smoke more than the uneducated: e.g., medical students and doctors smoke in higher proportions than the general population. (3) Most smokers consume less than 15 cigarettes a day but also engage in risky smoking behaviours, e.g., smoking to the butt, deep inhalation, taking one and a half puffs per minute instead of one. (4) The cigarettes manufactured and/or sold in Nigeria have higher tar contents than cigarettes sold in western countries [8]. (5) Knowledge about the danger of smoking to health is limited. This situation is exacerbated by the general lack of health information and of warnings on the risks of smoking by cigarette manufacturers. (6) Finally, the government continues to place high premium on the financial benefits (in sales and excise tax) from the tobacco and cigarette trade and thereby encourages smoking tacitly. This behaviour overlooks long term health risks in favour of short-term financial benefits. Even though these generalizations are based
students
on research findings and are incontestable to a great extent, a lot more needs to be known about tobacco use in Nigeria. How, for example, are important demographic variables related to cigarette smoking? What is the effect of smoking on the health of Nigerians? What is the extent of consumption of other tobacco products (cigars, snuff) in the general population? The present study was designed to answer these questions. Subjects and methods The study was conducted in three states in the Middlebelt region of Northern Nigeria. The States were Bauchi, Gongola and Plateau, all of which are within the Jos Zone of the Federal Office of Statistics (FOS) and in one of the tobacco growing areas of Nigeria.
Respondents A total of 1271 respondents participated in the study, comprising 1137 (89.5%) males and 134 (10.5%) females. The overrepresentation of males in the sample was due to the priority given to heads of household in the choice of respondents. Almost all respondents (92.5%) were above 20 years of age; more than 50% lived in urban
205
areas; 74.1% were married; 47.2% had no formal education; 30.6% and 27. 4% were civil servants and farmers, respectively. Other occupational categories were businessmen (19.8%), armed forces (1.90/o) and the unemployed (6.5O/ol. A slight majority (51.3%) earned an annual income of less than N3000, reflecting the low educational level of the sample. Procedure Each respondent was reached through a multistage, random selection method using the sampling frame of the Federal Office of Statistics (FOSl. Interviews were conducted individually by trained interviewers drawn from the FOS who were resident in each of the enumeration areas used in the study. Instrument The instrument was part of an 11-page questionnaire on substance abuse. The relevant section consisted of 27 items seeking information on tobacco use, personal data, and health problems. Most of the questions were forced-choice. Results Consumption of tobacco products The proportion of regular cigarette smokers in the sample was 22.6%. Occasional smokers constituted 4.20/o, past smokers 4.7% and those who never smoked (or smoked only experimentally) comprised 68.5% of the sample (Table 111. Among smokers, heavy smoking was more rampant than usually reported. Those who smoke at least a half-pack a day constituted 60.6% of the sample of smokers (n = 3401 and 16.2% of the overall sample. Information was sought on the use of cigar/ pipe-tobacco and snuff. The proportion of respondents who reported smoking cigar or pipe-tobacco “most of the time” was 17.9% and “occasionally” 8.4%. Snuff was consumed “several times/day” by 4.80/o, at least once a day by 2.8%. and at least once a week by 1.1%. In all, 10.2% of the sample had used snuff at least once in the year preceding the study. It is not clear whether cigar/pipe tobacco and
Table II.
Daily consumption
of tobacco cigarettes. 72
More than a pack One pack About half a pack Less than half a pack Only a few cigarettes then
now and
Used to smoke but quit Never (or only experimental) Total
%
72 71 63 81 53
5.6 5.6 5.0 6.4 4.2
60 871
4.7 68.5
1271
100
snuff users also smoked cigarettes and viceversa. No item in the questionnaire addressed the issue of multiple use of tobacco products. Types of cigarettes preferred More than one-third (39.3%) of the smokers expressed a preference for particular brands of cigarettes, 60.7% had no preferred brands. Filter-tipped cigarettes were the choice of 38.5%; 4.9% preferred non-filter cigarettes. The majority of smokers (56.6%) smoked both types. Sex As would be expected a significantly higher proportion of males than females were regular smokers (34.1%~ vs. 9.7%1, x2 = 32.9; P < 0.00001. More males than females smoked heavily: i.e., at least a half-pack/day (17.5% vs. 5.2%). It is noteworthy that the proportion of abstainers among women is as high as 90.3% (Table III).
Age
The highest proportion of smokers was found among those in their 30s. In this age group 27.5% were regular smokers of cigarettes. This was followed by respondents in their teens (23.2%), 40s (22.7%). 50s (22.2%) and 20s (17.9%). Also the least proportions of heavy smokers were found in the 20 - 39 and less than 20 age groups (11.9%) and the highest in the 30 - 39 and older age-groups.
206 Table III.
Distribution
Variables
of smokers n’
by different
Quantity
variables
of cigarettes
f%). smoked each day
At least one pack
About a half-pack
Less than 10 sticks
Infrequent occasional
Used to smoke
Never smoked
Age lyead < 20 20-29 30-39 40-49 50andabove
73 491 459 145 81
10.9 7.7 13.9 13.1 12.3
2.7 4.2 6.9 4.1 3.7
9.6 6.0 6.7 5.5 6.2
2.7 5.5 2.8 4.8 2.5
4.1 6.8 3.5 3.4 0
69.9 69.8 66.1 69.0 75.3
Education None Primary Post-primary Higher education
543 239 342 147
10.3 14.7 10.5 10.8
4.8 7.5 4.7 2.0
7.2 6.7 5.8 4.1
2.8 5.0 4.9 6.1
3.3 5.4 5.2 7.5
71.6 60.6 68.8 69.4
Income N 5000
619 261 102
12.6 10.7 12.8
5.9 5.3 3.9
7.7 6.9 2.9
3.5 3.9 6.8
4.8 3.4 2.9
65.4 69.7 70.6
Male Female
1137 134
12.0 1.8
5.5 3.4
6.9 1.5
4.5 1.5
5.1 1.5
65.9 90.3
h - Different
ns were used in calculating
Sex
the proportions
because
Education Respondents with only primary education had the highest proportion of regular smokers (28.9%) and those with the highest level of education had the lowest (16.9%). In fact respondents with primary education or less generally smoked more than those with at least a postprimary education. Income This variable provided a more consistent picture of the extent of smoking than other variables. smoking decreased with Regular increasing income from 29.9% in the lowest group to 19.6% in the highest income group. The high proportion of regular smokers among the lowest income group supports the earlier finding of a higher prevalence of smoking among the least educated, assuming that education and income are positively correlated.
