Tobacco smoking trends in Samoa over four decades: can continued globalization rectify that which it has wrought?

Abstract

BackgroundThe island country of Samoa (population 188,000 in 2011) forms part of Polynesia in the South Pacific. Over the past several decades Samoa has experienced exceptional modernization and globalization of many sectors of society, with noncommunicable diseases (NCD) now the leading cause of morbidity and mortality. The evolution of risk factor prevalence underpinning the increase in NCDs, however, has not been well described, including tobacco smoking which is related to cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease.MethodsThe present study examines tobacco smoking in relation to different forms and effects of globalization in Samoa using 7 population-based surveys (n = 9223) over 1978–2013.ResultsThe prevalence of daily tobacco smoking steadily decreased over 1978–2013 from 76% to 36% in men, and from 27% to 15% in women (p < 0.0001 both sexes). During 1991–2013, current tobacco smoking also steadily decreased from 64% to 40% in men (p < 0.0001), and from 21% to 17% in women (p < 0.05). Declines were similar in younger (25–44 years) and older (45–64 years) men and women. Colonial globalization facilitated the introduction and prolific spread of tobacco trade and consumption in the Pacific Islands from the sixteenth century, with many populations inexorably pulled into trade relations and links to the global economy. It has also been a different globalization which may have led to the decline in smoking prevalence in Samoa in recent decades, through global dissemination since the 1950s of information on the harmful effects of tobacco smoking derived from research studies in the USA and Europe.ConclusionsOver the past 35 years tobacco smoking has steadily declined among Samoan adults; the only NCD risk factor to demonstrate marked declines during this period. By 2013 tobacco smoking in women had decreased to levels similar to Australia and New Zealand (ANZ), however in men smoking prevalence remained more than three times higher than ANZ. The impact on smoking prevalence of the variety of tobacco control interventions that have been implemented so far in Samoa need to be evaluated in order to determine the most effective initiatives that should be prioritized and strengthened.

Tobacco smoking patterns in Samoa in 2010: Implications for interventions

“…In a 2005 study among Samoans in American Samoa, Hawaii and California, smoking was associated with being male, younger, married, and less educated 20 . In the temporal trends study in Samoa among men, non-smokers had higher education than smokers, 0.5-0.8 years, but among women there were few differences by education, except in 2013 when smokers had 0.6 years more education than nonsmokers 15 . Temporal trends of lower cigarette smoking were accelerated with more education in men, but impeded with more education among women 15 .…”

“…In the temporal trends study in Samoa among men, non-smokers had higher education than smokers, 0.5-0.8 years, but among women there were few differences by education, except in 2013 when smokers had 0.6 years more education than nonsmokers 15 . Temporal trends of lower cigarette smoking were accelerated with more education in men, but impeded with more education among women 15 . Among men aged 15-49 years, the 2014 Samoa DHS described lower tobacco use in the highest wealth quintile, those with more than secondary education, and residents of Northwest 'Upolu; in women in the same age group, there were few sociodemographic differences except for lower use among rural residents, especially those from Savai'i 16 .…”

“…Samoa is one LMIC where smoking is identified as an essential area for focused health promotion activities 14 . Smoking prevalence in Samoa among older and younger adults declined significantly from the late 1970s to 2013 15 . From 1978-2013, the percentage of men who smoked cigarettes daily decreased from 76% to 36%, and among women from 27% to 15%.…”

“…From 1978-2013, the percentage of men who smoked cigarettes daily decreased from 76% to 36%, and among women from 27% to 15%. From 1991-2013, current tobacco smoking decreased from 64% to 40% in men, and 21% to 17% in women 15 . The Samoa 2014 Demographic and Health Survey (DHS) reported that 47.2% of men and 17.0% of women 25-54 years of age used tobacco 16 .…”

TXTTaofiTapaa: pilot trial of a Samoan mobile phone smoking cessation programme

“…1 -2 Its impact weighs heavily on the health care system and economies that are already under significant financial constraints. Samoa is a country in the Pacific region where tobacco smoking has declined over the past decade 3 , but remains high with approximately 26% of adults reported to be smokers in 2013. 4 A recent review of smoking prevalence in Samoa describes a steady decline in tobacco use among males and females (39.5% and 16.8% respectively in 2013).…”