Abstract
BackgroundWhile knowledge of onset of smoking tobacco, and associated risk factors can aid the formulation of evidence-based policy and interventions, such information is scarce in South Africa. We assessed age at onset of tobacco smoking in South Africa and identified its risk factors.MethodsWe analysed data of 15,316 respondents aged 15–98 years from the 2012 South African National Health and Nutrition Examination Survey. Descriptive statistics and survival analysis techniques were used alongside weighted percentages.ResultsOverall lifetime prevalence of smoking was 20.5%. Among the 3360 ever-smoked respondents, the overall median age at smoking onset was 18 years (Inter-quartile range (IQR) =5) with 2% starting before age 10 while 60% had smoked before age 20. Likelihood of tobacco smoking was higher among adolescents (<=20 years) and those aged 20–29 years than those aged > = 60 years, thrice higher among males, 29% higher among urban dwellers and thrice higher in Western Cape and Free State than in North West Province. The onset of tobacco smoking was earlier among males, wealthier and “coloured” people from Northern and Eastern Capes.ConclusionThe onset of tobacco smoking peaked at 15–22 years and varied by province, sex, location, race and other characteristics. The age restrictions on smoking in South Africa has changed over time, coupled with the recent open and electronic advertisement of tobacco, and social media could have influenced the earlier onset of tobacco smoking in South Africa. Stricter regulations on tobacco-related advertisement and sales should be implemented.
Highlights
While knowledge of onset of smoking tobacco, and associated risk factors can aid the formulation of evidence-based policy and interventions, such information is scarce in South Africa
The current study aims to gain an understanding of the age at onset of smoking, the cumulative risk of smoking, and the associated risk factors using a national sample of South African adults
We found that age at smoking onset in South Africa is reducing with most smokers starting at age 15–24 years
Summary
While knowledge of onset of smoking tobacco, and associated risk factors can aid the formulation of evidence-based policy and interventions, such information is scarce in South Africa. We assessed age at onset of tobacco smoking in South Africa and identified its risk factors. Research across the Fagbamigbe et al Archives of Public Health (2020) 78:128 globe has shown that the majority of adults initiated tobacco use before the age of 18 [7]. In developing countries, including South Africa, the average age of tobacco initiation was between 12 and 19 years [8,9,10,11]. If the age of smoking onset continues to decrease, tobacco use will result in the death of 250 million children and young people alive today, many of them in developing countries [15, 16]. A better understanding of the age of when people initiate smoking, as well as when they started smoking is essential to develop more effective prevention efforts and smoking cessation programs for those who are most at risk
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