Sociodemographic inequalities in product-specific tobacco use in Myanmar: a nationally representative study of the 2015-2016 demographic and health survey.

INTRODUCTION: Tobacco use remains a major preventable cause of disease in low- and middle-income countries, and nationally representative evidence distinguishing tobacco product types in Myanmar remains limited. We aimed to provide nationally representative, product-specific estimates of smoked, smokeless, and dual tobacco use among individuals aged 15-49 years in Myanmar using data from the 2015-2016 Demographic and Health Survey, and to examine sociodemographic inequalities in tobacco use patterns.

METHODS: We conducted a cross-sectional secondary analysis using data from the 2015-2016 Myanmar Demographic and Health Survey (MDHS), the most recent nationally representative household survey with adult tobacco use indicators in Myanmar. The sample included 17,620 individuals aged 15-49 years with complete tobacco use data. Tobacco use was classified as no use, smoked tobacco only, smokeless tobacco only, or dual use. Weighted descriptive statistics and survey-weighted multivariable multinomial logistic regression adjusted for age, sex, education, residence, marital status, occupation, wealth quintile, and mass media exposure were used to assess associations with sociodemographic factors, reporting adjusted relative risk ratios (ARRRs) with 95% confidence intervals (CIs). Statistical significance was defined as p<0.05.

RESULTS: Overall, 86.3% reported no tobacco use; smoked tobacco use was 13.0%, whereas smokeless (0.4%) and dual use (0.3%) were rare. Older age (40-49 years) was associated with higher likelihood of smoked tobacco use (ARRR = 3.58, 95% CI 2.70, 4.74, p < 0.001). Men had a substantially higher likelihood of smoked tobacco use (ARRR = 21.96, 95% CI 18.38, 26.22, p < 0.001) and higher likelihood of smokeless and dual tobacco use, although estimates for the latter categories should be interpreted cautiously because of small numbers. Higher education and wealth were associated with lower likelihood of smoked tobacco use. Being not currently married or cohabiting was associated with higher likelihood of smoked tobacco use and dual use.

CONCLUSIONS: Smoked tobacco predominated among adults aged 15-49 years, while smokeless (chewing tobacco and snuff) and dual use were rare. Marked sociodemographic inequalities highlight the product-specific, equity-oriented tobacco control and updated surveillance. Findings should be interpreted considering the cross-sectional design, potential self-report bias, limited generalizability due to restriction to individuals aged 15-49 years, and the 2015-2016 survey period.