BACKGROUND: This study examines the relationship between changes in tobacco excise tax scores and changes in smoking prevalence while exploring gender and socioeconomic disparities in tobacco smoking in Sub-Saharan Africa (SSA) since the 2005 implementation of the WHO Framework Convention on Tobacco Control (FCTC).
METHODS: Data was obtained from adult participants in the Demographic and Health Surveys (DHS) conducted in 23 SSA countries between 2005 and 2023. We compared smoking prevalence between the first DHS survey conducted post-2005 and the most recent DHS survey available for each country. We explored differences in change in smoking prevalence by gender, income, and education level within each country and changes in smoking prevalence by changes in tax scores across countries. Smoking prevalence was computed as the percentage of respondents who reported current tobacco smoking. Socioeconomic status was assessed using wealth index quantiles, while the highest educational attainment was categorized into low (RESULTS: A higher increase in tax score was associated with a greater decrease in smoking prevalence over the two survey periods compared for each country (R²=0.24). In most countries, male smoking prevalence have decreased significantly, while female smoking prevalence have increased in some countries, especially in West-Central African sub-region. Smoking prevalence was consistently higher among the poorest and the least educated. These socioeconomic disparities increased, particularly in the Eastern-Southern African Sub-region, between the initial round of DHS surveys compared to the latest recorded round of DHS surveys
CONCLUSIONS: There is an urgent need to address the sociocultural and economic factors driving tobacco smoking among women and individuals of lower socioeconomic status. The implementation of the WHO FCTC, including significant excise tax increases and continuous surveillance and enforcement of the tobacco control laws, is critical to reducing the overall burden of tobacco-related diseases and the emerging disparities across SSA.