Smoking In South Africa Research Articles

The Effects of Inequality on the Substitution of Essential Goods for Tobacco Smoking in South Africa

Tobacco consumption contributes to a substantial amount of household expenditures, which might lead to decreased spending on other essentials. This study examines household head tobacco expenditures in various inequality settings. In this study, we investigated the impact of gender, race, and educational inequality and the substitution effect of tobacco expenditure on essentials such as children’s education and household food. We looked at how much of the resources household heads spend on tobacco in different inequality settings that replace households’ essentials. The panel setting of the National Income Dynamics Study (NIDS), South Africa’s first nationally representative household panel survey, is used as a data collection source for this study. These are household surveys conducted by the Presidency’s Office of Planning, Monitoring, and Evaluation. The panel data are subject to attrition in longitudinal research. We compared the conditional expenditure shares of various types of households using econometric models such as moment quantile regression. A negative and statistically significant estimated coefficient of tobacco expenditure and the coefficient of the interacted term (inequality and tobacco expenditure) demonstrated the substitution effect. The findings reveal that low-income households whose heads smoke tobacco invest less in their children’s education, while well-educated heads of high-income households’ place as much value on their children’s education as they do on cigarette expenditure. The study also points out that the share of income spent on cigarettes by black household heads is negatively connected to their children’s education across all quantiles compared to non-blacks. We conclude that low-income households are more likely to experience the substitution impact than high-income households. This study recommends, among other things, that low-income households should prioritize needs over non-essentials in order to maximize household satisfaction, and government should implement policies that will limit tobacco consumption expenditure.

Estimating the changing disease burden attributable to smoking in South Africa for 2000, 2006 and 2012.

Ongoing quantification of the disease burden attributable to smoking is important to monitor and strengthen tobacco control policies. To estimate the attributable burden due to smoking in South Africa for 2000, 2006 and 2012. We estimated attributable burden due to smoking for selected causes of death in South African (SA) adults aged ≥35 years for 2000, 2006 and 2012. We combined smoking prevalence results from 15 national surveys (1998 - 2017) and smoking impact ratios using national mortality rates. Relative risks between smoking and select causes of death were derived from local and international data. Smoking prevalence declined from 25.0% in 1998 (40.5% in males, 10.9% in females) to 19.4% in 2012 (31.9% in males, 7.9% in females), but plateaued after 2010. In 2012 tobacco smoking caused an estimated 31 078 deaths (23 444 in males and 7 634 in females), accounting for 6.9% of total deaths of all ages (17.3% of deaths in adults aged ≥35 years), a 10.5% decline overall since 2000 (7% in males; 18% in females). Age-standardised mortality rates (and disability-adjusted life years (DALYs)) similarly declined in all population groups but remained high in the coloured population. Chronic obstructive pulmonary disease accounted for most tobacco-attributed deaths (6 373), followed by lung cancer (4 923), ischaemic heart disease (4 216), tuberculosis (2 326) and lower respiratory infections (1 950). The distribution of major causes of smoking-attributable deaths shows a middle- to high-income pattern in whites and Asians, and a middle- to low-income pattern in coloureds and black Africans. The role of infectious lung disease (TB and LRIs) has been underappreciated. These diseases comprised 21.0% of deaths among black Africans compared with only 4.3% among whites. It is concerning that smoking rates have plateaued since 2010. The gains achieved in reducing smoking prevalence in SA have been eroded since 2010. An increase in excise taxes is the most effective measure for reducing smoking prevalence. The advent of serious respiratory pandemics such as COVID-19 has increased the urgency of considering the role that smoking cessation/abstinence can play in the prevention of, and post-hospital recovery from, any condition.

When people do not 'Zol': Reduced emergency centre attendance of patients with chronic obstructive pulmonary disease during coronavirus disease 2019 lockdown with the accompanying tobacco sales ban in South Africa.

The coronavirus disease 2019 (COVID-19) pandemic has spread throughout the world, with devastating effects of the virus as well as the repercussions of the resulting ‘lockdowns’. South Africa went into a national lockdown in March 2020 to mitigate the impact of the virus. This included a ban on the sales of tobacco and electronic cigarette products. The ban has been a highly contentious issue in South Africa, discussed worldwide, which has drawn many criticisms. The prevalence rate of smoking in South Africa was around 21.5%, with the Western Cape province having a prevalence rate of 39%. We compared the number of chronic obstructive pulmonary disease (COPD) presentations at a large regional referral hospital in the Western Cape province from January to August 2019 with the same period in 2020. Electronic emergency centre data showed a reduction of 69.28% in COPD presentations. To control for some confounders for the same period, we also reviewed patients presenting with urinary tract infections, which showed only a 30.60% reduction. This notable reduction in COPD presentations reduced service pressure of emergency centre and most likely benefitted patients’ health. Further research and policies are needed to ensure ongoing reduction in the prevalence of smoking.

