Sewpaul Ronel, Olivier Stephen, Ngubane Hloniphile, Zulu Thando, Sithole Mareca, Hanekom Willem A, Kruse Gina, Rigotti Nancy A, Siedner Mark J, Wong Emily B, Reddy Krishna P
Public Health, Societies and Belonging, Human Sciences Research Council, Cape Town, South Africa.
Africa Health Research Institute, KwaZulu-Natal, South Africa.
PLOS Glob Public Health. 2025 Feb 25;5(2):e0004126. doi: 10.1371/journal.pgph.0004126. eCollection 2025.
Tobacco smoking is increasing in many low-and-middle-income countries, but data about initiation and cessation patterns are sparse, particularly in rural areas. We investigated changes in smoking status and their determinants in rural South Africa. Participants enrolled in the Vukuzazi population cohort in rural KwaZulu-Natal, South Africa completed a baseline tobacco behavioural survey during 1 May 2018 to 31 March 2020. A follow-up survey was conducted during 4 May 2021 to 18 November 2022 among all participants aged ≥15 years who reported current and former smoking at baseline (to detect cessation and relapse) and in a random selection of participants aged 15-29 years who reported never smoking at baseline (to detect initiation). We fit regression models to estimate smoking initiation (from never to current or former smoking), cessation (from current to former smoking) and relapse (from former to current smoking) between baseline and follow-up, and to investigate the sociodemographic and behavioural variables associated with each outcome. Of those recruited, 52% (754/1448) participated in the follow-up survey, which occurred a median of 3.0 years (IQR: 2.6-3.2) from baseline. Initiation, cessation and relapse occurrence was 12.0% (95% CI: 8.4-16.8), 12.9% (95% CI: 10.0-16.5) and 10.9% (95% CI: 4.4-24.2), respectively. Males had significantly higher odds of initiation than females (adjusted odds ratio [AOR] 12.81, 95% confidence interval [CI]: 3.54-46.36). Moderate/heavy smoking (≥10 products per day; AOR 0.27, 95% CI: 0.08-0.93 relative to light smoking <10 products per day) and middle socioeconomic status (AOR 0.37, 95% CI: 0.15-0.89 relative to low socioeconomic status) were associated with lower odds of cessation. No covariates were significantly associated with relapse. In conclusion, most people retained their smoking status over approximately three years in rural South Africa. Fewer than one in eight smokers quit. Prevention interventions are needed to address high initiation among young males. People who smoke moderately or heavily and people with middle socioeconomic status may benefit from targeted cessation interventions.
在许多低收入和中等收入国家，吸烟人数正在增加，但关于开始吸烟和戒烟模式的数据却很稀少，尤其是在农村地区。我们调查了南非农村地区吸烟状况的变化及其决定因素。参与南非夸祖鲁 - 纳塔尔农村地区Vukuzazi人群队列研究的参与者在2018年5月1日至2020年3月31日期间完成了一项基线烟草行为调查。在2021年5月4日至2022年11月18日期间，对所有在基线时报告当前吸烟和曾经吸烟的≥15岁参与者（以检测戒烟和复吸情况）以及随机抽取的在基线时报告从不吸烟的15 - 29岁参与者（以检测开始吸烟情况）进行了随访调查。我们拟合回归模型来估计基线和随访之间的开始吸烟（从不吸烟到当前或曾经吸烟）、戒烟（从当前吸烟到曾经吸烟）和复吸（从曾经吸烟到当前吸烟）情况，并调查与每个结果相关的社会人口统计学和行为变量。在招募的人员中，52%（754/1448）参与了随访调查，随访调查距离基线的中位时间为3.0年（四分位间距：2.6 - 3.2年）。开始吸烟、戒烟和复吸的发生率分别为12.0%（95%置信区间：8.4 - 16.8）、12.9%（95%置信区间：10.0 - 16.5）和10.9%（95%置信区间：4.4 - 24.2）。男性开始吸烟的几率显著高于女性（调整后的优势比[AOR]为12.81，95%置信区间[CI]：3.54 - 46.36）。中度/重度吸烟（每天≥10支烟；相对于轻度吸烟<每天10支烟，AOR为0.27，95%置信区间：0.08 - 0.93）和中等社会经济地位（相对于低社会经济地位，AOR为0.37，95%置信区间：0.15 - 0.89）与较低的戒烟几率相关。没有协变量与复吸显著相关。总之，在南非农村地区，大多数人在大约三年时间里保持了他们的吸烟状态。每八名吸烟者中戒烟的不到一人。需要采取预防干预措施来解决年轻男性中吸烟率高的问题。中度或重度吸烟者以及中等社会经济地位的人可能会从有针对性的戒烟干预措施中受益。