of missing
information.
Smoking and health x2-Analyses were conducted to determine whether smokers experienced certain health problems more than non-smokers. Smokers had more cases of cancer (p < 0.0005); ulcers (P < 0.001); stroke P < 0.011; nervous condition P < 0.00001); kidney problem (P < 0.0011; liver problem P < 0.051; and blood circulation problem @’ < 0.000011 than non-smokers. There was no significant difference between the two groups in cases of hypertension and accidents. Awareness of the health consequences of smoking Are smokers aware of the health hazards of smoking? In order to answer this question a x2 analysis was conducted on responses by nonsmokers, light smokers (less than a half-pack/ day) and heavy smokers (at least a half-pack/ day). The analysis showed that light smokers
207
were more aware of the risks involved in smoking than both non-smokers and heavy smokers (x2 = 77.3; P < 0.0001). Surprisingly, a high proportion of non-smokers were unaware of the potential harm of smoking. Sixty-three percent either did not know or were not sure that smoking was harmful to health. Discussion The overall percentage of regular smokers in this study was 22.6%. Previous studies of adult populations [3,5] have generally shown lower prevalence. But at least two recent studies among physicians [l] and male post-secondary school students [6] have reported higher prevalence. Males in this study smoked much more than females (24.4% vs. 6.7%). Since males accounted for nearly ninety percent of the sample, generalizations about the extent of smoking in the population studied should be limited to males only. It is worthy of note that even though the proportion of smokers was not extremely high, smoking at least half a pack/day seemed to be the norm among smokers. In fact, 50% of male smokers consumed at least one pack of cigarettes/day. Considering that respondents with little income smoked more than others the impact of smoking on family income may be appreciable. In a review of information on smoking and health in Nigeria, Lucas and Erinosho [9] found that the prevalence of smoking was highest in the third decade of life. This was confirmed in this study: smoking (in particular heavy smoking) was more rampant in the 30 - 39 age group than all other groups. It is consoling that younger respondents smoked in less numbers even though the nature of the sample made it impossible to establish the extent of smoking among teenagers. Contrary to generally held beliefs the educated did not smoke more than the uneducated. Respondents with little or no formal education smoked more than those with primary school education and above. Since most of the educated respondents in the sample were civil ser-
vants it is possible that the policy of nonsmoking in offices may be having some beneficial effect. In fact the highest proportions of occasional smokers and those who have quit smoking were in this group. Probably because of the low educational and income levels of the sample there was no overriding preference for either particular brands or filter-tipped cigarettes. Most smokers tended to consume whatever cigarette was available. Smoking was related to health problems because cigarette smokers had a higher prevalence of most health problems than non-smokers. But it is not possible to state with certainty that smoking was responsible for these disorders especially since alcohol consumption is also associated with some of them. [lo]. Actually a correlation analysis showed a positive relationship between smoking and drinking. Moreover, some of the generally recognized smoking-related illnessess were not included in the list of disorders. The level of awareness of the health risk from smoking was low especially among heavy smokers and non-smokers. It is possible that non-smokers misunderstood the question on awareness and interpreted it to refer to their having any smoking related problems, and it is also likely that the relatively high awareness among light smokers was moderated by another factor, e.g, education. Whatever is the case, a tobacco policy in Nigeria (which is long overdue) must include a health education component not only for school children but for the general public. Such a policy should also include the risks involved in the use of other tobacco products - cigar, pipe tobacco, snuff. Except for the findings in this study no other information on the use of these products in Nigeria exist. It is suggested that in future research this broad perspective on tobacco use should be maintained in order to understand the extent of use and effects of different tobacco products. Acknowledgement This research Research Grant
was supported by No. SRGC/86-87/006
Senate of the
208
University of Jos. I am indebted to Fred Tamen for his assistance in coding and data analysis.
6
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Onadeko, B.O., Awotedu, A.A. and Onadeko, M.O. Smoking patterns of students in higher institutions of learning in Nigeria. In Forbes, W.F., Frecker, R.C. and Nostbaken, D. (Eds.1 Proceedings of the Fifth World Conference on Smoking and Health, Volume I. Ottawa: Canadian Council on Smoking and Health. Brew-Graves, S.H. (19861 Tobacco: The underrated killer. The Guardian, 11 February, p. 7. Awotedu, A.A., Higenbottam, T.W. and Onadeko, B.O. (1983) J. Epidemiol. Commun. Health 37.218-220. Lucas, A.O. and Erinocho-Francis, A.O. Smoking and Health in Nigeria. Report of WHO Expert Committee on Smoking and its Effect on Health. Wld. Hlth. Org. Techn. Dep. Ser. No. 568 Geneva 1975. Obot, IS. and Neighbors, H.V. Nig. J. Basic. Appl. Psychol. 1, ll- 22.