Age at the onset of tobacco smoking in South Africa: a discrete-time survival analysis of the prognostic factors

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.

The Economic Cost of Smoking in South Africa, 2016.

Chronic, noncommunicable diseases are on the rise globally, with tobacco consumption being an important contributing risk factor. These increases result in significant economic costs due to increased healthcare costs, productive lives lost, and productive days lost due to illness. Estimates of these economic costs are scarce in low- and middle-income countries. Drawing on a diverse range of data sources, direct healthcare costs, and productivity losses due to illness and premature deaths were estimated using the cost-of-illness approach. The present value of lifetime earnings was used to estimate productivity losses from premature deaths. We estimate that 25 708 deaths among persons aged 35-74 in 2016 are smoking-attributable. The economic cost of smoking was R42 billion (US$2.88 billion), of which R14.48 billion was for healthcare costs (hospitalization and outpatient department visits). The economic cost of smoking amounted to 0.97% of the South African GDP in 2016, while the healthcare cost of smoking-related diseases was 4.1% of total South African health expenditure. The costs are lower for women because of their lower smoking prevalence. The economic burden of smoking calls for a further scaling-up of tobacco-control interventions in South Africa. This article addresses the paucity of research on the detailed economic costs of smoking in low-and middle-income countries, including South Africa. Our calculations, based on an extensive range of recent data, provide the most detailed estimate to date and include quantification of the direct and indirect costs of smoking in South Africa. We found that the magnitude of the costs related to smoking in South Africa is larger than in the previous estimates and that for every Rand received in the form of cigarette tax, society loses 3.43 Rands. This article provides an economic case for evidence-based tobacco control in South Africa.

Tuberculosis remains the leading cause of death attributed to smoking in South Africa: results from the South African death certificate study

Tuberculosis remains the leading cause of death attributed to smoking in South Africa: results from the South African death certificate study

Addressing tobacco smoking in South Africa: Insights from behavioural science.

Behavioural risk factors such as tobacco smoking contribute significantly to the global and local disease burden. This article surveys three behavioural science interventions that could reduce rates of tobacco smoking in South Africa.

Waterpipe and Cigarette Smoking among University Students in the Western Cape, South Africa.

Cigarette smoking in South Africa decreased sharply since the early 1990s. Waterpipe smoking increased, especially among students. We estimate the prevalence of waterpipe and cigarette smoking and associated characteristics among university students in the Western Cape. An anonymous self-administered online questionnaire was sent to all registered students at 4 public Western Cape universities. The 4578 valid responses were weighted to represent the Western Cape's university student population. We present descriptive statistics and logistic regressions. We found that 63% of Western Cape university students ever smoked waterpipe, 9.9% of students smoked waterpipe in the past 30 days and 17.7% of students smoked cigarettes in the past 30 days. Waterpipe smoking has a strong socialization aspect. Controlling for confounders, current waterpipe smoking is associated with alcohol consumption (positively), age (negatively), population group (mixed-race and Indian students smoke more), religion (Muslims smoke more), faculty (medical students smoke less), and spending money (positively). Current cigarette smoking is associated with similar covariates, but not with age. Waterpipe smoking in the Western Cape is widespread, but less than cigarette smoking. Because all tobacco products are harmful, the government has an obligation to impose appropriate regulatory measures to reduce waterpipe consumption.

Intention to switch to smokeless tobacco use among South African smokers: results from the 2007 South African Social Attitudes Survey.

BackgroundSome smokeless tobacco products (SLT) have been shown to be associated with only a fraction of the risks of cigarettes. This study assessed South African smokers’ interest in switching to a hypothetical reduced harm SLT product.MethodsThe 2007 South African Social Attitudes Survey was analysed for 678 exclusive cigarette smokers. Respondents were asked about their perceptions about relative harm of snuff compared to cigarettes, and their interest in switching to snuff if informed it was 99% less harmful than cigarettes.ResultsAbout 49.7% of exclusive cigarette smokers believed that snuff was equally as harmful as cigarettes; 12.9% thought snuff was more harmful; 5.7% thought snuff was less harmful; while 31.8% did not know if there was a difference in harm between snuff and cigarettes. Approximately 24.2% of exclusive cigarette smokers indicated interest in switching to snuff, with significantly greater interest observed among those exposed to 100% smoke-free work environment. Interest in switching was highest (34.7%) among smokers who believed a priori that using snuff was more harmful than cigarettes, and lowest (14.5%) among those who did not know if there was a difference in harm. In a multi-variable adjusted logistic regression model, this latter group remained less likely to be interested in harm reduction switching (adjusted odds ratio = 0.42; 95% CI: 0.19–0.91).ConclusionAbout a quarter of smokers indicated interest in harm reduction switching to snuff. SLT products have a potential role in reducing the harm from smoking in South Africa, but only if they are not used to circumvent smoke-free laws that have been associated with reduced smoking.

