Abstract

Tobacco and alcohol use are among the most prevalent and harmful addictive behaviors globally, including in the Lao People’s Democratic Republic (Lao PDR). In Southeast Asia and the Western Pacific, substance use patterns are shaped by cultural, social, economic, policyrelated, and environmental factors. This study aimed to: (1) explore associations between different patterns of alcohol and tobacco use among men and women in Lao PDR, and (2) investigate the effect of poverty on the relationship between alcohol and tobacco use. We conducted a secondary analysis of the 2013 Lao National Adult Tobacco Survey (N = 9,706), a nationally representative sample of adults from all 17 provinces. Bivariate and multivariable logistic regression analyses explored associations between current smoking, alcohol abuse (>14 drinks/week), and sociodemographic factors, including income, age, and sex. Current smoking prevalence was higher among those reporting alcohol abuse than among non-abusers (34.1% vs. 23.7%). Alcohol abuse was strongly associated with daily smoking (OR = 2.26), and each additional drink per week increased smoking odds by 4%. Age amplified risk, with pronounced effects among low-income groups. Among males aged ≥35 years earning less than $1.90/day, alcohol abuse increased smoking odds more than sixteen-fold (OR = 16.24; 95% CI: 6.36– 41.48). Even without alcohol abuse, low income alone was linked to a ten-fold increase in smoking odds (OR = 10.44; 95% CI: 6.25–17.44). The clustering of tobacco and alcohol use was most pronounced among older, low-income men in rural areas. These patterns reflect a syndemic dynamic, where co-use compounds risk for both non-communicable and infectious diseases. Targeted interventions should prioritize underserved populations, addressing both behavioral and structural health determinants. Policy options include increasing taxation on tobacco and alcohol and expanding cessation support services. However, in rural communities, widespread home production of both substances may limit the impact of price-based measures. Tailored, community-level strategies that address economic hardship and cultural norms may be more effective in reducing the burden of co-use in these high-risk groups.

LLU Discipline

Nursing

Department

Nursing

School

School of Nursing

First Advisor

Anne Berit Petersen

Second Advisor

Fayette Nguyen Truax

Third Advisor

Pramil N. Singh

Degree Name

Doctor of Philosophy (PhD)

Degree Level

Ph.D.

Year Degree Awarded

2025

Date (Title Page)

6-2025

Language

English

Library of Congress/MESH Subject Headings

Tobacco use—Social aspects—Laos; Drinking of alcoholic beverages—Social aspects—Laos; Poverty—Laos—Statistics; Laos—Social conditions—21st century

Type

Dissertation

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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