Code for Regional inequalities and determinants of smoking cessation among adults across five WHO regions: a secondary dataset analysis of WHO STEPS surveys, 2012–2023

This repository contains the analytical materials supporting the study “Regional inequalities and determinants of smoking cessation among adults across five WHO regions: a secondary dataset analysis of WHO STEPS surveys, 2012–2023.” The study examined regional, socioeconomic, behavioural, comorbidity, and temporal inequalities in successful smoking cessation using harmonised data from the World Health Organization STEPwise approach to noncommunicable disease risk factor surveillance (WHO STEPS). The analysis included 54,460 adults who had ever smoked across five WHO regions: the African Region (AFRO), Eastern Mediterranean Region (EMRO), European Region (EURO), Region of the Americas (PAHO), and Western Pacific Region (WPRO). Smoking cessation was described using the quit ratio, defined as the proportion of former smokers among all ever smokers. Survey-weighted multivariable logistic regression models were used to estimate adjusted associations between successful smoking cessation and age, sex, educational attainment, residence, marital status, diagnosed hypertension, diagnosed diabetes, harmful alcohol use, physical activity, WHO region, and survey year. Region-specific models were additionally fitted to examine geographical heterogeneity. For the African subset, country-level tobacco-control policy indicators were incorporated to examine associations between the broader policy environment and smoking cessation. The repository is intended to support transparency, reproducibility, and secondary methodological evaluation of the study. Materials may include analysis scripts, variable-construction and harmonisation procedures, statistical-model specifications, regression diagnostics, supplementary tables, and derived analytical outputs used to generate the results reported in the manuscript. The analytical workflow accounts for the complex WHO STEPS survey design, including sampling weights, primary sampling units, and strata. The study found an overall survey-weighted quit ratio of 31.1%, with substantial regional variation. Successful cessation was more common among older adults, women, and participants with tertiary education, while harmful alcohol use was associated with substantially lower odds of cessation. Diagnosed hypertension was associated with higher odds of cessation, whereas diabetes was not independently associated. After accounting for the complex survey design, there was no evidence of an overall pooled temporal association with cessation, although regional patterns differed. Within the African subset, higher tobacco-control policy-score categories were associated with higher odds of successful smoking cessation. Because the underlying WHO STEPS surveys are cross-sectional, the analyses identify associations rather than causal effects. The repository should therefore be used alongside the accompanying manuscript for interpretation of the study design, variable definitions, statistical methods, limitations, and findings. Keywords: smoking cessation; quit ratio; WHO STEPS; tobacco control; health inequalities; health equity; Levesque Access to Health Care framework; survey-weighted logistic regression; noncommunicable diseases; Africa; global health; reproducible research.