‘Roll-your-own’ cigarette smoking in South Africa between 2007 and 2010

BackgroundThe prevalence of smoking and consumption of cigarettes have decreased in South Africa over the last 20 years. This decrease is a result of comprehensive tobacco control legislation, particularly large cigarette tax increases. However, little attention has been given to the potential use of ‘roll-your-own’ cigarettes as cheaper alternatives, especially among the socio-economically disadvantaged population. This study therefore sought to determine socio-demographic correlates of ‘roll-your-own’ cigarette use among South African adults (2007–2010).MethodsThis secondary data analysis used a merged dataset from two nationally representative samples of 2 907 and 3 112 South African adults (aged ≥16 years) who participated in the 2007 and 2010 annual South African Social Attitude Surveys respectively. The surveys used a face-to-face interviewer-administered questionnaire. The overall response rates were 83.1% for 2007 and 88.9% for 2010. Data elicited included socio-demographic data, current smoking status, type of tobacco products used, past quit attempts and self-efficacy in quitting. Data analysis included chi-square statistics and multi-variable adjusted logistic regression analysis.ResultsOf the 1 296 current smokers in this study, 24.1% (n = 306) reported using roll-your-own cigarettes. Some of whom also smoked factory-made cigarettes. Roll-your-own cigarette smoking was most common among black Africans and was more common among male smokers than among female smokers (27% vs 15.8%; p < 0.01). Compared to smokers who exclusively used factory-made cigarettes, roll-your-own cigarette smokers were less confident that they could quit, more likely to be less educated, and more likely to reside in rural areas. The odds of use of roll-your-own cigarette were significantly higher in 2010 than in 2007 (OR = 1.24; 95% CI: 1.07-1.44).ConclusionsDespite an aggregate decline in smoking prevalence, roll-your-own cigarette smoking has increased and is particularly common among smokers in the lower socio-economic group. The findings also suggest the need for a more intensive treatment intervention to increase self-efficacy to quit among roll-your-own cigarette smokers.

Lung cancer mortality in Sub-Saharan Africa

GLOBOCAN 2008 is an important resource for cancerresearch and health policy. Mortality and incidence estimatesof crude rates, age-standardized rates and absolute number ofcases by country and sex for the year 2008 are provided. Weagree with their conclusion that ‘‘Already the majority of theglobal cancer burden now occurs in developing countries,these proportions will rise in the next decades if rates remainunchanged.’’ Given the demographic transition that isongoing in developing countries, the absolute numbers willalmost certainly rise in the future.In Sub-Saharan Africa (SSA), population-based data onlung cancer incidence or mortality are not available, exceptSouth Africa and smaller island states. GLOBOCAN uses

Smoking in South Africa

Smoking in South Africa

Association of snuff use with chronic bronchitis among South African women: implications for tobacco harm reduction

Objective:Nasal use of snuff is the predominant form of tobacco use among black South African women. This study examines the association between snuff use and chronic bronchitis (CB) among black...

Tobacco Use Trends among Adolescents and Adults in South Africa

The purpose of this review is to synthesize the national prevalence data from eight surveys on tobacco use in South Africa over the past 13 years. Results from the national studies indicate that tobacco use among adults is on the decline in South Africa. The same applies to daily smoking and daily smokeless tobacco use among adolescents. However, onset of tobacco use and the prevalence of current smoking among adolescents seem not to have changed over the years. While exposure to tobacco smoke outside the home decreased from 56.5% in 1999 to 36.2% in 2002 among adolescents, exposure to tobacco smoke inside the home increased from 41.7% in 1999 to 73.3% in 2002. This change may be attributed to the introduction of the tobacco control act that from 2000 banned smoking in public places. The decline of overall daily smoking in South Africa may be attributed to the tobacco control strategy based on 1) rapidly increasing excise taxes on tobacco, and (2) comprehensive legislation, of which the most important features are banning all tobacco advertising and sponsorship, and prohibition of smoking in public and work places.

