South Africa has a huge burden of tobacco use. Nearly 1 in 3 (29.4%) people in South Africa use tobacco.The Global Adult Tobacco Survey South Africa, released this week, shows that more than 1 in 5 (21.2%) of those 15 years and older say they smoke every day, 4.6% smoked occasionally.

The survey, which was released by the national health department this week, shows significant gender differences. It shows that 41.7% of  men and 17.9% of women use tobacco. Thirty-five percent of men smoked daily and 6.1% smoked occasionally; as opposed to 8.3% of women who smoked daily and 3.3% occasionally.  

The survey was conducted in 2021, in all nine provinces in the country. Screening was done at a household level, with interviews conducted with 6,424 households; and at an individual level with 6,311 people being interviewed. The preliminary results were first published in 2022. 

People who smoke every day say they smoke 8.5 cigarettes a day; 33.9% of those who smoke daily say they smoke within the first 5 minutes of waking up. 

On average, adults aged 20-34 say they started smoking at the age of 17.  

Tobacco use is the leading cause of preventable deaths. The World Health Organisation (WHO) estimates that it causes eight million deaths globally every year. Data for tobacco-related deaths in South Africa is scarce, but research estimates that 25,708 people between the ages of 35-74 died of smoking-related causes in 2016. Dr Catherine Egbe, one of the researchers who conducted the survey says this number is likely to be higher as smoking prevalence has increased. 

Health department deputy director general Jeanette Hunter says the survey is critical in guiding the government’s anti-tobacco policies and interventions.   

“In South Africa, we’ve seen that the threat extends to ‘new generation’ products, such as e-cigarettes,” says Hunter during the webinar launch of the report.  

E-cigarettes

The survey found that 36.1% of all adults had ever heard of electronic cigarettes, and 6.2% of adults had ever used them. A little over two percent were currently using e-cigarettes (3.8% of men and 0.7% of women).  

Among those currently using e-cigarettes: 41.8% used e-cigarettes containing nicotine,  27.9% didn’t know if the e-cigarette they used contained nicotine.  

Most (70.3%) of people who used e-cigarettes cited enjoyment; 67.5% like the flavours; 45.1% perceived e-cigarettes as being less harmful than tobacco; and 43.5% use e-cigarettes because of friends and family who use the product. 

A little over 3% of adults reported smoking hubbly bubbly,  among youth aged 17-24 it was 7.1%. The mean age of initiation for those who have ever smoked hubbly was 21.  For those aged 15 to 24, the average age of initiation is 17.3yrs (over 51% started between ages 18 and 24).  

“The use [of e-cigarettes and hubbly] is on the increase because these products are aggressively marketed as healthier alternatives to traditional cigarettes. But research shows they are not,” says Hunter.

Research shows that e-cigarettes are at least as harmful as conventional cigarettes. That’s why, says Hunter, they’ve been included in the Tobacco Products and Electronic Delivery Systems Bill which is before Parliament awaiting final approval. 

But activists are concerned about the delays in getting the Bill passed into law. The Bill was approved by the Cabinet in 2022.  

Speaking during the webinar launch of the report, Zanele Mthembu from the Campaign for Tobacco Free Kids says steps taken by the government are commendable. 

“We really hope to see the findings of this survey being used to support the introduction of the Bill,” she says. 

“We and all the partners in Protectournext will keep pushing to ensure that the Bill sees the light of day. And that it’s introduced in its current form, without tampering or being watered down.”   

Recommendations   

The researchers who conducted the tobacco survey made the following recommendations: 

• That the tobacco survey be conducted on a regular basis (every three to five years). This would allow the public health fraternity to track tobacco use and gauge the impact of tobacco control policies. 

• Effective Implementation of smoke-free laws to ensure that people who don’t smoke are not exposed to second-hand smoke. 

• Graphic or pictorial health warnings on cigarette and tobacco packaging. 

• Total and comprehensive bans on all forms of advertising at points of sale as proposed by the anti-tobacco Bill. 

• Consistent and annual increase of taxes on all tobacco and nicotine products. – Health-e News