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Geospatial spread of e-cigarette vape shops in South Africa and the relationship with tobacco product use among adults
Abstract
We estimated the spatial distribution of e-cigarette vape shops in South Africa and measured associations with tobacco use among adults. We linked geocoordinates of identified vape shops to internet protocol addresses of individual participants in the 2018 Health 24 survey (n = 18,208). We used logistic regression to measure the associations between proximity to vape shops and tobacco-related behaviors. In total, we identified 240 vape shops; 49.6% of these were within a 5 km radius of a higher educational institution. Proximity to vape shops was associated with ever e-cigarette use among young adults aged 18–29 years (AOR = 1.33, 95%CI = 1.16–1.54). Efforts to regulate e-cigarette marketing can benefit public health.
... The use of e-cigarettes has grown remarkably in South Africa (Ayo-Yusuf et al., 2022). As of 2018, e-cigarette users were estimated to be 1.09 million (Agaku et al., 2021b). E-cigarettes are mainly promoted on online platforms and distributed through franchise vape shops (Visagie, 2017). ...
... E-cigarettes are mainly promoted on online platforms and distributed through franchise vape shops (Visagie, 2017). In 2020, more than 240 vape shops were identified in South Africa, strategically located close to institutions of higher learning (Agaku et al., 2021b). The growth in the popularity of e-cigarettes has also generated much research interest. ...
... The growth in the popularity of e-cigarettes has also generated much research interest. The most notable studies focused on the safety of e-cigarettes (van Zyl-Smit, 2013), e-cigarette selling propositions (Muposhi and Dhurup, 2018), e-cigarette advertising exposure (Agaku et al., 2021a) and geospatial spread of e-cigarette vape shops (Agaku et al., 2021b). However, there is no known empirical study in South Africa that has focused on e-cigarette waste disposal behaviours yet. ...
Irresponsibly disposed electronic cigarette (e-cigarette) waste poses significant public health and environmental harm. This study explores downstream social marketing interventions that can be used to curtail the growth of e-cigarette waste in South Africa through the lenses of the social norms approach. This study harnesses the power of social marketing to identify downstream interventions that can be used by marketers to curb the problem of e-cigarette waste. An exploratory research design and a qualitative method were employed. Six virtual focus groups were conducted to collect cross-sectional data from South African electronic cigarette users. Reciprocal altruism, social orientation value, moral licensing and ecological beliefs were found to be the main normative influences that characterise e-cigarette waste. The results support the proposition that social marketers should employ a downstream approach to develop interventions to curtail the growth of e-cigarette waste. Such measures are envisaged to complement upstream initiatives. This study offers new insights on how to manage e-cigarette waste in the context of an emerging market.
... More than 4 years later, the Bill still has not been passed as law, despite more recent local studies supporting regulation of e-cigarettes [1 ••, 13••, [23][24][25][26][27][28][29][30][31]. E-cigarette manufacturers and retailers have lobbied against the passage of this bill and released at least two reports asserting the bill "is not based on credible evidence" [32][33][34]35••]. ...
... These articles were reviewed using a targeted framework that sought to empirically evaluate the claims made by the e-cigarette industry in South Africa. In addition to grey literature, a total of 13 peer-reviewed e-cigaretterelated studies conducted in South Africa were found, 11 were included [1••, 13••, [23][24][25][26][27][28][29][30][31], and two were excluded because their subject matter was not related to the discussion of this paper [36,37]. Results are presented thematically using broad areas discussed in the industry reports based on available literature. ...
... Furthermore, the WHO Framework Convention for Tobacco Control (WHO FCTC) requires parties to ban "ALL" forms of advertisements, promotions, and sponsorship, a recommendation at odds with the industry's preferred scope of policy implementation. In addition, e-cigarette shops with colourful, sleek branding are proliferating in the public space in South Africa [30,50]. In March 2021, following the launch of the e-cigarette brand-Vuse, the British American Tobacco (BAT) announced plans to open 67 "Vuse inspiration" stores throughout South Africa [50]. ...
Purpose of Review
This narrative review of the published scientific literature on e-cigarettes in South Africa examines and responds to reports commissioned by the e-cigarette industry about proposed regulations in South Africa.
Recent Findings
The results of a nationally representative study suggest that the number of e-cigarette users is much larger than the number provided by the industry-commissioned reports. Contrary to industry claims, e-cigarettes are more expensive than regular cigarettes and the proposed regulation, the Control of Tobacco Products and Electronic Delivery Systems Bill, which aims to regulate e-cigarettes as tobacco products rather than as medicines would benefit public health. Furthermore, the government’s proposed tax on e-cigarettes would generate much-needed revenue for the government and reduce e-cigarette uptake by youths.
Summary
E-cigarettes were introduced to the South African markets about a decade ago. E-cigarette consumption has grown exponentially without a commensurate decrease in cigarette smoking. Yet, e-cigarettes are not yet regulated as tobacco products as the e-cigarette industry continues to aggressively lobby against the passing of a proposed legislation that would have achieved this. This legislation, the “Control of tobacco products and electronic delivery systems bill”, is yet to be passed into law over 4 years after its inception. This narrative review was conducted on peer-reviewed South African literature on e-cigarettes up to December 2021, supplemented by a search of the grey literature, government publications, and industry-commissioned reports. We found that reports commissioned by the e-cigarette industry misrepresented the potential impact of restricting e-cigarette advertisements and promotions. Furthermore, by underestimating the prevalence of e-cigarette use in the population, these reports also attenuated the revenue-generating ability of potential e-cigarette excise taxes as proposed by the South African National Treasury Department. The regulation of e-cigarettes would benefit public health in South Africa.
... However, if authorities unchecked this trend it may rise because e-cigarettes are less harmful than combustible tobacco products [13], the long-term effects of it use are unknown, and evidence are still gathering on the adverse health effects of e-cigarettes [14]. Also, with mass marketing strategies and access to e-cigarette shops, the use of e-cigarettes can rise correspondingly [15]. The implication of this could lead to higher prevalence in the future, and e-cigarettes aiding as gateway products for young adults to progress to combustible tobacco use [15], leading to a concurrent increase in tobacco-induced diseases. ...
... Also, with mass marketing strategies and access to e-cigarette shops, the use of e-cigarettes can rise correspondingly [15]. The implication of this could lead to higher prevalence in the future, and e-cigarettes aiding as gateway products for young adults to progress to combustible tobacco use [15], leading to a concurrent increase in tobacco-induced diseases. ...
Background:
Modern e-cigarettes are more socially acceptable alternatives to combustible cigarettes among teenagers and young adults because
of their attractive appearance, user-friendly features, less unpleasant smoking experiences, tempting flavors, and capacity for
discrete usage. But, if this habit continue without supervision, may have deleterious effects on physical and mental health.
