Cigarette Smoking Trends and Social Disparities Among South African Adults, 2003–2011

Ayo‐Yusuf, Olalekan A.; Olutola, Bukola Ganiyat; Agaku, Israel

doi:10.1093/ntr/ntu264

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…First, we did not examine the interaction between the SES indicators and tobacco control policy variables that can potentially influence the socio-economic gradient of quitting probability. For example, an increase in the cost of purchasing tobacco products driven by higher tax and price is more likely to trigger quitting among low-SES smokers [64, 65]. We also did not examine relevant smoking-related variables as mediators of the association between SES indicators and quitting behaviour, something that should be considered in future studies.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys

et al. 2019

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Introduction Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs. Methods Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008–2011) and the International Tobacco Control Surveys (2009–2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country. Results Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR≈0.8, p<0.10). Conclusion Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys

et al. 2019

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“…When stratified by education and income, smoking is more prevalent among people with lower levels of income and educational attainment [ 18 , 42 , 62 – 65 ]. However, a positive gradient in smoking has been found among women in South Africa, especially among highly educated women [ 66 ]. These variations in smoking behaviour in different countries and settings could be attributed to the stages of cigarette epidemic, cultural influences or the effectiveness of domestic tobacco control policies and strategies [ 62 , 66 – 68 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, a positive gradient in smoking has been found among women in South Africa, especially among highly educated women [ 66 ]. These variations in smoking behaviour in different countries and settings could be attributed to the stages of cigarette epidemic, cultural influences or the effectiveness of domestic tobacco control policies and strategies [ 62 , 66 – 68 ]. In recent years smoking rates have declined or even remained relatively constant in many high-income countries.…”

Section: Discussionmentioning

confidence: 99%

Inequalities in health and health risk factors in the Southern African Development Community: evidence from World Health Surveys

Umuhoza

Ataguba

2018

Int J Equity Health

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BackgroundSocioeconomic inequalities in health have been documented in many countries including those in the Southern African Development Community (SADC). However, a comprehensive assessment of health inequalities and inequalities in the distribution of health risk factors is scarce. This study specifically investigates inequalities both in poor self-assessed health (SAH) and in the distribution of selected risk factors of ill-health among the adult populations in six SADC countries.MethodsData come from the 2002/04 World Health Survey (WHS) using six SADC countries (Malawi, Mauritius, South Africa, Swaziland, Zambia and Zimbabwe) where the WHS was conducted. Poor SAH is reporting bad or very bad health status. Risk factors such as smoking, heavy drinking, low fruit and vegetable consumption and physical inactivity were considered. Other environmental factors were also considered. Socioeconomic status was assessed using household expenditures. Standardised and normalised concentration indices (CIs) were used to assess socioeconomic inequalities. A positive (negative) concentration index means a pro-rich (pro-poor) distribution where the variable is reported more among the rich (poor).ResultsGenerally, a pro-poor socioeconomic inequality exists in poor SAH in the six countries. However, this is only significant for South Africa (CI = − 0.0573; p < 0.05), and marginally significant for Zambia (CI = − 0.0341; P < 0.1) and Zimbabwe (CI = − 0.0357; p < 0.1). Smoking and inadequate fruit and vegetable consumption were significantly concentrated among the poor. Similarly, the use of biomass energy, unimproved water and sanitation were significantly concentrated among the poor. However, inequalities in heavy drinking and physical inactivity are mixed. Overall, a positive relationship exists between inequalities in ill-health and inequalities in risk factors of ill-health.ConclusionThere is a need for concerted efforts to tackle the significant socioeconomic inequalities in ill-health and health risk factors in the region. Because some of the determinants of ill-health lie outside the health sector, inter-sectoral action is required.

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“…Differential patterns of smoking between sexes have been postulated to explain up to one third of the sex differences seen in global TB epidemiology [ 15 ]. While smoking is still twice as common in South African men than women, the only group with an increasing smoking prevalence are young, educated (>grade 12) women in the setting of urbanisation [ 16 ]. These patterns of alcohol and smoking use may well be contributing to the narrowing of the sex gap in local TB epidemiology.…”

Section: Discussionmentioning

confidence: 99%

TB epidemiology: where are the young women? Know your tuberculosis epidemic, know your response

2018

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BackgroundThe global predominance of tuberculosis in men has received significant attention. However, epidemiological studies now demonstrate that there is an increased representation of young women with tuberculosis, especially in high HIV burden settings where young women bear a disproportionate burden of HIV. The role of the HIV epidemic, as well as changes in behavioural, biological, and structural risk factors are explored as potential explanations for the increasing burden of tuberculosis in young women.DiscussionAs young women are particularly vulnerable to HIV infection in sub-Saharan Africa, it is unsurprising that the TB epidemic in this setting has become increasingly feminised. This age-sex trend of TB in South Africa is similar to WHO estimates for other countries with a high HIV prevalence where there are more female than male cases notified up to the age of 25 years. The high prevalence of anaemia of chronic disease in young women with HIV is an additional potential reason for their increased TB risk. The widespread use of injectable medroxyprogesterone acetate contraception, which has been shown to possess selective glucocorticoid effect and oestrogen suppression, in young women may be an important emerging biological risk factor for tuberculosis in young women. Behavioural factors such as alcohol use and tobacco smoking patterns are further factors which may be responsible for the narrowing of the sex gap in TB epidemiology. In comparison to the significantly higher alcohol consumption rates in men globally, there is a narrowing gap in alcohol consumption between the sexes in South Africa with alarming rates of alcohol abuse in young women. There is a similar narrowing of the tobacco smoking gap between the sexes in South Africa, with increasing smoking prevalence in young women.ConclusionWith nearly 70% of all TB patients being co-infected with HIV in our setting, it is not surprising that the age and sex distribution of TB is increasingly resembling the distribution of HIV in this region of dual hyperendemicity. New TB service design must begin to reflect the presence of young women as a significant group burdened by the disease.

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Cigarette Smoking Trends and Social Disparities Among South African Adults, 2003–2011

Cited by 8 publications

References 18 publications

Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys

Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys

Inequalities in health and health risk factors in the Southern African Development Community: evidence from World Health Surveys

TB epidemiology: where are the young women? Know your tuberculosis epidemic, know your response

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