Non-cigarette Tobacco Use and Stroke Among West Africans: Evidence From the SIREN Study

Adekunle Gregory Fakunle, Akinkunmi Paul Okekunle, Osahon Jeffery Asowata, Onoja Akpa, Fred S. Sarfo, Albert Akpalu, Kolawole Wahab, Reginald Obiako, Morenikeji Komolafe, Lukman Owolabi, Godwin O. Osaigbovo, Abiodun M. Adeoye, Hemant K. Tiwari, Ezinne O. Uvere, Joshua Akinyemi, Carolyn Jenkins, Oyedunni Arulogun, Philip Ibinaiye, Lambert T. Appiah, Temilade BelloArti Singh, Joseph Yaria, Benedict Calys-Tagoe, Godwin Ogbole, Ijezie Chukwuonye, Chidinma Melikam, Philip Adebayo, Yaw Mensah, Oladimeji Adebayo, Sunday Adeniyi, Wisdom Oguike, Arnett Donna, Rufus Akinyemi, Bruce Ovbiagele, Mayowa Owolabi

Research output: Contribution to journalArticlepeer-review


Introduction: Non-cigarette tobacco (NCT) represents a form of tobacco use with a misperceived significance in chronic disease events. Whether NCT use is sufficient to promote stroke events, especially among Africans, is yet to be understood. This study assessed the relationship between NCT use and stroke among indigenous Africans. Methods: A total of 7617 respondents (NCT users: 41 vs. non-NCT: 7576) from the Stroke Investigative Research and Educational Network (SIREN) study were included in the current analysis. NCT use was defined as self-reported use of smoked (cigars or piper) or smokeless (snuff or chewed) tobacco in the past year preceding stroke events. Stroke was defined based on clinical presentation and confirmed with a cranial computed tomography/magnetic resonance imaging. Multivariable-adjusted logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for the relationship of NCT with stroke at a two-sided p < .05. Results: Out of the 41 (0.54%) who reported NCT use, 27 (65.9%) reported using smokeless NCT. NCT users were older than non-NCT users (62.8 ± 15.7 vs. 57.7 ± 14.8 years). Overall, NCT use was associated with first-ever stroke (OR: 2.08; 95% CI: 1.02, 4.23) in the entire sample. Notably, smokeless NCT use was independently associated with higher odds of stroke (OR: 2.74; 95% CI: 1.15, 6.54), but smoked NCT use (OR: 0.16; 95% CI: 0.02, 1.63) presented a statistically insignificant association after adjusting for hypertension and other covariates. Conclusions: NCT use was associated with higher odds of stroke, and public health interventions targeting NCT use might be promising in reducing the burden of stroke among indigenous Africans. Implications: A detailed understanding of the relationship between NCT use and stroke will likely inform well-articulated policy guidance and evidence-based recommendations for public health prevention and management of stroke on the African continent.

Original languageEnglish
Pages (from-to)589-596
Number of pages8
JournalNicotine and Tobacco Research
Issue number5
Publication statusPublished - 1 May 2024


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