Therefore, there is a need to determine the patterns of use, especially among adolescents and young adults. This study aims to
assess the prevalence and factors associated with electronic cigarette use among university students in South Karachi, Pakistan.
Objective: To determine the prevalence and associated factors with e-cigarette use among young adults studying in Colleges of
Karachi, Pakistan
Method: A cross-sectional study with Purposive sampling technique. All students’ aged 16-19 attending college and university
were included. A structured questionnaire was designed specifically for the study.
Result: Almost half (n=504, or 50.4%) of the 1000 students used to vape. The study's findings also showed that 41.9% of
participants used to vape daily, 32.2% of participants who had been using e-cigarettes for less than a year. When analyzing the
relationship between demographic factors and student e-cigarette usage, it was found that birth order (p=0.035), school type
(p=0.013), and chronic disease (p=0.014) all exhibited statistically significant associations.
Conclusion: Vaping is incredibly popular with college and university students in Karachi. The prevalence of vaping among these
college students is associated with their gender, being born in the fifth or higher position in the birth order, attending a private
school, and having a chronic disease. It is crucial to spread knowledge of the negative effects of vaping, such as lung damage
brought on by e-cigarette or vaping usage (EVALI)
... This strategy exploits the visibility of these locations to attract younger consumers, a demographic particularly vulnerable to peer pressure and social trends. A South African study revealed that nearly half of surveyed vape shops were located within 5 km radius of educational institutions, correlating with higher e-cigarette use among young adults aged 18-29 years (Agaku, 2021). ...
Introduction: Historically, tobacco use among women and girls in sub-Saharan Africa has been significantly lower than among men. However, recent trends show a concerning rise in smoking rates within this demographic. This shift necessitates a deeper examination of the role tobacco industry marketing plays in driving these changes. Focusing on five key countries, Nigeria, South Africa, Rwanda, Kenya, and Senegal, this research provides a comprehensive analysis of industry marketing tactics targeting women and girls in the region.
Aims and Methods: This study aims to investigate the evolving strategies used by the tobacco industry to market products to African women and girls. A mixed-methods approach was employed, combining a literature review, quantitative surveys, and qualitative semi-structured interviews. In addition, a historical analysis of tobacco industry documents and an evaluation of tobacco control laws and regulations in the five surveyed countries were conducted to gain deeper insights into industry practices.
Results: Findings from TIDs suggest that the tobacco industry has systematically targeted women for several decades, with a particular focus on young women aged 18-24. None of the surveyed countries currently have comprehensive laws addressing new and emerging products like e-cigarettes. Tobacco marketing was most commonly encountered in nightclubs, bars, lounges, and parties, with 32.8% of participants reporting exposure in these settings. Social media exposure varied across countries, while television shows and movies consistently showed high exposure rates (77.2%) across all five nations. Key informant interviews highlighted dominant themes such as brands targeting females, cultural perceptions of female tobacco use, femininity, autonomy, influencer marketing, digital strategies, harm reduction narratives, proximity marketing, peer and parental influences, and the perceived benefits of tobacco, particularly in terms of flavor, taste, and smell.
Conclusion and Implications: The tobacco industry uses sophisticated marketing strategies to enhance product appeal, particularly targeting women through emerging products, flavor manipulation, and harm reduction messaging. Proximity marketing in social settings has proven effective in increasing the access of young women to tobacco products. Critical regulatory gaps remain, particularly concerning e-cigarettes and other novel tobacco products. The adequacy and enforcement of existing TAPS regulations, especially those concerning digital media and cross-border advertising, need urgent attention. Countries should adopt proactive regulations that anticipate industry adaptations and reduce the need for frequent updates. TAPS bans must be extended to encompass emerging tobacco and nicotine products across both traditional and digital platforms. Additionally, regulations need to target proximity and harm-reduction marketing to safeguard young women and prevent the normalization of tobacco use among these vulnerable demographics.
... University students are frequently attracted to new products and have historically been at the forefront of societal changes in substance use that eventually manifest in the general population 18 . A study in South Africa revealed that nearly 50% of e-cigarette shops or vendors are clustered within a 5 km radius of higher education institutions 19 . It is therefore important to understand student's knowledge, perceptions, and experiences of e-cigarette use in the South African context. ...
Introduction:
E-cigarettes have rapidly gained a market share in South Africa and globally. Concerns have been raised over the growing popularity of e-cigarettes among young people, who are frequently drawn to these novel products and are especially targeted by marketers. Using a qualitative method, this study aimed to gain insight into young adults' knowledge, experiences, and perceptions of e-cigarette use in Cape Town, South Africa.
Methods:
We conducted five focus groups (FGs) among students of the University of Cape Town (n=48; 46% females; 54% males; aged 18–25 years). These FGs, which included both e-cigarette users and non-users, were audio-taped, transcribed verbatim, and analyzed thematically using Nvivo 12 software.
Results:
Despite their lack of information about the chemical constituents of e-cigarettes and their harm, participants perceived them as healthier than combustible cigarettes. Participants equated the pleasant smell and environmental friendliness of e-cigarettes with safety. The absence of e-cigarette regulation was interpreted as evidence of their safety. Participants indicated that the lack of anti-ecigarette indoor policies, the deceptive marketing regarding their safety, and their low price compared to combustible cigarettes, had key roles in increasing young people's use of e-cigarettes.
Conclusions:
Findings highlight factors at multiple levels contributing to e-cigarette use among young people in South Africa. Comprehensive strategies for e-cigarette regulation and prevention are needed. Potential strategies include increasing knowledge of e-cigarette harms through evidence-based communication campaigns and strengthening e-cigarette regulations by limiting e-cigarette advertisements, banning vaping in public places, and reducing the flavors used in e-cigarettes.
... Nigeria have examined regulations of e-cigarettes 51-53 including the geospatial spread of vape shops and its relation to e-cigarette use, especially among adolescents and young adults. 77,78 Considering the huge relevance of these studies to policy formulation and implementation, it is highly recommended that similar studies be conducted in ...
Background and Aims
E‐cigarettes will continue to be a public health issue in Nigeria. To curb the growing menace of the e‐cigarette use in Nigeria through evidence‐based approach, it is crucial to first map the empirical research landscape of e‐cigarettes in Nigeria. No known study has mapped the existing empirical evidence and gaps concerning e‐cigarettes in Nigeria; hence, this scoping review was conducted.
Methods
This scoping review adopted the research design by Arksey and O'Malley. Four databases (PubMed, SCOPUS, CINAHL Complete, and APA PsycINFO) were searched to retrieve literature on e‐cigarettes in Nigeria. With the aid of Rayyan web application, all retrieved literature were deduplicated and screened based on the review's eligibility criteria. Only those peer‐reviewed journal papers meeting the inclusion criteria were included in the review. Relevant data from the included papers were charted, collated, and summarized.
