Sociodemographic correlates of tobacco use among Cambodian men aged 15-49 years : evidence from the Cambodia demographic and health survey 2021-2022

Introduction
This study investigated associations of tobacco use with alcohol consumption and sociodemographic factors among Cambodian men aged 15-49 years.
Methods
Data were drawn from the Cambodia Demographic and Health Survey (CDHS) 2021-2022, including 8825 men. The main outcome was tobacco use, classified as smoked or smokeless tobacco. Multivariable logistic regression was performed to identify determinants of any tobacco use, smoking tobacco, and smokeless tobacco use.
Results
The prevalence of any tobacco use, smoked tobacco, and smokeless tobacco use was 21.5% (95% confidence interval (CI): 20.2-22.9), 20.1% (95% CI: 18.9-21.4), and 0.93% (95% CI: 0.7-1.2), respectively. The highest prevalence of any tobacco use occurred in the northeast highlands, where the majority of the country's indigenous populations reside: Stung Treng (40.7%), followed by Mondulkiri and Ratanak Kiri (each 39%). Smoked tobacco was most common in Mondulkiri (36.5%) and Ratanak Kiri (34.5%), while smokeless tobacco use was highest in Mondulkiri (19.1%) and Stung Treng (6%). Independent predictors of any tobacco use included older age, lower educational attainment, agricultural or manual occupations, lower household wealth, and alcohol consumption. A dose-response association was observed between the frequency of alcohol use and tobacco consumption.
Discussion and Conclusions
Tobacco use remains a significant public health threat among Cambodian men, driven by socioeconomic disparities and alcohol consumption. Control efforts should prioritize agricultural and manual laborers as high-risk groups, and province-specific interventions in northeastern Cambodia through health awareness and behavioral change programs. Integrated tobacco and alcohol control policies to decrease exposure, initiation, and usage, and particularly higher taxation, are essential to reducing the dual burden of substance use in Cambodia.