ATIM Publications

Find some of the latest and credible research into various issues around tobacco control by ATIM.

Utilization of smoking cessation aids among South African adult smokers: findings from a national survey of 18 208 South African adults.

Agaku, I., Egbe, C.O. and Ayo-Yusuf, O.A., 2021.

While several cessation aids exist in South Africa there is limited data showing the utilization and access to these resources. This study examined the usage of various cessation aids among current South African smokers who had ever attempted to stop smoking. Data came from a large, cross-sectional online web-based survey of 18 208 South African adults aged 18 years or older conducted in 2018. Overall, the survey found that 22.4% of the study population were current smokers of any combustible tobacco product. Awareness of cessation aids among current smokers of any combustible tobacco product was as follows: smoking cessation counselling programmes, 50.8%; nicotine replacement therapy, 92.1%; and prescription cessation medication, 68.2%. Awareness of cessation aids was lowest among Black Africans, men, and persons with little or no income. Among current combustible smokers who attempted to quit in the past, ever e-cigarette users were more likely than never e-cigarette users to have ever used any cessation aid. The percentage of adults who quit within the past year who reported ever use of various cessation aids was as follows: ever used any cessation aid, 36.6%; ever used nicotine replacement therapy, 26.7%; ever used prescription medication, 18.4%; and ever used cessation counseling, 8.9%. These findings show that utilization of counseling is very low in South Africa despite its effectiveness, affordability, and accessibility. The higher usage of cessation aids among e-cigarette users may suggest that any putative benefits of e-cigarettes on cessation may be partly attributable to pharmacotherapy/counselling given simultaneous use patterns among past quit attempters using e-cigarettes. Comprehensive tobacco control and strategies can help decrease tobacco use.

Geospatial Spread of e-cigarette vape shops in South Africa and the relationship with tobacco product use among adults.

Agaku, I., Egbe, C.O. and Ayo-Yusuf, O.A., 2021.

Given the observed increase in e-cigarette vendors, there is a need for up-to-date information on where e-cigarettes are sold and how these points-of-sales are distributed across the country. The study characterized the geospatial distribution of e-cigarette vape shops in South Africa and measured the association with tobacco use amongst adults. Geocoordinates of the identified vape shops were linked to the individual-level data of 18 208 participants in a 2018 web survey of South African adults. Geographic analyses identified 240 vape shops or vendors in South Africa. Vape shops were clustered around higher education institutions and 49.6% of these shops were located within a 5km radius of these institutions. A positive association was observed between proximity to vape shops and ever-cigarette use among adults aged 18-29 years.

Non-Smoker's Exposure to Second-Hand Smoke in South Africa during 2017.

Ngobese, S. P., Egbe, C. O., Londani, M. and Ayo-Yusuf, O. A., 2020.

Nicotine dependence, socioeconomic status, lifestyle behaviours and lifetime quit attempts among adult smokers in South Africa

Ayo-Yusuf, O.A. and Omole, O.B., 2020.

Little is known in South Africa about the relationship between smokers’ nicotine dependence levels, socio-economic status and other lifestyle behaviours. The study explored the relationship between nicotine dependence, socio-economic status, lifestyle behaviours and lifetime quit attempts among adult smokers in South Africa. Results of the study showed an association of high nicotine dependence (HND) with high socioeconomic status. The study concludes that although cessation treatment based on an integrated lifestyle behavioural intervention package may suffice for most smokers, a more intense cessation treatment package is needed for smokers of higher socio-economic status..

Associations Between electronic cigarette use and quitting behaviours among South African adult smokers.

Agaku, I., Egbe, C.O. and Ayo-Yusuf, O.A., 2021.