Results
A total of six papers were included in this review. The reviewed papers reported a lifetime prevalence of e‐cigarette use (or vaping) ranging from 5.8% to 19.8%, with a current e‐cigarette use prevalence of 11.8%, among different population groups in Nigeria. The major determinants of e‐cigarette use, as reported in these articles, include being a youth, having a health condition, severe anxiety, tobacco use, peer influence, and current alcohol use. Dry mouth and oral lesions (gingival inflammation and oral ulcers) were also identified to be the medical conditions associated with e‐cigarette use in Nigeria. Lastly, one of the included papers identified a lack of clear regulation on e‐cigarettes in Nigeria.
Conclusion
There is an urgent need for more scientific investigations on the sociodemographic, economic, health, and regulatory landscape of e‐cigarettes in Nigeria, as robust empirical evidence is needed for the effective planning, implementation, and evaluation of evidence‐based policies and interventions on e‐cigarettes control and regulation in Nigeria.
... Tobacco industry promotional activities in the Sub-Sahara African region [5][6][7] have created a richly enabling environment for tobacco use characterized by unfettered access to cigarettes sold in single sticks, some of the cheapest cigarettes on the globe, a relatively weak tobacco regulatory climate, and aggressive marketing towards youth [8][9][10] . ...
INTRODUCTION
Examining gender differences in youth tobacco use is important as it aligns tobacco control within the context of broader human development goals seeking to eliminate gender inequalities. In this study, we examined gender differences in adolescent use of cigarettes, smokeless tobacco, shisha, and e-cigarettes in Africa.
METHODS
This was a cross-sectional study using data from the Global Youth Tobacco Survey. Our analytical sample comprised 56442 adolescents aged 13–15 years from 20 African countries. Weighted, country-specific prevalence estimates were computed overall and by gender. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to examine whether correlates of tobacco use differed between boys and girls.
RESULTS
Ever cigarette smoking prevalence was significantly higher among boys than girls in 16 of the 20 countries, but a significantly higher percentage of girls reported earlier age of cigarette smoking initiation than boys within pooled analysis. Some of the largest gender differences in current cigarette smoking were seen in Algeria (12.2% vs 0.8%, boys and girls, respectively), Mauritius (21.2% vs 6.6%), and Madagascar (15.0% vs 4.1%). Current use of e-cigarettes, shisha, and smokeless tobacco was generally comparable between boys and girls where data existed. Among girls, higher levels of reported exposure to tobacco advertisement were positively associated with shisha smoking whereas perceived tobacco harm was inversely associated with current cigarette and shisha smoking. Among boys, perceived social acceptability of smoking at parties was associated with an increased likelihood of cigarette smoking (APR=2.27; 95% Cl: 1.20–4.30).
CONCLUSIONS
The prevalence of cigarette smoking among boys was higher than that of girls in many countries. However, girls who smoke tend to start at an earlier age than boys. Differential gender patterns of cigarette and non-cigarette tobacco product use among youth may have implications for future disease burden. As the tobacco control landscape evolves, tobacco prevention efforts should focus on all tobacco products, not just cigarettes.
... Physical access to points of sale is a major determinant of tobacco use. 30 Furthermore, some of the locked-down places during government mobility restrictions are recreational environments which provide smoking cues, and their lockdown may have contributed to reduced tobacco consumption, including places such as bars, night clubs, and lounges. 31 Several explanations could be offered for the observation that overall cigar sales during the pandemic increased even as less mobility to points of sale during the same period was associated with decreased cigar sales. ...
Introduction
We examined the potential impact of COVID-19 on trends in volume sales of non-cigarette combustible and smokeless tobacco products in the United States.
Aims and Methods
We analyzed monthly national sales for cigars, smokeless tobacco, pipe, and roll-your-own tobacco during June 2019–June 2021. Data were from the U.S Department of the Treasury. Interrupted time-series were used to measure associations of the COVID-19 “shock” (taken as June 2020 or 6 months after the first diagnosis of COVID-19 in the United States) and volume sales. Negative binomial regression was used to evaluate associations between volume sales and changes in community mobility.
Results
Within interrupted time-series analysis, the shock of the COVID-19 pandemic was associated with an initial increase in the number of little cigars sold by 11.43 million sticks (p < .01), with no significant sustained change in trend. The COVID-19 shock was also associated with an initial increase in large cigar volume sales by 59.02 million sticks, followed by a subsequent decrease by 32.57 million sticks per month (p = .005). Every 10% reduction in mobility to retail stores was significantly associated with reduced volume sales of little cigars (IRR = 0.84, 95% CI, 0.71 to 0.98) and large cigars (IRR = 0.92, 95% CI, 0.88 to 0.96). Other findings were statistically nonsignificant.
Conclusions
COVID-19 was associated with increased volume sales for cigars and there was a significant association between reduced mobility to points of sale and reduced cigar volume sales. Intensified efforts are needed to prioritize evidence-based tobacco prevention and control efforts amidst the pandemic.
... However, many of our findings support those from other countries, and we would suggest that findings from Soweto could be similar to other urban, low-resource African environments. Furthermore, no data on e-cigarette use was available, despite increasing use in South Africa, accumulating evidence for health risks, and a lack of data specific to settings such as Soweto (Agaku et al., 2021;Naidoo et al., 2021). Lastly, qualitative insights into the motivation behind smoking could increase our understanding of driving factors in young women. ...
Background
Tobacco use is a major public health risk worldwide, which has increased on the African continent over the past 40 years. Socio-economic factors impact tobacco use and exposure, but little is known about the scope of this problem in young women living in an urban, historically disadvantaged township in contemporary South Africa. This study aimed to identify the prevalence of tobacco use in a cohort of young South African women using serum cotinine, and to assess the association between a number of socio-economic and social factors and tobacco use in this setting.
Methods
Secondary analysis was conducted on cross-sectional data from the Healthy Life Trajectories Initiative (HeLTI) study. Serum cotinine was measured and a cut-off of ≥10 ng/ml was classified as tobacco use. Household socio-economic, socio-demographic and health information were collected by an interviewer-administered questionnaire.
Results
Cotinine data was available for 1508 participants, of whom 29.2% (n=341) had cotinine levels indicative of tobacco use. In regression analyses, moderate to severe socio-economic vulnerability (score 2-3 OR 1.66, p=0.008; score ≥4: OR 1.63, p=0.026) and multiparity (OR 1.74, p=0.013) were associated with tobacco use. In addition, alcohol dependence (OR 3.07, p<0.001) and drug use (OR 4.84, p<0.001) were associated with tobacco use.
