COVID-19 and a temporary ban on tobacco sales in South Africa: impact on smoking cessation.

OBJECTIVE: To evaluate the impact of COVID-19 plus a temporary ban on the sale of tobacco and vaping products, on smoking cessation in South Africa, by reviewing research surveys conducted while the prohibition was in place. METHOD: An internet search was conducted on 20 August 2020, using the key words: 'South Africa', 'survey', 'poll', 'smoking', 'cigarettes', 'tobacco", 'vaping', and 'COVID-19'. There were no language restrictions. Additional studies were identified through press reports. Only studies conducted between March and August 2020 were included. RESULTS: Four surveys which reported on smokers quitting behaviour were included. None had been published in a peer reviewed journal. The heterogeneity of the data did not allow pooling. Support for the ban on tobacco sales amongst smokers varied from 6% to 36%. Similarly, there were inconsistent findings about quitting behaviour. Nationally, between 16% to 49% of smokers reported not smoking during the ban. CONCLUSIONS: Cigarette smoking in SA dropped during the 2020 COVID-19 lockdown, but the estimates were inconsistent, probably because of survey design. There was evidence that the lockdown achieved the fastest rate of decline in smoking prevalence in the country's history. The true extent of the fall though is uncertain. Prevalence studies post lockdown, using probability sampling, may more accurately show how many people quit smoking.

Estimating the burden of disease attributable to smoking in South Africa in 2000.

OBJECTIVES: To quantify the burden of disease attributable to smoking in South Africa for 2000. DESIGN: The absolute difference between observed lung cancer death rate and the level in non-smokers, adjusted for occupational and indoor exposure to lung carcinogens, was used to estimate the proportion of lung cancer deaths attributable to smoking and the smoking impact ratio (SIR). The SIR was substituted for smoking prevalence in the attributable fraction formula for chronic obstructive pulmonary disease (COPD) and cancers to allow for the long lag between exposure and outcome. Assuming a shorter lag between exposure and disease, the current prevalence of smoking was used to estimate the population-attributable fractions (PAF) for the other outcomes. Relative risks (RR) from the American Cancer Society cancer prevention study (CPS-II) were used to calculate PAF. SETTING: South Africa. OUTCOME MEASURES: Deaths and disability-adjusted life years (DALYs) due to lung and other cancers, COPD, cardiovascular conditions, respiratory tuberculosis, and other respiratory and medical conditions. RESULTS: Smoking caused between 41,632 and 46,656 deaths in South Africa, accounting for 8.0 - 9.0% of deaths and 3.7 - 4.3% of DALYs in 2000. Smoking ranked third (after unsafe sex/ sexually transmitted disease and high blood pressure) in terms of mortality among 17 risk factors evaluated. Three times as many males as females died from smoking. Lung cancer had the largest attributable fraction due to smoking. However, cardiovascular diseases accounted for the largest proportion of deaths attributed to smoking. CONCLUSION: Cigarette smoking accounts for a large burden of preventable disease in South Africa. While the government has taken bold legislative action to discourage tobacco use since 1994, it still remains a major public health priority.

The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study.

This article describes the patterns and effects of maternal snuff use, cigarette smoking and exposure to environmental tobacco smoke during pregnancy on birthweight and gestational age, in women living in Johannesburg and Soweto in 1990. A cohort of 1593 women with singleton live births provided information about their own and household members' usage of tobacco products during pregnancy. The women completed a questionnaire while attending antenatal services. Data on gestational age and birthweight were obtained from birth records. Women who smoked cigarettes or used snuff during pregnancy accounted for 6.1% and 7.5% of the study population respectively. The mean birthweight of non-tobacco users was 3148 g [95% CI 3123, 3173] and that of the smokers 2982 g [95% CI 2875, 3090], resulting in a significantly lower mean birthweight of 165 g for babies of smoking mothers (P = 0.005). In contrast, women using snuff gave birth to infants with a mean birthweight of 3118 g [95% CI 3043, 3192], which is a non-significant (P = 0.52) decrease (29.4 g) in their infants' birthweights compared with those not using tobacco. A linear regression analysis identified short gestational age, female infant, a mother without hypertension during pregnancy, coloured (mixed racial ancestry), and Asian infants compared with black infants, lower parity, less than 12 years of education and smoking cigarettes as significant predictors of low birthweight, while the use of snuff during pregnancy was not associated with low birthweight. The snuff users, however, had a significant shorter gestational age than the other two groups of women. The birthweight reduction adjusted for possible confounders was 137 g [95% CI 26.6, 247.3 (P = 0.015)] for cigarette smokers and 17.1 g [95% CI -69.5, -102.7, P = 0.69] for snuff users respectively, compared with the birthweight of non-tobacco users. Among women who did not smoke cigarettes or use snuff, exposure to environmental tobacco smoke did not result in significant effects on the birthweight of their infants. In conclusion, infants of cigarette smokers had significantly lower birthweights than those of non-tobacco users or snuff users who are exposed to nicotine during pregnancy. Passive smoking did not affect birthweight significantly in this population.

Psychologists and tobacco: attitudes to cessation counseling and patterns of use.

