## DISCUSSION

The smoking rate among UPF was 25.5% compared to 5.3% of the general population. The relatively high smoking rate in the UPF places a substantial burden on a police force that is understaffed and a country with limited financial resources. Importantly, cigarette smoking poses a national security risk due to its negative impact on UPF personnel health and readiness. Further, the rate of smoking among UPF was similar to high rates found among police officers in other countries. For example, Khan et al.27 found a 25.4% current smoking rate among police in Bangladesh. Thus, there is a need for targeted tobacco interventions in this high-risk occupation. We recommend that the UPF: 1) design and implement organizational tobacco control policies to eliminate tobacco use at the workplace; 2) educate their officers about the negative impact of smoking on health and readiness; and 3) develop intervention programs designed to prevent and treat tobacco dependence among officers. Given that UPF officers may serve as role models to Ugandan youth and are tasked to enforce the national tobacco control laws, encouraging personnel to avoid tobacco should be a national public health priority.

As with our previous study of the Ugandan military, this study demonstrates that although the rate of smoking is relatively low in Uganda’s general population, certain occupations have relatively high rates of usage. This suggests that similar occupational groups, such as prison guards and firefighters, may also evidence high rates of tobacco use. Thus, additional studies are needed to provide an insight on the smoking situation in all first responder and uniformed occupations.

### Limitations

There are some limitations to this study. First, the study was conducted only at the large police barracks of Nsambya in Uganda, and although the barracks is typical of the UPF, additional research is needed to ensure the results are generalizable to the police as a whole. There may be urban and rural differences in tobacco consumption. Some studies have found that smokers living in rural areas are more likely to smoke 15 or more cigarettes per day than smokers living in urban areas27. Second, the skip interval used to identify even-numbered homes assumes that odd-numbered homes were not significantly different. However, we saw no reason to suspect that the homes differed and using this skip-interval method reduced study burden. Third, self-reporting might have introduced some bias or led to under-reporting of true cigarette prevalence due to police officers’ regulatory obligations in law enforcement. However, this study found a relatively high rate of self-reported cigarette use despite the risk of under-reporting. Fourth, lost productivity associated with cigarette smoking contains instances where cigarette smoking may play a coincidental rather than a causal role. If so, the higher costs of healthcare might be associated with, rather than caused by, smoking. Fifth, police officers rotate between different duty stations in similar environments including outdoors. Thus, we could not easily ascertain the effect of outdoor environment of the smoking patterns. Last, no qualitative data were collected, which may have provided more insight into factors influencing cigarette smoking among police officers.

## CONCLUSIONS

Tobacco use among the Ugandan Police Force represents a significant burden to a country’s health system that is struggling with poor infrastructure, limited health workers and infectious diseases. Importantly, cigarette smoking poses a national security risk due to its negative impact on police force readiness. Thus, there is an urgent need for tailored tobacco interventions and organizational policy for the Ugandan Police. Our recommendations and study findings are applicable in the context of the increased consumption rate in police officers compared to the general population, which we largely attribute to the nature of the profession. In addition, the police profession is male dominated and as such this study’s results may allow inferences for men in particular and the rest of the population in general.