Conclusion
Young women with multiple children, moderate to severe socio-economic vulnerability, and alcohol and drug use were identified as more likely to use tobacco, indicating the need for targeted anti-tobacco interventions to curb the impact of tobacco on the growing burden of noncommunicable diseases in this setting.
... However, if unchecked this trend may rise because while e-cigarettes are less harmful than combustible tobacco products [22], the long-term effects of use are unknown, and evidence is accumulating on the adverse health effects of e-cigarettes [4,23]. Also, with increasing marketing and access to e-cigarette shops, the use of e-cigarettes can rise correspondingly [24]. The implication of this could be a higher prevalence in the future, and ecigarettes serving as gateway products for young adults to progress to combustible tobacco use [4,16], leading to a concurrent increase in tobacco-induced diseases. ...
Background
Electronic cigarettes (e-cigarettes) have emerged in the Nigerian market, and if used without supervision, may have damaging effects on the physical and mental health of users. Therefore, there is a need to determine the patterns of use, especially among adolescents and young adults. This study aims to assess the prevalence and factors associated with electronic cigarette use, as well as the relationship between their use and anxiety among adolescents and young adults in Lagos, Nigeria.
Method
An online cross-sectional study among participants aged between 15–35 years. The survey had three sections: sociodemographic information, the pattern of e-cigarette use, and a 7-item Generalized Anxiety Disorder (GAD-7) scale. Bivariate and multivariable logistic regression analysis was used to identify factors associated with e-cigarette use. P-values <0.05 were considered significant. Statistical analysis was done using STATA-15.0 software.
Results
Data from a total of 949 respondents was analysed. Participants had a mean age of 23.36 years (±3.97) and were predominantly female (55.64%). The prevalence of e-cigarette ever-use was 7.9% (95% CI: 5.8,10.0). Older age and being male were independently associated with higher odds of e-cigarette use. After adjusting for age and sex, alcohol use (p<0.001), friend’s use (p<0.001), and other tobacco product or substance use (p:0.05) remained significantly associated with higher odds of e-cigarette use. There was no association between anxiety levels and e-cigarette use.
Conclusion
These findings suggest a higher likelihood of e-cigarette use among alcohol consumers, poly-tobacco or substance users and individuals with friends who use e-cigarettes. Health providers and policy makers in Nigeria might consider preventive measures aimed at young adults with the identified risk factors, as well as close monitoring of trends in e-cigarette use in the coming years.
... 13 Another study showed strategic placement of e-cigarette vape shops as a form of promotion and advertisement in South Africa: Of the at least 240 vape shops identified in South Africa during 2020, 39% were within a 10 km radius of a university or college campus, and 65.3% were within a 20 km radius. 14 During 2018, an estimated 1.09 million South Africans aged 16+ years reported using e-cigarettes although most users reported nondaily use. 15 Specifically, 295 081 South African adults reported using e-cigarettes that year every day, or 0.73% prevalence, while 794 936 persons reported using e-cigarettes some days or 1.98% prevalence. ...
Objectives
In South Africa, the Control of Tobacco and Electronic Delivery Systems Bill seeks to regulate e-cigarettes as tobacco products, including their advertising, promotion and sponsorship. Population data on e-cigarette advertising in South Africa are needed to inform public health programs, practice and policy. We examined self-reported e-cigarette advertising exposure during 2017.
Design
Cross-sectional.
Setting
Household-based survey.
Participants
3063 individuals who participated in the 2017 South African Social Attitudes survey, a nationally representative, in-person survey of the non-institutionalised civilian adult population aged ≥16 years
Exposure
‘In the past 12 months, have you seen advertisements or promotions for e-cigarettes (including e-shisha, e-pipe) on any of the following media: newspapers/magazines, billboards, in the malls or any other source?’
Main outcomes
Beliefs and attitudes regarding e-cigarettes.
Findings
Participants’ mean age was 37.7 years. Overall, 20.1% reported exposure to e-cigarette advertisements. By age, exposure was most prevalent among those aged 16–19 years (24.6%). Top sources of exposure among those exposed were stores, 40.7%; malls, 30.9%; and television, 32.5%. Of those aware of e-cigarettes, 61.2% believed ‘e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes’; 62.7% believed that ‘e-cigarette advertisements and promotions may make ex-smokers think of starting smoking cigarettes again’; and 59.5% supported the statement that ‘e-cigarette smoking should be banned indoors just as traditional cigarette smoking’. Notably, teens aged 16–19 reported the lowest prevalence (49.0%) of those believing that ‘e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes’, whereas this percentage was highest among those aged 55–64 years (73.2%).
Conclusion
Comprehensive regulatory efforts are needed to address e-cigarette advertising, marketing and sponsorship in order to protect public health. The urgent enactment of the new tobacco control legislation, The Control of Tobacco Products and Electronic Delivery Systems Bill, can help reduce youth exposure to e-cigarette advertising in South Africa.
Introduction
Population‐level smoking (cigarette or tobacco or nicotine use) has reduced in high‐income nations, but not proportionally compared to less developed regions. This study aimed to estimate smoking prevalence in Sub‐Saharan Africa (SSA).
Approach
Databases searched included PubMed, EMBASE, PsycINFO, African Journal Online, the Global Health Data Exchange and Google Scholar. The search terms included ‘cigarette’, ‘smoking’, ‘tobacco’, ‘nicotine’, ‘prevalence’ and ‘Sub‐Saharan Africa’. Prevalence data on smoking was extracted separately for adolescents (10–17) and adults (18+). Prevalence of lifetime, past 12‐ and 6‐month smoking was included. Weighted pooled prevalence was calculated using MetaXL, while meta‐regression analysis was conducted with Stata version 17. For the estimation of pooled prevalence, we employed a DerSimonian–Laird estimation method. The risk of bias tool was utilised to assess the quality of the studies.
Key Findings
We included 195 papers. Overall, between 2018 and 2023, the weighted lifetime smoking prevalence was 8.8% (95% confidence interval [CI] 5.1, 13.4%), with a past‐year prevalence of 10.8% (CI 4.0%, 19.9%), and daily smoking was 3.5% (CI 0.0%, 9.5%) in SSA. Among adolescents, the lifetime prevalence was 4.5% (CI 2.0%, 8.0%), with a past‐year prevalence of 4.1% (CI 0.0%, 13.4%) and daily smoking was 4.7% (CI 1.0%, 10.6%). Among adults, the lifetime prevalence of smoking was 12.7% (CI 6.6%, 20.4%), 12.1% (CI 2.6%, 26.2%) in the past year and daily smoking was 3.3% (CI 0.0%, 9.8%).
Implications
These findings highlight the importance of maintaining consistent monitoring and ensuring timely follow‐up in implementing smoking prevention measures and regulations in SSA countries.