Estimating the burden of disease attributable to smoking in South Africa in 2000.

To quantify the burden of disease attributable to smoking in South Africa for 2000. The absolute difference between observed lung cancer death rate and the level in non-smokers, adjusted for occupational and indoor exposure to lung carcinogens, was used to estimate the proportion of lung cancer deaths attributable to smoking and the smoking impact ratio (SIR). The SIR was substituted for smoking prevalence in the attributable fraction formula for chronic obstructive pulmonary disease (COPD) and cancers to allow for the long lag between exposure and outcome. Assuming a shorter lag between exposure and disease, the current prevalence of smoking was used to estimate the population-attributable fractions (PAF) for the other outcomes. Relative risks (RR) from the American Cancer Society cancer prevention study (CPS-II) were used to calculate PAF. South Africa. Deaths and disability-adjusted life years (DALYs) due to lung and other cancers, COPD, cardiovascular conditions, respiratory tuberculosis, and other respiratory and medical conditions. Smoking caused between 41,632 and 46,656 deaths in South Africa, accounting for 8.0 - 9.0% of deaths and 3.7 - 4.3% of DALYs in 2000. Smoking ranked third (after unsafe sex/ sexually transmitted disease and high blood pressure) in terms of mortality among 17 risk factors evaluated. Three times as many males as females died from smoking. Lung cancer had the largest attributable fraction due to smoking. However, cardiovascular diseases accounted for the largest proportion of deaths attributed to smoking. Cigarette smoking accounts for a large burden of preventable disease in South Africa. While the government has taken bold legislative action to discourage tobacco use since 1994, it still remains a major public health priority.

Tobacco use in South Africans during 1998: the first demographic and health survey.

To determine smoking patterns in South Africa, and to identify groups requiring culturally appropriate smoking cessation programmes. A random sample of 13,826 people (> 15 years), was interviewed to identify tobacco use patterns and respiratory symptoms. Peak expiratory flow rates were measured. Multinomial regression analyses identified sociodemographic factors related to tobacco use, and the latter's association with respiratory conditions. In 1998, 24.6% adults (44.2% of males and 11.0% of females) smoked regularly. Coloured women had a higher rate (39%) than African women (5.4%). About 24% of the regular smokers had attempted to quit, with only 9.9% succeeding. African women (13.2%) used smokeless tobacco more frequently than others. Of the nonsmokers 28% and 19% were exposed to environmental tobacco smoke in their homes and workplaces, respectively. The regression analysis showed that the demographic characteristics of light smokers (1-14 tobacco equivalents per day) and heavy smokers (> or = 15 tobacco equivalents per day) differed. Light smoking occurred significantly more frequently in the poorest, least educated and urban people. The relative risk for light smoking was 18 in Coloured women compared with African women. Heavy smoking occurred most frequently in the highest educated group. A dose-response was observed between the amount smoked and the presence of respiratory diseases. Smoking in South Africa is decreasing and should continue with the recently passed tobacco control legislation. Culturally appropriate tobacco cessation programmes for the identified target groups need to be developed.

Smoking in South Africa: the health and economic impact

Correspondence to: Dr Yach. Abstract Objective -To describe the health and economic impact of tobacco in South Africa and to indicate current prevention activities. Methods Routinely available mortality statistics, hospital discharge data, and prevalence data from the private and public sectors were collated and analysed. Results -In 1988 deaths from smoking related diseases in South Africa accounted for 33 7 % of white, 25 8 % of Asian, 16-6% of coloured (mixed race), and 5-4% of African deaths. The per centage of all potential years of life lost (35 to 64 years) owing to deaths from smoking-related diseases between 1968 and 1988 declined among white and Asian men but increased among other groups. The overall smoking rate in 1989-90 in people over 16 years of age was 31%. Smoking rates among African and coloured men were particularly high; rates among African and Asian women were particularly low; rates for all races were lowest among those with a uni versity education. When the 1976 smoking rates were applied to the 1990 base popu lation, there were 320000 more African smokers, 80000 more coloured smokers, 40000 more Asian smokers, and 270000 fewer white smokers. Increases were related to the unopposed impact of aggressive tobacco company marketing among susceptible groups. Advertisers targeted cinemas, billboards, and the radio. The total economic cost of smoking-related diseases was estimated to be between 1390 billion and 2453 billion rands in 1988 ($1 is about 25 rands). Conclusion As South Africa undergoes further sociopolitical change, compre hensive tobacco prevention programmes are needed to ensure that gains made in reducing infectious diseases are not eclipsed by the costs of increasing smoking-related disease.