Preventing tobacco epidemic in LMICs with low tobacco use - Using Nigeria GATS to review WHO MPOWER tobacco indicators and prevention strategies.

Introduction: Tobacco is a major preventable cause of disease and death globally and increasingly shifting its burden to low and middle-income countries (LMICs) including African countries. We use Nigeria Global Adult Tobacco Survey data to examine indications of a potential tobacco epidemic in a LMIC setting and provide potential interventions to prevent the epidemic.
Methodology: Global Adult Tobacco Survey data from Nigeria (2012; sample=9765) were analyzed to examine key tobacco indicators. Estimates and confidence intervals for each indicator were computed using SPSS software version 21 for complex samples.
Results: 5.5% of adult Nigerians use any tobacco and exposure to secondhand smoke was mainly high in bars (80.0%) and restaurants (29.3%). Two-thirds of smokers (66.3%) are interested in quitting. Among those who attempted to quit, 15.0% used counseling/advice and 5.2% pharmacotherapy. Awareness was high that tobacco use causes serious illnesses (82.4%), heart attack (76.8%) and lung cancer (73.0%) but only 51.4% for stroke. Awareness that secondhand smoke can cause serious illness was also high (74.5%). Overall 88.5% support tobacco products tax increase.
Conclusion: Although tobacco use is relatively low in Nigeria as in other African countries, high smoking rate among men compared to women might indicate potential increase in prevalence. Challenges to preventing increasing smoking rate include limited use of evidence-based cessation methods among quit attempters, social acceptability of smoking particularly in bars and restaurants, and gap in knowledge on tobacco-related diseases. However, ratification of WHO FCTC and signing into law of the Tobacco Control law provide the impetus to implement evidence-based interventions.
(Published by Elsevier Inc.)