Background Globally, smoking leads to over 7 million preventable deaths annually, with higher rates in men (16%) than women (7%). While smoking has declined in high-income countries, tobacco use in Rwanda is comparatively low, affecting 14% of men and 3% of women. Objective The study aimed to identify the factors associated with tobacco smoking among workers and their spouses in Rwanda. Method This research employed a cross-sectional study design conducted from May to December 2018 in a beverage manufacturing industry in Rwanda. The target population was 822 participants, including industry employees and their spouses, aged 30 to 75 years. Using the Cochrane formula, the initial sample size was determined to be 384, and after the non-response rate adjustment and correction, the final sample size was set at 440. A combination of stratified and simple random sampling was used to ensure the sample's representativeness. Results The analysis reveals 6.8% were smokers and several key predictors of smoking behavior. Participants with elevated cardiovascular disease (CVD) risk (>=10%) have significantly higher odds of smoking, with an adjusted odds ratio of 2.946 (95% CI: 1.102-7.875, p=0.03), suggesting that CVD risk is a crucial factor in smoking behavior due to overlapping lifestyle risks. Additionally, high serum uric acid (SUA) levels (>=7 mg/dl) are strongly associated with smoking, with an adjusted odds ratio of 4.278 (95% CI: 1.141-11.872, p=0.005), indicating that elevated SUA levels are over four times more likely to be linked to smoking. Age is another significant predictor, with participants aged 50 years or older being nearly three times more likely to smoke compared to younger individuals, as shown by an adjusted odds ratio of 2.766 (95% CI: 1.126-6.797, p=0.02). Participants with hypertension or those treated for hypertension have lower adjusted odds ratio of 0.380 (95% CI: 0.100-1.446, p=0.049). Conclusion The study found that tobacco smoking is relatively rare in this population, with elevated cardiovascular disease risk. High serum uric acid levels, and older age identified as significant predictors of smoking.