Background and aim:
Heated tobacco products (HTPs) are electronic devices that heat processed tobacco to release an aerosol containing nicotine and other chemicals. Limited data exist on worldwide HTP use prevalence. This meta-analytic review estimated the prevalence of HTP use by country, WHO region, year, sex/gender, and age.
Methods:
Five databases (Web of Science, Scopus, Embase, PubMed, and PsycINFO) were searched between January 2015 and May 2022. Included studies reported the prevalence of HTP use in nationally representative samples post-modern HTP device market entry (2015). A random effects meta-analysis was used to estimate overall prevalence for lifetime, current, and daily HTP use.
Results:
Forty-five studies (n=1,096,076) from 42 countries/areas from the European Region (EUR), Western Pacific Region (WPR), Region of the Americas (AMR) and African Region (AFR) met inclusion criteria. Estimated pooled prevalence for lifetime, current and daily HTP use was 4.87% (95% confidence interval [CI]:4.16,5.63), 1.53% (95%CI:1.22,1.87), and 0.79% (95%CI:0.48,1.18), respectively, across all years (2015-2022). Lifetime HTP use prevalence significantly increased by 3.39% for WPR (0.52% [95%CI:0.25,0.88] in 2015 to 3.91% [95%CI:2.30,5.92] in 2019) and 5.58% for EUR (1.13% [95%CI:0.59,1.97] in 2016 to 6.98% [95%CI:5.69,8.39] in 2020). Current HTP use increased by 10.45% for WPR (0.12% [95%CI:0,0.37] in 2015 to 10.57% [95%CI:5.59,16.88] in 2020) and 1.15% for EUR (0% [95%CI:0,0.35] in 2016 to 1.15% [95%CI:0.87,1.47] in 2020). Meta-regression revealed higher current HTP use in WPR (3.80%[95%CI:2.88,4.98]) compared with EUR (1.40%[95%CI:1.09,1.74]) and AMR (0.81%[95%CI:0.46,1.26]), and for males (3.45%[95%CI:2.56,4.47]) compared with females (1.82%[95%CI:1.39,2.29]). Adolescents had higher lifetime HTP use prevalence (5.25%[95%CI:4.36,6.21]) than adults (2.45%[95%CI:0.79,4.97]). Most studies scored a low risk of sampling bias due to their nationally representative sampling.
Conclusion:
The prevalence of heated tobacco products (HTP) use increased in the European and Western Pacific Regions between 2015 and 2020, with nearly 5% of the included populations having ever tried HTP and 1.5% identifying as current users during the study period.
Purpose
What factors trigger innovation adoption of heated tobacco products (HTPs) in an emerging economy? The study aims to integrate the diffusion of innovation and consumer resistance theory to develop a framework to measure the adoption of HTPs.
Design/methodology/approach
The study used a self-administered questionnaire, and the data was collected from 272 respondents. The study used the covariance-based structural equation modelling.
Findings
The findings suggest that relative advantage, compatibility, trialability, observability and perceived cost significantly affect innovation adoption of HTPs.
Research limitations/implications
The study provides theoretical and practical implications for researchers and the tobacco industry.
Originality/value
The study, if not the only, is among the few in an emerging economy that explores heated tobacco products adoption by integrating the diffusion of innovation and consumer innovation resistance theory.
Declines in cigarette smoking prevalence in many countries and the consolidation of the tobacco industry have prompted the introduction of other forms of nicotine delivery. These include electronic nicotine delivery systems (ENDS), heated tobacco products (HTPs) and oral nicotine products (ONPs). Evolving over time, some of these products now deliver nicotine at levels comparable to cigarettes and may serve as effective substitutes for smokers. However, certain products, especially ENDS like JUUL, have also appealed to youth and non-smokers, prompting concerns about expanding nicotine use (and potentially nicotine addiction). The tobacco industry could shift away from primarily promoting cigarettes to promoting ENDS, HTPs and/or ONPs, though at this time it continues to heavily promote cigarettes in low and middle-income countries. Differing regulatory regimes may place upward and downward pressures on both cigarettes and these newer products in terms of population use, and may ultimately drive the extent to which cigarettes are or are not displaced by ENDS, HTPs and/or ONPs in the coming decade.
Background:
The use of e-cigarettes, also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on TV and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences.
Objective:
The aim of this two-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television.
Methods:
In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on two popular television channels (Discovery and AMC).
Results:
In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under four headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from ispot.tv, and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapped into the most at 97.4% (n=37) and 52.6% (n=20), respectively.
Conclusions:
The findings bring forward the multi-dimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective anti-vaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these pro-vaping messages.
Clinicaltrial:
Vaping is increasingly prevalent and controversial. Vape shops and convenience stores are common but distinct sources of vaping products, and where they locate may reflect likely target markets. This study examined the density and neighborhood demographics of vape shops and convenience stores in six metropolitan statistical areas (MSAs): Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, Seattle. We identified 459 vape shops using Yelp and Google application programming interfaces and 10,777 convenience stores using ReferenceUSA and Dun & Bradstreet. Retailers were geocoded to census tracts (n=4,442), and logistic regressions were conducted using as predictors percent non-White, percent youth (5-17 years or 5-20 years), and median household income from the American Community Survey, 2013-2017. Per 10,000 young adults, vape shop density ranged from 0.6 (Boston, San Diego) to 1.7 (Oklahoma City), and convenience store density ranged from 12.6 (San Diego) to 26.3 (Oklahoma City). Logistic regressions indicated that vape shops more likely resided in tracts with lower percentages of youth in Boston, but higher percentages of youth in Atlanta, as well as with lower incomes in Boston and Seattle. Convenience stores more likely resided in tracts with lower percentages of non-Whites in Atlanta and Boston; lower incomes in Atlanta, Boston, San Diego, and Seattle; and higher percentages of youth in Atlanta, Boston, and Minneapolis. These common retail sources of vaping products differentially locate in relation to neighborhood sociodemographics across MSAs. Findings suggest that, in some MSAs, vape shops and convenience stores may target youth and lower income populations.
Background
Prior to the final deeming rule, federal law in the USA prohibited electronic cigarettes (e-cigarettes) from being marketed as smoking cessation products; for other therapeutic purposes and in ways that conveyed Food and Drug Administration (FDA) approval/endorsement. After August 2016, additional federal prohibitions were added including false/misleading and unauthorised modified risk tobacco product (MRTP) claims. No systematic investigation of e-cigarette health claims has been conducted in the retail environment. We sought to document and characterise claims made in vape shops.
Methods
Between November 2015 and February 2016, before final deeming rule implementation, two trained data collectors conducted unannounced observational assessments of 46 vape shops in North Carolina. Data collectors used wearable imaging technology to document health claims about e-cigarettes. Photos were coded for five claim types: (1) cessation device; (2) drug effect/device; (3) FDA-approved/endorsed; (4) false/misleading and (5) MRTP. Photos were double coded; differences between coders were adjudicated and reviewed by an expert panel.
