BMC Public Health · Oct 26, 2026
Socioeconomic and demographic patterning of concurrent tobacco smoking and alcohol consumption among men in Malawi: evidence from the 2024 Malawi demographic and health survey
By Ngoma C
Background: Tobacco smoking and alcohol consumption are major behavioural risk factors for non-communicable diseases that frequently co-occur, yet in Malawi they have typically been studied separately. This study examined the prevalence and socioeconomic correlates of concurrent (dual) tobacco smoking and alcohol consumption among Malawian men. Methods: This study used a cross-sectional secondary analysis of the 2024 Malawi Demographic and Health Survey among men aged 15–54 years in the national survey domains ( N = 8,583, after excluding 330 men in the Dzaleka refugee camp sample from 8,913 interviewed; no missing data). Dual use was current tobacco smoking together with current alcohol consumption. Survey-weighted logistic, modified Poisson and multinomial regression estimated prevalence and associated factors. Education and household wealth were adjusted for each other, employment and the other covariates in a single mutually adjusted model. Sensitivity analyses used continuous covariates, heavier drinking and any tobacco use. Results: Prevalence was 12.1% (95% CI: 11.2–12.9) for smoking, 22.7% (21.4–24.0) for alcohol consumption and 7.3% (6.6–8.1) for dual use, about 2.7 times the 2.7% expected if the behaviours were independent. Dual use rose to a plateau around ages 40–44 years (adjusted odds ratio [AOR] = 15.78, 95% CI: 8.13–30.62; adjusted prevalence ratio [aPR] = 12.68, 6.90–23.30, versus ages 15–19). Odds were lower among men in the richest than the poorest households (AOR = 0.42, 0.27–0.65) and among men with higher education than none (AOR = 0.40, 0.20–0.78), and higher among employed men (AOR = 1.63, 1.19–2.23). Currently married or cohabiting men had higher crude but lower adjusted odds than never-married men (AOR = 0.53, 0.35–0.78); the age-stratified association was higher at ages 15–24 years but lower from age 25 years. Previously married or separated men had higher odds (AOR = 2.04, 1.23–3.37). Wealth and education patterns resembled those for smoking only rather than alcohol consumption only. Conclusions: Dual use is unevenly distributed; it is more common among older and employed men and men in the poorest households and less common among men with higher education. These are adjusted associations from cross-sectional data. Integrating tobacco and alcohol screening and cessation support within existing primary healthcare and non-communicable disease platforms may help address co-occurring use among groups with a higher prevalence.