Differences in smoking by location of residence, ethnic group and country oforigin: The Ghanaian perspective in sub-Saharan Africa and Europe.

This PhD research examined how: smoking varied among a homogenous population from Ghana living in different locations; among different ethnic groups living in Amsterdam and; across the sub-Saharan African region. Ghanaians comprised one of the largest African migrant groups living in Europe. This provided an opportunity to study how smoking differed between migrant and non-migrant Ghanaians and to other ethnic groups. The factors associated with smoking were determined to inform strategies to prevent smoking among immigrant ethnic-minority groups living in developed countries. Three study methods were used: a systematic review of smoking in sub-Saharan Africa; a crosssectional study of Ghanaian populations living in 3 European cities and Ghana (RODAM); and a cross-sectional study of ethnic groups living in Amsterdam (HELIUS). The main findings that emerged showed that gender seems to be the strongest determinant of smoking among adults in sub-Saharan Africa. Smoking among the Ghanaian migrant population is multi-factorial in nature, with exposure to a high smoking environment having a strong influence, though the prevalences are still far lower than the European population. Factors including one’s immediate social networks operating through family, religion, social communities, culture and higher education are associated with a lower uptake of smoking. Compared to the Dutch and other ethnic groups in the Netherlands, Ghanaians smoked significantly less. However, the higher levels of smoking prevalence and higher levels of smoking cessation among some ethnic minority groups compared to the Dutch are largely, but not completely explained by SES. Smoking among migrant populations is related to cultural attitudes that exist towards smoking in both the country of origin and the host country. It implies that if smoking is made culturally abnormal, as in Ghana, a significant reduction in the prevalence and onset can occur in developing countries where the smoking epidemic is increasing. Anti-smoking policies designed to target smoking within the lower SES groups of ethnic minority groups may substantially reduce ethnic inequalities in smoking. Role in data collection Throughout the PhD, I was a part of the data collection team for the RODAM project at the London location. Data collection was conducted during 2012 and 2015. The team was responsible for recruiting Ghanaian residents living in London into the study and collecting data according to the study protocol. To accomplish this, the team visited several locations across the London boroughs where Ghanaian communities often congregated for church services or meetings. This usually occurred on Sundays or Saturdays, depending on the occasion. At these meetings, the project was advertised to the Ghanaian community and invitations to participate were sent out. After an informed consent to participate was received, participants visited the data collection venue to participate in the study. I was often assigned the responsibility of taking physical anthropometric measurements from participants including weight and height, waist and hip ratios, bio-electrical impedance monitor, sitting blood pressure and lying blood pressure measurements. Due to my inability to speak the local Ghanaian language, I was unable to interview participants who often preferred to speak their local Asante Twi language. During September 2013, for two weeks, I visited the study location in Ghana, to participate in the fieldwork activities at the Kumasi and Obuasi locations.