Tobacco smoking patterns in Samoa in 2010: Implications for interventions
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International Health Institute, School of Public Health, Brown University, Providence, United States
Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, United States
Samoa Ministry of Health, Apia, Samoa
Lutia i Puava ae Mapu i Fagalele, Apia, Samoa
Department of Epidemiology, School of Public Health, Brown University, Providence, United States
Department of Anthropology, Brown University, Providence, United States
Stephen T. McGarvey   

International Health Institute, School of Public Health, Brown University, Providence, Rhode Island 02912, United States
Publication date: 2019-12-17
Submission date: 2019-08-20
Final revision date: 2019-10-22
Acceptance date: 2019-11-17
Tob. Prev. Cessation 2019;5(December):50
Tobacco use in Samoa has been described over time by age, sex and education, but little work exists on other sociodemographic factors associated with tobacco use. We describe current smoking and daily tobacco use in adults from Samoa, with a focus on sex and age stratified analyses of the influence of occupation, education, census region, household asset ownership and alcohol use in order to help develop potential targeted interventions.

In 2010, a nationwide survey of 3745 adults aged 25–65 years from 33 villages was completed in Samoa. Current smoking status, daily tobacco use, as well as current alcohol use, and a variety of sociodemographic factors were assessed by interview. Bivariate and multivariable models, and sex and age group stratified analyses, were performed to determine different patterns of correlates.

More than half of all men (51.3%) and 21.8% of women were current tobacco smokers. Men and women smoked on average 10.9 and 8.7 cigarettes/ day, respectively. Twenty per cent of men consumed ≥20 cigarettes/day. In men, being married, a subsistence-farmer/laborer, an alcohol user, and having low household assets, were independently associated with being a tobacco smoker (all p<0.01). Among women, not completing secondary education, being 25–34 years, residing in urban Apia, and being an alcohol user, were independently associated with being a tobacco smoker (all p<0.01).

Tobacco use in Samoa remains high and correlates of smoking suggest that interventions for cessation need to be developed within the contexts of sex, age, education, and household socioeconomic status.

