Predictors of high tobacco use prevalence among adults in Autonomous Province of Vojvodina, Serbia

Abstract

Introduction Introducing a sub-national surveillance system could significantly improve the monitoring of factors related to current tobacco use prevalence and the impacts of tobacco control measures. This study utilizes initial data from the newly established “Surveillance of Behavioural Risk Factors of Non-Communicable Diseases in Vojvodina” (SBRF-NCD-V) system in the Autonomous Province of Vojvodina (APV), Serbia. Materials and methods This cross-sectional study involved 3910 healthcare users aged 18 years and older, interviewed between May 20 and August 30, 2023, across all 44 Primary Healthcare Centers in the 7 districts of APV, with sampling proportional to Census data and stratified by gender, age and type of settlement. The questionnaire used was adapted from the BRFSS instrument developed by the CDC. Two multivariate binary logistic regression models analysed associations between current (daily or occasional) tobacco smoking and 6 sociodemographic factors, as well as 7 health-related or modifiable lifestyle risk factors, stratified by gender to calculate odds ratios. Results and discussion The prevalence of daily (28.8%) or occasional (7.2%) tobacco smoking in APV (36.0%; 95% CI 34.5–37.5) surpasses national levels in Serbia and ranks among the highest in Europe. Dual use of combustible tobacco and e-cigarettes accounted for 21.7% of cases. Higher likelihoods of smoking were observed among age groups 18–34 compared to 35–49 years, rural residents (OR = 1.2; 95% CI = 41.4–46.7; p = 0.009), those with lower education levels (for primary school OR = 2.0; 95% CI = 11.7–15.4; p < 0.001), the employed (OR = 1.5; 95% CI = 64.5–69.5; p = 0.015), and individuals self-assessing their socioeconomic status as ‘poor or very poor’ (OR = 1.8; 95% CI = 11.0–14.6; p < 0.001). Significant predictors of smoking included poorer health self-assessment, higher self-assessed Body Mass Index, e-cigarette use, at least 1-hour daily tobacco exposure, alcohol consumption at least 3 times weekly and/or binge drinking, and lower physical activity levels. Conclusion Factors contributing to the high prevalence of tobacco smoking in APV, Serbia, include younger age, rural residence, lower education, employment status, lower socioeconomic status, poorer health self-assessment, higher BMI (excluding women), e-cigarette use, tobacco exposure, alcohol consumption, and lower physical activity (excluding men). These findings underscore the need for targeted interventions, such as the efficacy of local inspection services and monitoring plans, to support policy measures aimed at addressing tobacco use in the region.