Trends in adult tobacco use from two South African demographic and health surveys conducted in 1998 and 2003

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South African Medical Journal

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University of Cape Town

Introduction: Since tobacco use peaked in the early 1990s in South Africa, it has declined significantly. This reduction has been attributed to the government’s comprehensive tobacco control policies that were introduced in the 1990s. Objective: To assess the pattern of tobacco use between the South African Demographic and Health Surveys in 1998 and 2003. Methods: Multi-stage sampling was used to select approximately 11 000 households in cross-sectional national surveys. Face-to-face interviews, conducted with 13 826 adults (41% men) aged ≥15 years in 1998 and 8 115 (42% men) in 2003, included questions on tobacco use according to the WHO STEP-wise surveillance programme. Logistic regression analysis was used to assess the independent effects of selected characteristics on smoking prevalence. Results: Daily or occasional smoking prevalence among women remained unchanged at 10-11%; among men it decreased from 42% (1998) to 35% (2003). The decline for men was significant among the poorest and those aged 25-44 years. Strong age patterns were observed, peaking at 35-44 years, which was reduced for men in 2003. Higher income and education were associated with low prevalence of smoking while living in urban areas was associated with higher rates. African men and women smoked significantly less than other population groups. Conclusion: Despite decreasing smoking rates in some subgroups, a gap exists in the efforts to reduce tobacco use as smoking rates have remained unchanged in women and young adults, aged 15-24 years.