The authors thank the Samoan participants of the study, local village authorities and the many members of our field team over the years, especially research associates Melania Selu and Vaimoana Lupematisila. We acknowledge the Samoa Ministry of Health, Bureau of Statistics, and the Ministry of Women, Community, and Social Development for their partnership in this research.
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
This work was supported by the United State National Institute of Health, National Heart, Lung and Blood Institute (Grant No. R01-HL093093). The funders reviewed the research application for the present study but had no direct role in the design of this study of tobacco use, nor the collection, analysis, interpretation of data and writing of the manuscript.
STM conceived and led the study. ACA performed the majority of the statistical analysis and with STM wrote the initial draft of the manuscript. With guidance from STM, NLH led the fieldwork data collection in 2010 and contributed to writing the manuscript. MSR facilitated the 2010 fieldwork in Samoa, and with TN, contributed to the discussion of the interpretation and public health implications of the findings. All authors read and approved the final manuscript.
Not commissioned; externally peer reviewed.
Walser T, Cui X, Yanagawa J, Lee JM, Heinrich E, Lee G, et al. Smoking and Lung Cancer. Proc Am Thorac Soc. 2008;5(8):811-815. doi:10.1513/pats.200809-100TH
Gopal DM, Kalogeropoulos AP, Georgiopoulou VV, Smith AL, Bauer DC, Newman AB, et al. Cigarette Smoking Exposure and Heart Failure Risk in Older Adults: The Health, Aging, and Body Composition Study. Am Heart J. 2012;164(2):236-242. doi:10.1016/j.ahj.2012.05.013
World Health Organization. WHO Report on the Global Tobacco Epidemic 2013: Enforcing Bans on Tobacco Advertising, Promotion and Sponsorship. Geneva, Switzerland: World Health Organization; 2013. Accessed August 20, 2019.
Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014;311(2):183-192. doi:10.1001/jama.2013.284692
Gilmore AB, Fooks G, Drope J, Bialous SA, Jackson RR. Exposing and addressing tobacco industry conduct in low and middle income countries. Lancet. 2015;385(9972):1029-1043. doi:10.1016/S0140-6736(15)60312-9
Hoy D, Roth A, Viney K, Souares Y, Lopez AD. Findings and Implications of the Global Burden of Disease 2010 Study for the Pacific Islands. Prev Chronic Dis. 2014;11:E75. doi:10.5888/pcd11.130344
Kessaram T, McKenzie J, Girin N, Roth A, Vivili P, Williams G, et al. Tobacco Smoking in Islands of the Pacific Region, 2001-2013. Prev Chronic Dis. 2015;12:E212. doi:10.5888/pcd12.150155
Rasanathan K, Tukuitonga CF. Tobacco smoking prevalence in Pacific Island countries and territories: a review. NZ Med J. 2007;120(1263):36-46. doi:10.18356/aa45d7f2-en
Katulanda P, Wickramasinghe K, Mahesh JG, Rathnapala A, Constantine GR, Sheriff R, et al. Prevalence and Correlates of Tobacco Smoking in Sri Lanka. Asian Pac J Public Health. 2011;23(6):861-869. doi:10.1177/1010539509355599
Khan MMH, Khan A, Kraemer A, Mori M. Prevalence and correlates of smoking among urban adult men in Bangladesh: slum versus non-slum comparison. BMC Public Health. 2009;9(1):149. doi:10.1186/1471-2458-9-149
Reda AA, Kotz D, Biadgilign S. Adult tobacco use practice and its correlates in eastern Ethiopia: A cross-sectional study. Harm Reduct J. 2013;10(1):28. doi:10.1186/1477-7517-10-28
Hosseinpoor AR, Parker LA, Tursan d’Espaignet E, Chatterji S. Social Determinants of Smoking in Low- and Middle-Income Countries: Results from the World Health Survey. PLoS ONE. 2011;6(5):e20331. doi:10.1371/journal.pone.0020331
Bosdriesz JR, Mehmedovic S, Witvliet MI, Kunst AE. Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women? Int J Equity Health. 2014;13(1):14. doi:10.1186/1475-9276-13-14
Samoa Ministry of Health. Health Sector Plan 2008-2018. Accessed August 20, 2019.
Linhart C, Naseri T, Lin S, Taylor R, Morrell S, McGarvey ST, et al. Tobacco smoking trends in Samoa over four decades: can continued globalization rectify that which it has wrought? Glob Health. 2017;13(1):31. doi:10.1186/s12992-017-0256-2
Government of Samoa. Samoa Demographic and Health Survey 2014. Apia, Samoa: Samoa Bureau of Statistics, Ministry of Health; 2014. Accessed August 20, 2019.
