Revaluating the triad of women, tobacco and violence in Nigeria: findings from the 2013 NDHS survey

Background Tobacco use is an unambiguous health threat but the discourse on its effects and use predictors is more often focused on physical rather than psychological factors. The authors of this paper previously examined associations between domestic violence and tobacco use in women. In line with the MPOWER focus of monitoring tobacco use and predictors, we re-evaluate these relationships in the latest DHS survey of women in Nigeria. Methods Data from the 2013 DHS survey in Nigeria was analysed. The dataset examined tobacco use in a nationally representative sample of 38,740 women and violence experience in a subset of 27,634 women aged 15 - 49 years. Logistic regression models were fitted to derive adjusted odds of association between tobacco use and violence experience or perpetration in various domains, controlling for the effect of geographic location and womens' education. Results The prevalence of tobacco use among women was 0.4% (95% CI 0.3-0.6), a 55% reduction from 2008 values. 0.2% smoked cigarettes, 0.1% used snuff or chewing tobacco respectively. Tobacco use showed a consistent association with experience of severe physical violence in both the 2008 and 2013 surveys with a 60% increase in tobacco users violence odds. Experiencing sexual violence and perpetrating physical violence were not associated with tobacco use in 2013 counter to findings in 2008. Similarly experiencing emotional violence was a predictor of tobacco use in 2013 a change from 2008 findings Violence domains Adjusted odds (95% CI) 2008 Adjusted odds (95% CI) 2013 Experiencing severe physical violence 2.9 (2.2 - 3.9) 3.5 (1.8 - 7.2) Experiencing sexual violence 2.9 (2.0 - 4.1) 1.5 (0.3 - 4.4) Experiencing emotional violence 1.1 (0.5 - 2.1) 1.9 (1.1 - 3.3) Perpetrating physical violence 2.2 (1.3 - 3.8) 1.2 (0.3 - 4.3) [Table 1: Logistic odds of violence and tobacco use] Conclusions Despite the absolute reduction in tobacco use prevalence in this report, tobacco use and violence maintain a worrying co-occurrence in Nigerian women. Tobacco control efforts must identify vulnerable sub populations like women in domestic violence situations as priority for intervention. National programmes should explore opportunities for synergy between tobacco control and violence prevention programmes for women.