Abstract
HIGHLIGHTS: Public health relevance—How does this work relate to a public health issue? Tobacco use remains a major preventable health problem in rural South Africa and contributes to chronic disease and early death. This study addresses limited local evidence on tobacco use in adults attending healthcare facilities in the rural OR Tambo District. Public health significance—Why is this work of significance to public health? More than one in four adults in the study reported current tobacco use, with much higher use among men. Tobacco use was strongly associated with alcohol consumption and lower education, identifying groups at higher risk. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? Primary healthcare services should strengthen routine screening and integrated cessation support for both tobacco and alcohol use. Public health policies and programmes in rural communities should prioritise male-focused, education-sensitive prevention, and cessation strategies. ABSTRACT: 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.