Disentangling Inequalities in Tobacco Use: A Decomposition of Rural Urban Differences Among Men in Nigeria

IntroductionTobacco smoking is a leading contributor to preventable mortality globally, with deaths projected to reach 10 million annually by 2030. While historically more prevalent in high-income countries, recent evidence indicates a rising burden of tobacco use in low- and middle-income countries, including Nigeria. This study aimed to examine rural-urban disparities in tobacco use among Nigerian men and identify the key contributing factors. MethodsThis cross-sectional study utilized data from the most recent Nigeria Demographic and Health Survey (NDHS), comprising 13,311 men. We carried out descriptive statistics and the Blinder-Oaxaca decomposition technique to assess differences in tobacco use between rural and urban populations and to quantify the contribution of materialistic, behavioral/cultural, and psycho-social factors to the observed disparity. ResultsA small but significant 0.4 percentage point difference in tobacco use was observed between rural and urban men. The materialistic perspective, primarily household wealth and educational attainment, explained the majority of the disparity. Men from the richest and richer households contributed 417.3% and 129.8% to the gap, respectively, while primary and secondary education accounted for 34.4% and 143.2%. Contrary to prior studies, urban men with higher education levels reported higher tobacco use than their rural counterparts. Behavioral/cultural and psycho-social factors, including religion and marital status, helped reduce the rural-urban tobacco use gap. Specifically, being Muslim was associated with lower tobacco use, likely due to cultural and religious norms. ConclusionAlthough the rural-urban disparity in tobacco use among Nigerian men is modest, it is primarily driven by materialistic factors such as wealth and education. These findings emphasize the need for targeted policy interventions focusing on socioeconomic inequalities, alongside strengthened enforcement of tobacco control laws, to reduce tobacco use in both rural and urban populations. Key MessagesO_ST_ABSWhat is already known about the topic?C_ST_ABSTobacco use is a major contributor to preventable death globally, with an increasing burden shifting toward low- and middle-income countries (LMICs) like Nigeria. Prior research indicates that rural populations in LMICs often have higher tobacco use due to factors like poverty, lower education, and limited health information. What this study addsThis study is among the first to use the Blinder-Oaxaca decomposition method to analyze rural-urban differences in tobacco use among Nigerian men. Uniquely, it finds that urban men with higher education levels report higher tobacco use, contradicting global and earlier local trends. Cultural and religious factors (e.g., Islam) and psychosocial elements (e.g., occupation and marital status) reduced the disparity. How the study might affect research, practice, or policyThis study encourages further exploration of why higher-educated urban men are smoking more, suggesting a potential shift in the social meaning or pressures associated with smoking. This calls for tailored tobacco cessation interventions that consider urban wealth and education as emerging risk markers, particularly among men aged 25 - 34 years.