Bollars C, Naseri T, Thomsen R, Varghese C, Sørensen K, de Vries N, et al. Adapting the WHO package of essential noncommunicable disease interventions, Samoa. Bull World Health Organ. 2018;96(8):578-583. doi:10.2471/BLT.17.203695
Ministry of Health, Bureau of Statistics, ICF Macro. Samoa Demographic and Health Survey, 2009. Apia, Samoa: Ministry of Health, Bureau of Statistics, ICF Macro; 2010. Accessed August 20, 2019.
Ministry of Health, World Health Organization. American Samoa NCS Risk Factors: STEPS Report. Apia, Samoa and Geneva, Switzerland: Ministry of Health and World Health Organization; 2014. Accessed August 20, 2019.
Mishra SI, Osann K, Luce PH. Prevalence and predictors of smoking behavior among Samoans in three geographical regions. Ethn Dis. 2005;15(2):305-315. Accessed August 20, 2019.
Barnes SS, Small C, Bennett J, Barnes J, Keogh R. Prevalence of smoking in rural Samoa. NZ Med J. 2010;123(1309):134-136. PMID:20186235.
Tanielu H, McCool J, Umali E, Whittaker R. Samoan Smokers Talk About Smoking and Quitting: A Focus Group Study. Nicotine Tob Res. 2018;20(9):1132-1137. doi:10.1093/ntr/ntx152
World Health Organization. Gender-Responsive Tobacco Control: Evidence and Options for Policies and Programmes. Geneva, Switzerland: World Health Organization; 2018. Accessed August 20, 2019.
Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, et al. 21st-Century Hazards of Smoking and Benefits of Cessation in the United States. N Engl J Med. 2013;368(4):341-350. doi:10.1056/NEJMsa1211128
Xi B, Liang Y, Liu Y, Yan Y, Zhao M, Ma C, et al. Tobacco use and second-hand smoke exposure in young adolescents aged 12–15 years: data from 68 low-income and middle-income countries. Lancet Glob Health. 2016;4(11):e795-e805. doi:10.1016/S2214-109X(16)30187-5
Hawley NL, Minster RL, Weeks DE, Viali S, Reupena MS, Sun G, et al. Prevalence of Adiposity and Associated Cardiometabolic Risk Factors in the Samoan Genome-Wide Association Study. Am J Hum Biol. 2014;26(4):491-501. doi:10.1002/ajhb.22553
Bureau of Statistics. Population and Housing Census 2011. National Data Archive. Published 2011. Accessed August 20, 2019.
Galanis DJ, McGarvey ST, Quested C, Sio B, Afele-Fa’amuli SA. Dietary intake of modernizing Samoans: implications for risk of cardiovascular disease. J Am Diet Assoc. 1999;99(2):184-190. doi:10.1016/S0002-8223(99)00044-9
Wang D, Hawley NL, Thompson AA, Lameko V, Reupena MS, McGarvey ST et al. Dietary Patterns Are Associated with Metabolic Outcomes among Adult Samoans in a Cross-Sectional Study. J Nutr. 2017;147(4):628-635. doi:10.3945/jn.116.243733
Government of Samoa. Samoa Household Income and Expenditure Survey 2013/14. In: Statistical Abstract 2014. Apia, Samoa: Bureau of Statistics; 2014. Accessed August 20, 2019.
Do YK, Bautista MA. Tobacco use and household expenditures on food, education, and healthcare in low- and middle-income countries: a multilevel analysis. BMC Public Health. 2015;15(1):1098. doi:10.1186/s12889-015-2423-9
McCool J, Tanielu H, Umali E, Whittaker R. Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study. JMIR Mhealth Uhealth. 2018;6(8):e173. doi:10.2196/mhealth.9033
De Leon J, Rendon DM, Baca-Garcia E, Aizpuru F, Gonzalez-Pinto A, Anitua C, et al. Association between smoking and alcohol use in the general population: stable and unstable odds ratios across two years in two different countries. Alcohol and Alcoholism. 2007;42(3):252-257. doi:10.1093/alcalc/agm029
Meader N, King K, Moe-Byrne T, Wright K, Graham H, Petticrew M, et al. A systematic review on the clustering and co-occurrence of multiple risk behaviours. BMC Public Health. 2016;16(1):657. doi:10.1186/s12889-016-3373-6
The Tobacco Atlas. Samoa Factsheet. Accessed August 20, 2019.
Government of Samoa. Samoa tobacco control act 2008. Accessed August 20, 2019.
Government of Samoa. Samoa Tobacco Control Regulations 2013. https://www.tobaccocontrollaws.... Accessed August 20, 2019.
World Health Organization. WHO report on the global tobacco epidemic 2019: Country profile Samoa. Geneva, Switzerland, World Health Organization; 2019. Accessed August 20, 2019.
Wojcik GL, Graff M, Nishimura KK, Tao R, Haessler J, Gignoux CR, et al. Genetic analyses of diverse populations improves discovery for complex traits. Nature. 2019;570(7762):514-518. doi:10.1038/s41586-019-1310-4