In Ethiopia, knowledge of harm increases intentions to quit smoking

In Ethiopia, access to information about the harms of smoking is one of the key factors in quitting smoking, a study confirms, which is reviving interest in health warnings.

Sociodemographic data on smoking cessation are still quite scarce in Africa. Based on the Global Adult Tobacco Survey (GATS), a component of the Global Tobacco Surveillance System (GTSS), an Ethiopian study provides some additional details[1].

Intentions to stop linked to the level of knowledge of the damage

Among the 10,150 participants surveyed in 2016, the prevalence of smoking in Ethiopia was 3.7% of the population, or about 2.5 million smokers. The intention to quit smoking was reported by 42% of smokers. Men stated this intention more often than women, but seemed to have more difficulty maintaining smoking abstinence, which corroborates the results of other studies.

Knowledge of the harms associated with smoking, as well as a higher income and education level, are more strongly associated with the intention to quit smoking, again confirming data from other studies. Having received advice from a health professional was not, however, correlated with the intention to quit smoking, contrary to what is usually found; the hypotheses of very limited access to care and resources, but also of less training of caregivers on this topic and of an insufficient sample size, are put forward to explain this gap. Only a quarter of the attempts to quit were made with support (medical: 14.7%; pharmaceutical tool: 3.1%; traditional medicine: 5.6%; other methods: 13.7%), three quarters being made without any help.

The importance of health warnings

Ethiopia ratified the Framework Convention on Tobacco Control (FCTC) in 2014 and, following a 2019 tobacco law, introduced health warnings on 70% of the surface of cigarette packs.[2]. This study confirms the importance of the presence of these health warnings, as well as that of public communication campaigns and any information on the consequences of smoking. The fact that men in Ethiopia integrate this information more can be interpreted as the fact that they are more exposed than women to information on smoking disseminated in the media. The integration of this information could also be correlated with the greater tobacco consumption of men, in terms of the number of cigarettes smoked, which suggests a stronger tobacco dependence among men.

The presence of health warnings is crucial, since knowledge of the harms is shown here to double the chances of trying to quit smoking, and quadruple the chances of actually succeeding. These graphics and their visibility on 70% of the surface of the pack are all the more essential in low- and middle-income countries, where the level of education of the population is low. Tobacco manufacturers are aware of this, which leads them to actively fight any proposed regulation reinforcing the presence of these health warnings. A recent example, revealed in a press release by Léonce SESSOU, Executive Secretary of the Alliance Against Tobacco in Africa (ATCA), indicates that Mauritania has been able to resist significant pressure from the tobacco industry which opposed the expansion of health warnings on packs[3].

The study also confirms the interest in developing surveillance studies in order to better understand the evolution of the tobacco epidemic on the African continent.

Keywords: Ethiopia, ATCA, Africa, health warnings, smoking cessation

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M.F.