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Background Concurrently using two (dual users) or more than two (poly tobacco users) tobacco products is common in developing (low-and middle-income) countries, especially among men, and has been linked to increased health risks and nicotine addiction compared to single tobacco product use. Very little is known about the impact of migration on tobacco use patterns among these populations. This study aims to explore socioeconomic and migration related risk factors in association with poly tobacco use among men in 15 developing countries. Methods Data from 15 countries around the world were obtained from the most recent wave of the Demographic and Health Survey (DHS), collected between 2015 and 2018. A total of 155,425 men aged 15-49 were surveyed. Outcomes included single, dual and poly use, examined by education, wealth, and migration status. Migration status was defined as whether the respondent slept or reside away from home in the last 12 months. Multilevel regression models were used to estimate the between those covariates and tobacco use. Results In all studied countries, prevalence of dual and poly-tobacco use was highest in respondents with low socioeconomic status (SES). SES gradients in dual and poly tobacco use by education (Risk Ratio [RR]=0.64; 95%CI: 0.55-0.67 for higher education vs illiterates) and wealth index (RR = 0.15; 95%CI: 0.11-0.20 for richest vs poorest) were observed. Furthermore, results showed higher risks of being a poly user among migrant men (RR = 1.70; 95%CI: 1.65-1.71). Conclusions We found higher risk of dual and poly tobacco use among male respondents with lower SES and migration backgrounds. This underlines the need to develop strategies to reduce smoking inequality, especially focusing on individuals with a migration background who may have more complex smoking histories and habits. Key messages The first study to examine the relationship between poly-tobacco use in men and their migration status in developing countries, highlighting SES gradients in use and risks among the population. Findings imply that policy makers should consider targeting populations with migration background to tackle smoking inequality.

Socioeconomic inequalities, migration and poly tobacco use among male adults in developing countries