Results
At least one health claim was displayed in 41.3% (n=19) of retailers, ranging from 0 to 27 claims per retailer. All claim types were found. Cessation device claims were the most prevalent (62.2%, n=84), followed by MRTP (27.4%, n=37), drug effect/device (8.1%, n=11), false/misleading (1.5%, n=2), and FDA approved/endorsed (0.7%, n=1). Retail chains made the majority of claims compared with independent shops (88.9% vs 11.1%).
Conclusions
Many vape shops displayed e-cigarette health claims, which are all now FDA prohibited. These claims could mislead consumers and influence behaviour. Findings highlight the need for retailer education, continued surveillance, enforcement specific to advertising and research on consumer perceptions of claims.
The rate of Hookah use among college students during the last decade is about 30%. Although college students perceive hookah use as a safer alternative to conventional cigarettes, hookah use increases the risk of disease and nicotine dependence, and therefore remains an area of concern. Presently, the US Food and Drug Administration (FDA) has little regulation for the manufacture, distribution, or sale of hookah. This review attempts to assess empirical literature relating to hookah use while focusing on the consequences for regulatory policy. PubMed (including MEDLINE 2010–2017), PsycINFO, EBSCO, Scopus (Elsevier) databases were examined to pinpoint articles published in English. The following terms were used in the searches: Hookah or Waterpipe or nargile or “arghile” or “shisha” or “hubble bubble” or “alternative tobacco product” or “flavored tobacco”. Hookah use may initiate smoking among tobacconaïve college students. College students who use hookah are generally not aware of the increased risks for tobacco related diseases as it relates to their behavior. In addition, few public health messages target college-age adults with anti-hookah messages. A lack of information regarding the dangers and potential harms of hookah use may be misinterpreted as a sign of “safety” which inadvertently may imply a suggestion of no need for safety measures. Hence, a research agenda that would inform about health policy actions has been proposed.
Purpose
To compare the retail distribution and density per population of electronic and conventional cigarettes in smoke-free communities with and without e-cigarette restrictions.
Design
A cross-sectional study with field observations of retail tobacco stores.
Setting
Two Central Kentucky counties with 100% smoke-free workplace regulations; counties selected on the basis of whether e-cigarette use was restricted.
Subjects
Fifty-seven tobacco retailers in two counties, including conventional retailers and stand-alone e-cigarette stores.
Measures
Type and location of store and products sold; addresses of stores and schools geocoded with ArcGIS.
Analysis
Bivariate comparisons between counties, rates and confidence intervals for frequency of tobacco retailers and e-cigarette stores per population.
Results
Fifty-three percent of tobacco retailers sold e-cigarettes. E-cigarette availability did not differ by whether smoke-free regulation covered e-cigarettes. Rates of tobacco retailers and e-cigarette distributors per 10,000 were 8.29 and 4.40, respectively, in the two-county area. Of the 40 schools, 88% had a tobacco retailer and 68% had an e-cigarette distributor within 1 mile.
Conclusion
In this exploratory study, e-cigarette use restriction was not related to store availability. For a relatively new product, e-cigarettes were readily available in retail outlets and close to schools.
Waterpipe smoking has been growing in popularity in the United States and worldwide. Most tobacco control regulations remain limited to cigarettes. Few studies have investigated waterpipe tobacco smoke exposures in a real world setting. We measured carbon monoxide (CO), particulate matter (PM)2.5, and airborne nicotine concentrations in seven waterpipe cafes in the greater Baltimore area. Area air samples were collected between two and five hours, with an average sampling duration of three hours. Waterpipe smoking behaviors were observed at each venue. Indoor air samplers for CO, PM2.5, and airborne nicotine were placed in the main seating area 1-2 m above the floor. Indoor airborne concentrations of PM2.5 and CO were markedly elevated in waterpipe cafes and exceeded concentrations that were observed in cigarette smoking bars. Air nicotine concentrations, although not as high as in venues that allow cigarette smoking, were markedly higher than in smoke-free bars and restaurants. Concentrations of PM approached occupational exposure limits and CO exceeded occupational exposure guidelines suggesting that worker protection measures need to be considered. This study adds to the literature indicating that both employees and patrons of waterpipe venues are at increased risk from complex exposures to secondhand waterpipe smoke.Journal of Exposure Science and Environmental Epidemiology advance online publication, 16 April 2014; doi:10.1038/jes.2014.19.
Importance:
E-cigarette use in public places may renormalise tobacco use.
Objective:
To measure associations between e-cigarette use in public places and social norms among youth.
Design:
Cross-sectional survey.
Setting:
School-based.
Participants:
24 353 never tobacco users in US 6th-12th grades who completed the 2016-2017 National Youth Tobacco Surveys.
Exposure:
Individuals were classified as exposed in public places within the past 30 days to: (1) neither e-cigarette secondhand aerosol (SHA) nor combustible tobacco secondhand smoke (SHS); (2) SHA only; (3) SHS only; and (4) both SHA and SHS.
Outcomes:
Outcomes were overestimation of peer e-cigarette use (a measure of descriptive norms), harm perception and susceptibility. Data were analysed using descriptive statistics and logistic regression (p<0.05).
Results:
Overall prevalence of SHS and SHA exposure in public places was 46.6% and 18.3%, respectively. SHA exposure in public places was associated with increased odds of overestimating peer e-cigarette use (adjusted OR (AOR): 1.83; 95% CI 1.29 to 2.58) and decreased odds of perceiving e-cigarettes as harmful (AOR: 0.63; 95% CI 0.51 to 0.79), compared with those exposed to neither emission. SHA exposure in public places was also associated with increased susceptibility to using e-cigarettes (AOR: 2.26; 95% CI 1.82 to 2.81) and cigarettes (AOR: 1.51; 95% CI 1.20 to 1.90). E-cigarette harm perception was lower among students in jurisdictions with no comprehensive clean indoor air laws (AOR: 0.79; 95% CI 0.71 to 0.88) or cigarette-only laws (AOR: 0.88; 95% CI 0.78 to 0.99) than in those prohibiting both cigarette and e-cigarette use in public places.
Conclusions:
Prohibiting both e-cigarette and cigarette use in public places could benefit public health.
Cigarette smoking in the U.S. is declining, but e-cigarette (e-cig) use is rapidly expanding. E-cig brands utilize social media for promotion and have the autonomy to disseminate messages that encourage the use of their products. The current study categorized the most frequent strategies among popular e-cig brands on Twitter. A content analysis of over 1800 tweets was performed based on Philip Morris brand personality characteristics. Most tweets emphasized e-cigs’ economic value (24.2%) and normalized their use by portraying e-cigs as “cool” (23.1%). E-cig brands are employing similar strategies as tobacco companies and easily connecting to young adults through social media.
