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.