BACKGROUND: Psychologists can play an important role in helping their clients stop using tobacco. The extent to which they do so, or quit themselves, has not been reported previously. The utility of snus in reducing smoking prevalence is also questioned and merits study. METHOD: A 36-item self-completion questionnaire was mailed to a random sample of 1000 Swedish psychologists. RESULTS: The response rate was 85%. Very few psychologists (1%) 'often' helped clients to stop using tobacco. While a majority (72%) believed that quitting tobacco use would improve their client's quality of life, most (75%) thought that it was not their responsibility to help clients stop and 74% felt they lacked the necessary skills. About 8% of psychologists smoked cigarettes daily. Use of snus as an aid to cigarette cessation was common in men, but not women, although overall, the percentage of smokers who had quit smoking (72%) did not differ by gender. CONCLUSIONS: Most Swedish psychologists have stopped smoking, but very few help their clients to quit. Targeted campaigns aimed at encouraging and supporting psychologists to treat nicotine dependence are needed. This could increase cessation rates in the population. Snus helped reduce smoking prevalence among men and is a potentially useful harm reduction tool.

[Fatal deception: the tobacco industry's "new" world standards for tobacco marketing]. / Engaño mortal: las "nuevas" normas mundiales de la industria tabacalera para la comercialización del tabaco.

Being increasingly threatened by the worldwide antismoking struggle, the major tobacco companies are eager to improve their public image. This leads the companies to adopt inconsequential "measures" such as the tobacco industry's "new" standards for tobacco marketing that were "voluntarily" issued in September 2001 by the British American Tobacco company. These measures are clearly attempts to reduce the disapproval generated by the companies' promotion and advertising campaigns, which indirectly target young people. With these standards the tobacco companies supposedly commit themselves, among other things, to not using advertising directed at youth and to not selling or distributing tobacco products in places frequented by young people. This document explains why these measures are completely ineffective, are not anything new, and are a subtle effort to feign a conscientious, responsible attitude, which is far from genuine. As long as there are marketing activities directed at adults, young people will be exposed to the influence of those activities. Many countries have completely prohibited the marketing of tobacco products, given that the "new" marketing standards do not represent progress in any way whatsoever.

Tobacco use in South Africans during 1998: the first demographic and health survey.

OBJECTIVE: To determine smoking patterns in South Africa, and to identify groups requiring culturally appropriate smoking cessation programmes. METHODS: A random sample of 13,826 people (> 15 years), was interviewed to identify tobacco use patterns and respiratory symptoms. Peak expiratory flow rates were measured. Multinomial regression analyses identified sociodemographic factors related to tobacco use, and the latter's association with respiratory conditions. RESULTS: In 1998, 24.6% adults (44.2% of males and 11.0% of females) smoked regularly. Coloured women had a higher rate (39%) than African women (5.4%). About 24% of the regular smokers had attempted to quit, with only 9.9% succeeding. African women (13.2%) used smokeless tobacco more frequently than others. Of the nonsmokers 28% and 19% were exposed to environmental tobacco smoke in their homes and workplaces, respectively. The regression analysis showed that the demographic characteristics of light smokers (1-14 tobacco equivalents per day) and heavy smokers (> or = 15 tobacco equivalents per day) differed. Light smoking occurred significantly more frequently in the poorest, least educated and urban people. The relative risk for light smoking was 18 in Coloured women compared with African women. Heavy smoking occurred most frequently in the highest educated group. A dose-response was observed between the amount smoked and the presence of respiratory diseases. CONCLUSIONS: Smoking in South Africa is decreasing and should continue with the recently passed tobacco control legislation. Culturally appropriate tobacco cessation programmes for the identified target groups need to be developed.

Engaño mortal: las nuevas normas mundiales de la industria tabacalera para la comercialización del tabaco / Fatal deception: the tabacco industry's new world standards for tobacco marketing

Being increasingly threatened by the worldwide antismoking struggle, the major tobacco companies are eager to improve their public image. This leads the companies to adopt inconsequential "measures" such as the tobacco industry's "new" standards for tobacco marketing that were "voluntarily" issued in September 2001 by the British American Tobacco company. These measures are clearly attempts to reduce the disapproval generated by the companies' promotion and advertising campaigns, which indirectly target young people. With these standards the tobacco companies supposedly commit themselves, among other things, to not using advertising directed at youth and to not selling or distributing tobacco products in places frequented by young people. This document explains why these measures are completely ineffective, are not anything new, and are a subtle effort to feign a conscientious, responsible attitude, which is far from genuine. As long as there are marketing activities directed at adults, young people will be exposed to the influence of those activities. Many countries have completely prohibited the marketing of tobacco products, given that the "new" marketing standards do not represent progress in any way whatsoever

Tobacco-free Mecca and Medina

Political, economic, social, cultural, environmental and others factors can all favour health or be harmful to 'good health'. The aim of health advocates is to modify these factors to promote health [1]. Religion too provides opportunities to improve health [2]. It can offer motivation, encouragement and support for healthy lifestyles and behavioural choices. In 2002, the Ministry of Health of Saudi Arabia adopted a new and radical policy approach to strengthening tobacco control through religion. It launched an initiative to make the two holiest cities in Islam, Mecca and Medina, not just smoke-free but literally tobacco-free. The rationale and experiences of the Saudi government in regulating tobacco use in Mecca and Medina are examined in this report