Introduction:
Alternative tobacco products (ATPs), such as cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS), have a strong presence in the U.S. retail environment amid declining cigarette consumption. This study documented the promotion of ATPs in tobacco retailers in New York City and examined associations with neighborhood demographics.
Methods:
Data on product availability and advertising were collected from a stratified, random sample of tobacco retailers in 2017 (n=796). Multilevel models estimated adjusted prevalence ratios (aPRs) for each outcome by neighborhood racial/ethnic composition and median household income.
Results:
Nearly half (49.8%) of retailers carried 99-cent cigarillos, but availability was significantly greater in neighborhoods in the highest (vs. lowest) quartile for the percentage of Black residents [68.2%, aPR: 1.59 (1.19, 2.11)] and in the lowest (vs. highest) income quartile [67.3%, aPR: 1.56 (1.04, 2.35)]. Conversely, retailers in neighborhoods with the highest percentage of White residents were significantly more likely to carry ENDS [66.4%, aPR: 1.71 (1.11, 2.62)]. Advertisements for ENDS were less common in neighborhoods in the highest (vs. lowest) quartiles for the percentage of Black and Hispanic residents [20.3%, aPR: 0.64 (0.41, 0.99); 22.9%, aPR: 0.62 (0.40, 0.98)].
Conclusions:
The marketing of inexpensive, combusted tobacco products disproportionately saturates low-income, minority communities, while potentially lower risk, non-combusted products are more accessible in largely White and higher income neighborhoods. This pattern may exacerbate tobacco-related inequities. Public health policies should prioritize reducing the appeal and affordability of the most harmful tobacco products to help reduce health disparities.
Implications:
While cigarette promotion at the point-of-sale is well-documented in the literature, questions remain about the ways in which alternative tobacco products (ATPs) are marketed in communities. Importantly, these products fall on a continuum of harm, with combusted tobacco overwhelmingly responsible for tobacco-related death and disease. We found that retailers in minority and low-income communities were more likely to carry and advertise inexpensive ATPs such as cigarillos, while potentially less risky, non-combusted products such as smokeless tobacco and e-cigarettes were more accessible in higher income and predominantly White neighborhoods. Policies aligned with product risk may help reduce health disparities.
Introduction:
Flavored e-cigarette (ECIG) use and Internet marketing have increased in the U.S. This study examined the content used to promote flavored ECIG liquids on retailer websites.
Methods:
Four ECIG liquid retailers from four U.S. geographic regions (n = 16) were randomly selected. Menthol, apple, and tobacco flavored liquids were purchased in April of 2016 (n = 144, 48 unique flavors). Staff analyzed the text and image descriptors displayed on liquid bottles and retailer websites and coded content for presence of specific flavor, taste/smell, chemesthesis (i.e., touch), America/patriotic, and product quality/potentially modified risk content. A follow-up of retailer websites was conducted in March 2018.
Results:
Nearly all (97.9%) ECIG liquids included a description that promoted flavor. Most descriptions including images of something other than an ECIG liquid bottle (e.g., 62% of tobacco ECIG liquid images included dried tobacco leaves, 43% of menthol ECIG liquid images included mint leaves or ice, 62% of apple ECIG liquid images included an apple). Images often promoted product sensations (e.g., cool, ice), sweet tastes of other products (e.g., chocolate, apple pie), or other appeals (e.g., America). Menthol and apple descriptions/images were more likely than tobacco descriptions/images to promote appeals related to chemesthesis (e.g., cool, warm, moist; p < .05). Most flavors were still available in 2018 and included the same flavor descriptions from 2016.
Conclusions:
Flavored ECIG liquid marketing often includes text descriptions and images that appeal to consumer sensations. Studies are needed to examine how access to point-of-sale Internet advertisements influences attitudes, perceptions, and purchasing of ECIG products, especially among at-risk populations such as youth.
Importance
Two components of social norms—descriptive (estimated prevalence) and injunctive (perceived acceptability)—can influence youth tobacco use.
Objective
To investigate electronic cigarettes (e-cigarette) and cigarette descriptive norms and measure the associations between overestimation of e-cigarette and cigarette prevalence and tobacco-related attitudes and behaviours.
Design
Cross-sectional.
Setting
School-based, using paper-and-pencil questionnaires.
Participants
US 6th-12th graders participating in the 2015 (n=17 711) and 2016 (n=20 675) National Youth Tobacco Survey.
Exposure
Students estimated the percent of their grade-mates who they thought used e-cigarettes and cigarettes; the discordance between perceived versus grade-specific actual prevalence was used to categorise students as overestimating (1) neither product, (2) e-cigarettes only, (3) cigarettes only or (4) both products.
Outcomes
Product-specific outcomes were curiosity and susceptibility (never users), as well as ever and current use (all students). Descriptive and multivariable logistic regression analyses were performed. Statistical significance was at P<0.05. Data were weighted to be nationally representative.
Results
More students overestimated cigarette (74.0%) than e-cigarette prevalence (61.0%; P<0.05). However, the associations between e-cigarette-only overestimation and e-cigarette curiosity (adjusted OR (AOR)=3.29), susceptibility (AOR=2.59), ever use (AOR=5.86) and current use (AOR=8.15) were each significantly larger than the corresponding associations between cigarette-only overestimation and cigarette curiosity (AOR=1.50), susceptibility (AOR=1.54), ever use (AOR=2.04) and current use (AOR=2.52). Despite significant declines in actual e-cigarette use prevalence within each high school grade level during 2015–2016, perceived prevalence increased (11th and 12th grades) or remained unchanged (9th and 10th grades).
Conclusions
Four of five US students overestimated peer e-cigarette or cigarette use. Counter-tobacco mass media messages can help denormalise tobacco use.
Background:
Electronic cigarettes (ECIGs) aerosolize liquids often containing flavorants for inhalation. Few studies have examined the role of flavors in ECIG use. This study's purpose was to examine reasons for flavored ECIG use using a mixed-method approach, concept mapping (CM).
Methods:
Forty-six past 30-day adult ECIG users recruited from vape forums/conferences completed three online CM tasks. Participants brainstormed responses to a prompt: "A specific reason I use flavored e-liquid in my electronic cigarette product is…". The final 107 brainstormed statements were sorted by participants into groups of similar content. Participants rated each statement on a 7-point scale (1-Definitely NOT a reason to 7-Definitely a reason) based on a prompt: "This is a specific reason why I used flavored e-liquid in my electronic cigarette product in the past month." A cluster map was generated from participants' sorting and ratings using CM statistical software. Cluster mean ratings were compared.
