Prevalence and correlates of smoked and smokeless tobacco use in Saudi Arabia: evidence from the 2021 national health survey

Tobacco use, both smoked and smokeless, remains a major public health concern in Saudi Arabia, significantly contributing to the burden of non-communicable diseases. Saudi Arabia is ranked fourth in the world in terms of tobacco sales and importation. The aim of this study was to assess the prevalence and correlates of tobacco use (both smoked and smokeless) among the adult population of Saudi Arabia using the most recent nationally representative survey data. Data derived from the 2021 National Health Survey (NHS) were used for analyses. The NHS is a cross-sectional survey conducted by the General Authority for Statistics in Saudi Arabia to collect data from a sample consisting of the Saudi population aged 15 years and older. Descriptive statistics, bivariate analyses, and multivariable logistic regression models were used to assess prevalence and to identify socioeconomic correlates of current smoked and smokeless tobacco use. Among the 1530 respondents, the prevalence of current smoked and smokeless tobacco use was 15.6% and 8.6%, respectively. Gender, age, and monthly income were significantly associated with increased odds of both forms of tobacco use. Men were over 14 times more likely to smoke tobacco [adjusted odds ratio (AOR) = 14.8, 95% CI = 7.03-31.5] and were 8 times more likely to use smokeless tobacco (AOR = 8.00, 95% CI = 3.53-18.1) compared to women. Additionally, individuals aged 25-44 years, those earning 12,000-20,000 Saudi Riyal monthly and residing in Al-Baha region had higher odds of tobacco use compared to their counterparts. In contrast, being married and having higher education were associated with lower odds of both smoked and smokeless tobacco use. The observed prevalence of tobacco use highlights a need for more targeted, evidence-based public health interventions, especially for men, middle-aged adults, individuals with low- to middle-range income and those residing in Al-Baha region. Strengthening tobacco control policies and enforcement may help reverse this rising trend.