Social Risk Factors Associated With Daily Tobacco Smoking and Binge Drinking Among Zambians: Evidence From the 2017 STEPS Survey

Abstract Background: The burden of disease attributable to tobacco smoking and harmful alcohol consumption poses a major threat to sustainable development in most low- and middle-income countries. However, evidence on tobacco use and harmful alcohol consumption to inform context-specific interventions addressing these harmful social behaviours is limited in the African context. This study aimed to determine the social risk factors associated with daily tobacco smoking and binge drinking in Zambia.Methods: The study stems from nationwide population-based representative survey data collected using the World Health Organization’s STEPwise approach for non-communicable disease risk factor surveillance in 2017 among 18–69-year-old Zambians. The main outcomes were daily tobacco smoking and binge drinking, and the demographic and socioeconomic variables included sex, marital status, age, residence, level of education and occupation. Prevalence ratios were calculated using log-binomial regression analysis.Results: Overall, 4302 individuals (weighted percentage 49.0% men and 51.0% women) participated in the survey. The prevalence of daily tobacco smoking was 9.04%, and 11.6% of participants engaged in binge drinking, both of which were higher among men than women (17.1% vs. 1.28% and 18.6% vs. 5.29%, respectively). The risk of daily tobacco smoking was significantly higher in men (PR 14.3; 95% CI [9.74, 21.0]) than women, in the >45-year-old group (PR 1.44; 95% CI [1.03, 1.99]) compared to the 18–29-year-old group, and in those with no education (PR 2.70; 95% CI [1.79, 2.99]) or primary education (PR 1.86; 95% CI [1.22, 2.83]) compared to those with higher secondary or tertiary education. The risk of binge drinking was 3.67 times higher (95% CI [2.83, 4.76]) in men than in women. Significantly lower levels of binge drinking were observed among rural residents (PR 0.59; 95% CI [0.46, 0.77]) compared to urban residents and students/homemakers (PR 0.58; 95% CI [0.35, 0.94]) compared to the employed.Conclusion: This study shows huge differences between men and women regarding tobacco smoking and binge drinking in Zambia. A high occurrence of tobacco smoking was observed among men, older members of society and those with lower levels of education, while binge drinking was more common in men and in those living in urban areas. There is a need to reshape and refine preventive and control interventions for tobacco smoking and binge drinking to target the most at-risk groups in the country.