Africa Centre for Tobacco Industry Monitoring and Policy Research, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa.
S Afr Med J. 2024 Jun 24;114(6b):e1535. doi: 10.7196/SAMJ.2024.v114i16b.1535.
Trends data up to 2018 suggest that tobacco smoking was increasing in South Africa (SA), but only limited information is available on the impact of the COVID-19 pandemic on the current pattern of use of tobacco and nicotine products (TNPs).
To assess trends in sociodemographic patterns in the use of TNPs and the extent to which sociodemographic factors and non-cigarette tobacco use may explain possible changes in rates of TNP use between 2017/18 and 2021.
Data from three waves (2017, 2018 and 2021) of the South African Social Attitudes Survey (total N=8 140) were analysed. The sociodemographic correlates of current daily and non-daily use of factory-manufactured cigarettes (FMCs), roll-your-own (RYO) cigarettes, waterpipe/hubbly, electronic cigarettes (ECigs), snuff (a smokeless tobacco) and any combination of FMCs, RYO cigarettes and waterpipe/hubbly ('current smoking') in 2017/18 (pre-pandemic) were compared with those for 2021 (during the pandemic). Chi-square analyses and generalised linear models were used to compare the prevalence of TNP use between the two periods. A Blinda-Oaxaca decomposition analysis was also used to explore the roles of various sociodemographic factors, including any differences in the use of TNPs, that may explain any observed differences in smoking rates between 2017/18 and 2021.
Current smoking increased significantly from 22.4% (95% confidence interval (CI) 20.4 - 24.5) in 2017/18 to 27.6% (95% CI 24.3 - 31.1) in 2021 (p=0.009). Smoking of FMCs did not change significantly overall between these two periods (20.1% v. 22.1%; p=0.240), except for a significant increase among those who self-identified as black African and a decrease among those who self-identified as coloured and those currently employed. However, the use of waterpipe/hubbly, ECigs, RYO cigarettes and snuff increased significantly. Women, individuals aged <35 years and black Africans had the largest increase in waterpipe/hubbly and ECig use. A decomposition analysis showed that increased waterpipe/hubbly and RYO use explained 52% and 15%, respectively, of the increase in smoking rates, while lower employment during 2021 compared with 2017/18 explained 15% of the increase in smoking rates during 2021.
The use of all TNPs continued to increase in SA, particularly among women and unemployed people. These findings have policy and practice implications for addressing socioeconomic disparities in tobacco-related diseases.
截至 2018 年的趋势数据表明，南非的烟草吸烟率呈上升趋势，但关于 COVID-19 大流行对当前烟草和尼古丁产品（TNP）使用模式的影响，只有有限的信息。
评估 2017/18 年至 2021 年期间，TNP 使用的社会人口统计学模式趋势，以及社会人口统计学因素和非香烟烟草使用在多大程度上可以解释 TNP 使用率可能发生的变化。
对南非社会态度调查的三个波次（2017 年、2018 年和 2021 年）的数据进行了分析。比较了 2017/18 年（大流行前）和 2021 年（大流行期间）当前每日和非每日使用工厂制造香烟（FMCs）、自卷香烟（RYO）、水烟/水烟管、电子烟（ECigs）、鼻烟（一种无烟烟草）和 FMCs、RYO 香烟和水烟/水烟管的任何组合（“当前吸烟”）的社会人口统计学相关性。使用卡方分析和广义线性模型比较了这两个时期 TNP 使用的流行率。还使用 Blinda-Oaxaca 分解分析来探讨各种社会人口统计学因素的作用，包括 TNP 使用的任何差异，这些差异可能解释了 2017/18 年和 2021 年吸烟率的任何观察到的差异。
当前吸烟率从 2017/18 年的 22.4%（95%置信区间[CI] 20.4-24.5）显著增加到 2021 年的 27.6%（95% CI 24.3-31.1）（p=0.009）。这两个时期之间，FMCs 的吸烟率总体上没有显著变化（20.1% v. 22.1%；p=0.240），除了自认为是黑非洲人的人有显著增加，以及自认为是有色人种和目前就业的人的人有减少。然而，水烟/水烟管、电子烟、RYO 香烟和鼻烟的使用显著增加。女性、<35 岁的人以及黑非洲人水烟/水烟管和电子烟的使用增加幅度最大。分解分析表明，水烟/水烟管和 RYO 使用率的增加分别解释了吸烟率增加的 52%和 15%，而 2021 年的就业率低于 2017/18 年，这解释了 2021 年吸烟率增加的 15%。
南非所有 TNP 的使用继续增加，特别是在女性和失业人群中。这些发现对解决与烟草相关疾病的社会经济差异具有政策和实践意义。
