A comprehensive, health-promotion approach to tobacco control

Abstract

reported in this month’s SAMJ. The data sustaining the message were drawn from four Global Youth Tobacco Surveys (GYTSs) conducted among nationally representative samples of South African (SA) school learners during 1999, 2002, 2008, and 2011. The setting was public schools across the 9 provinces of SA, and the more than 7 000 learners in grades 8 - 10, aged 12 - 20 years. The percentage of learners who admitted to being current smokers (smoked a cigarette on at least one day in the 30 days preceding the survey) declined from 23% in 1999 to 16.9% in 2011 - a 26.5% reduction. Reductions in smoking prevalence, however, were less pronounced among girls and among ethnic black learners. These remarkable changes occurred during a time when smoking among young people was on the rise globally. At that time, also the SA Government, of which I was privileged to serve as Minister of Health from 1994 to 1999, was introducing a comprehensive set of health promotion measures to curb the harmful effects of tobacco use on health. [2-5] These included interventions at the ecological level such as legislation banning the advertising of tobacco products, classifying nicotine as an addictive drug, restricting smoking in public places, and increasing excise duties on cigarettes. In addition, there were interventions aimed at the individual such as school health education and improving health literacy, and changes in the national school curriculum declaring nicotine a drug of addiction. The GYTSs show that as well as a 26.5% decline in smoking prevalence among these adolescents over a 12-year period, changes in smoking-related attitudes and behaviours also occurred among these learners, reflecting what were profound socio-cultural shifts in attitudes to smoking in SA society at large during those years, resulting in sustained reductions of 54% in per capita cigarette consumption among adults during the same period. [6] Of concern, however, in the two GYTSs from 2008 to 2011, was an observed increase in smoking prevalence in learners, particularly notable in girls, who are known to be a principal target for the tobacco industry, which seeks to recruit adolescents into a lifetime of addiction to nicotine. These findings are important, as hitherto most nationally representative data on the impact of tobacco control measured over a period of more than a decade came from high-income countries (HIC). The tobacco industry, on the other hand, has targeted lowand middle-income countries (LAMICs) such as our own, where 80% of smokers now reside, as its target for market growth in tobacco consumption over the coming years. The GYTSs demonstrate that public health measures in tobacco control, using a health promotion approach, do work, and could be adopted by countries across the developing world in the setting of the Framework Convention on Tobacco Control (FCTC) for example, [7]