Prevalence and Factors Associated with Tobacco Use Among Adults Attending Selected Healthcare Facilities in the OR Tambo District, Rural Eastern Cape Province, South Africa.

Tobacco use is a primary global public health concern. In South Africa, particularly in the rural Eastern Cape, there is a paucity of comprehensive information about the burden of tobacco use and its associated factors. This study aimed to determine the prevalence of tobacco use and identify associated factors among adults seeking care at healthcare facilities in the OR Tambo District. A quantitative cross-sectional study was conducted among 246 adults (≥18 years) using a three-stage random sampling of sub-districts, clinics, and participants. Data were collected through structured interviews using the WHO STEPS questionnaire. Descriptive statistics, Chi-square tests, t-tests, and logistic regression analyses were applied. Overall, 27.2% of participants reported current tobacco use, with prevalence substantially higher among men (70.4%) than women (21.9%). Multivariate logistic regression confirmed male gender (AOR = 8.14, p < 0.001) and alcohol consumption (AOR = 19.5, p < 0.0001) as independent predictors of tobacco use. Higher education reduced smoking risk significantly (secondary education: AOR = 0.15; p = 0.036; tertiary education: AOR = 0.07; p = 0.014). Tobacco use remains highly prevalent in the rural Eastern Cape. Targeted interventions should focus on men, integrate tobacco-alcohol cessation programs, and expand education-based prevention strategies to reduce the burden of tobacco use in rural communities.