Results:
Analysis revealed five clusters of reasons for flavored ECIG use including Increased Satisfaction/Enjoyment, Better Feel/Taste than Cigarettes, Variety/Customization, Food Craving Suppression, and Social Impacts. Statements in the Increased Satisfaction/Enjoyment and Better Feel/Taste than Cigarettes clusters were rated significantly higher than statements from other clusters (ps<0.05). Some statements indicated flavors were perceived as masking agents for nicotine or other bad tastes associated with cigarette smoking making ECIG use more palatable.
Conclusions:
Flavored ECIGs are used for many reasons. Some statements suggested flavors may increase the rewarding and possible addictive effects of ECIGs. These results support continued examination of the role of flavors and ECIG use behaviors.
Introduction:
Waterpipe tobacco smoking is prevalent among college students in the U.S. and increasing in popularity. Waterpipe smoking establishments are almost completely unregulated, and limited information exists documenting the expansion of this industry. The objective of this study was to identify U.S.-based waterpipe establishments and measure their proximity to colleges/universities.
Methods:
Waterpipe establishments and their addresses were compiled using five Internet-based directories during 2014 and analyzed in 2015. Addresses were geocoded and overlaid on a U.S. map of accredited colleges/universities. Proximity of colleges/universities to the nearest waterpipe establishment was measured in 3-mile increments. Multinomial logistic regression was used to model the factors associated with proximity of waterpipe establishments to colleges/universities.
Results:
A total of 1,690 waterpipe establishments and 1,454 colleges/universities were included in the study. Overall, 554 colleges/universities (38.1%) were within 3 miles of a waterpipe establishment. Proximity of waterpipe establishments to colleges/universities was associated with higher full-time student enrollment. Public colleges/universities and those with a smoke-free campus policy were at lower odds of having waterpipe establishments within 3 miles of their campuses.
Conclusions:
Waterpipe smoking establishments are more likely to be located near large colleges/universities. This study should inform initiatives aimed at reducing retail tobacco establishment exemptions.
Background:
We investigated the impact of proximity of tobacco retail outlets to schools on tobacco-related behavior and attitudes of school personnel in sub-Saharan Africa.
Methods:
A pooled analysis of the 2006-2011 Global School Personnel Surveys from 19 sub-Saharan African countries was performed (n=12,201). Multivariate logistic regression analyses were applied to measure the relationship between proximity of tobacco outlets to school premises and school personnel's tobacco-related behavior and attitudes (p<0.05).
Results:
Among all school personnel, there was a significant association between the presence of tobacco outlets on school premises and current cigarette smoking (adjusted odds ratio [aOR]=3.89; 95% confidence interval [CI]: 2.17-7.20), current smokeless tobacco use (aOR=2.63; 95%CI: 1.04-6.65), and permissiveness towards tobacco industry sponsorship activities in school (aOR=2.27; 95%CI: 1.37-3.78). Complete smoke-free school policies were associated with lower odds of current cigarette smoking (aOR=0.42; 95%CI: 0.23-0.74), but were not significantly associated with current smokeless tobacco use. Among lifetime any tobacco users, there was a significant association between the presence of tobacco outlets on school premises and use of combustible (aOR=2.03; 95%CI: 1.09-3.75) and smokeless (aOR=3.85; 95%CI: 1.51-9.81) tobacco products on campus within the past year.
Conclusions:
Policies limiting the distance of tobacco outlets from schools, coupled with complete tobacco-free school policies may reduce tobacco use among school personnel.
Exposure to second-hand tobacco smoke (SHS) has been associated with several adverse health effects including increased risk of lung cancer, heart disease and also asthma in children.1 Hence, the WHO's Framework Convention on Tobacco Control (FCTC) obligates parties to the Convention, to implement measures to protect all people from the exposure to SHS.2 Even prior to signing the WHO FCTC in 2005, the South African government in 2001 implemented a regulation to restrict smoking in public places, including restaurants.3 However, the current regulation in South Africa allows for a designated ‘smoking area’. It is pertinent to note that the enabling legislation provided for a ban in smoking in public places, but also gave the Minister of Health powers to permit smoking in a prescribed portion of a public place. The Minister at that time exercised these powers.
It has been suggested that currently there are no …
Previous studies have indicated that explaining a hypothetical event makes the event seem more likely through the creation of causal connections. However, such effects could arise through the use of the availability heuristic; that is, subjective likelihood is increased by an event becoming easier to imagine. Two experiments were designed to demonstrate this principle. In Experiment 1, subjects asked to imagine Jimmy Carter winning the presidential election (prior to the election) predicted that he was more likely to win than subjects asked to imagine Gerald Ford winning. In Experiment 2, subjects asked to imagine a good college football season for the previous championship team were more likely to predict a major bowl bid than subjects asked to imagine a bad season, although the effect did not appear in predictions of the season record. In both studies, subjects who were also asked to explain the imaginary event were no different from subjects who only imagined. Several other attributional distortions are interpreted in terms of the availability heuristic.
Introduction A revised indoor air quality law has been implemented in Virginia to protect the public from the harmful effects of secondhand smoke exposure. This legislation contains exemptions that include allowances for smoking in a room that is structurally separated and separately ventilated. The objective of the current study was to examine the impact of this law on air quality in waterpipe cafés, as well as to compare the air quality in these cafés to restaurants that allow cigarette smoking and those where no smoking is permitted.
Methods Indoor air quality in 28 venues (17 waterpipe cafés, five cigarette smoking-permitted restaurants and six smoke-free restaurants (five with valid data)) in Virginia was assessed during 4 March to 27 May 2011. Real-time measurements of particulate matter (PM) with 2.5 μm aerodynamic diameter or smaller (PM2.5) were obtained and occupant behaviour/venue characteristics were assessed.
Results The highest mean PM2.5 concentration was observed for waterpipe café smoking rooms (374 μg/m3, n=17) followed by waterpipe café non-smoking rooms (123 μg/m3, n=11), cigarette smoking-permitted restaurant smoking rooms (119 μg/m3, n=5), cigarette smoking-permitted restaurant non-smoking rooms (26 μg/m3, n=5) and smoke-free restaurants (9 μg/m3, n=5). Smoking density was positively correlated with PM2.5 across smoking rooms and the smoke-free restaurants. In addition, PM2.5 was positively correlated between smoking and non-smoking rooms of venues.
Conclusions The PM2.5 concentrations observed among the waterpipe cafés sampled here indicated air quality in the waterpipe café smoking rooms was worse than restaurant rooms in which cigarette smoking was permitted, and state-required non-smoking rooms in waterpipe cafés may expose patrons and employees to PM2.5 concentrations above national and international air quality standards. Reducing the health risks of secondhand smoke may require smoke-free establishments in which tobacco smoking sources such as water pipes are, like cigarettes, prohibited.
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Vaping Industry Thriving in South Africa
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