E-cigarettes have been widely touted as cessation aids in South Africa, yet this has not been demonstrated empirically. This study investigated the relationship between e-cigarette use and its association to smoking cessation among South African adults. The study compared varying intensities of e-cigarette use, from never users to regular users; the outcomes were quitting smoking at less than 1 month, up to 6 months, and up to 12 months. Relapse, defined as restarting smoking behavior after having quit for any length of time, was also assessed. Data came from a large national survey of 18 208 South African adults. The results showed that e-cigarette use, while associated with higher likelihood of quitting short-term, was associated with lowered likelihood of long-term quitting and higher likelihood of smoking relapse among ever-established smokers who had tried to quit. These findings underscore the need to educate smokers that e-cigarettes are not effective for long-term quitting. The use of evidence-based interventions such as cessation counseling and medications can help with long-term quitting. There is also a need to restrict unsubstantiated claims of e-cigarettes as effective cessation aids in South Africa.

Potential revenue from taxing e-cigarettes and comparison of annual costs of daily e-cigarette use versus daily cigarette smoking among South African adults

Agaku, I., Egbe, C.O. and Ayo-Yusuf, O.A., 2021.

This study seeks to inform policymaking under the proposed ‘The Control of Tobacco and Electronic Delivery Systems Bill’ by showing the potential benefit of taxing e-cigarettes and comparing daily e-cigarette use and cigarette use among the South African adult population. The study extracted e-cigarette retail prices from 231 South African e-cigarette vendor websites and compared the annual costs associated with daily cigarette smoking in the 2018 South African Social Attitudes Survey (SASAS) versus daily e-cigarette use based on cumulative costs of consumables plus device costs. The findings concluded that daily costs were higher for e-cigarettes than cigarettes. The study also estimated that at least ZAR 900 million could be generated from taxing e-cigarettes at 75% of the cigarette excise rate as proposed by the Minister of Health. The study also recommended levying an e-cigarette excise tax to help reduce youth access given their price sensitivity, while still providing flexible options for adult smokers seeking ways to quit and reduce tobacco-related harms.

Text messaging promoting physician-led brief intervention tobacco cessation: A before-and-after study among physicians in three tertiary hospitals in Nigeria

Odukoya, O., Faseru, B., Uguru, N., Jamda, M., Onigbogi, O., James, O., Leischow, S. and Ayo-Yusuf, O., 2020.

This study evaluated a text messaging intervention designed to increase the knowledge and practices of physicians in Nigeria to help smokers quit. The study targetted all physicians in 3 tertiary care hospitals located in 3 geopolitical zones in Nigeria. They were sent 2-3 text messages weekly over a 13-week period to create awareness and improve cessation practices using the “Ask, Advise and Refer” (AAR) model. Results show that participants were more likely to indicate awareness of the AAR approach after the intervention (60%) than before (21.2%). the study concludes that a brief and low-cost text messaging intervention to physicians increased the awareness and practice of AAR in those who participated in the study. However, the relatively low participation rate highlights the importance of new research to improve and expand text messaging as an intervention among physicians to help them foster tobacco treatment among their patients.

News media coverage of shisha in Nigeria from 2014 to 2018

Abraham, E.A., Egbe, C.O. and Ayo-Yusuf, O.A., 2019.

The study sought to explore the coverage of shisha use by five national newspapers in Nigeria. Between 2014 and 2018, we found 30 relevant publications about shisha. Some newspaper articles reported that shisha smoking was gaining popularity among youths, especially in tertiary institutions across the country. Similarly, some misconceptions about the safety of smoking shisha among shisha users was reported. Addiction to shisha was also reported as being so common that many shisha users were no longer satisfied with just visiting nightclubs and shisha cafes but now own the shisha paraphernalia. There were also reports that the tobacco in shisha was in some instances being replaced or mixed with other hard drugs like marijuana. Subtle advertisement of shisha lounges, which is a violation of the Nigeria National Tobacco Control Act, was also observed.The study concludes that there is a need for increased sensitization of the public through the media on the dangers of shisha smoking and other tobacco product use. There is also a need for a national survey to determine the prevalence of shisha use in Nigeria.

Roll-your-own smoking and quitting behaviour among South African adults during 2007 - 2016.

Moyo, T., and Ayo-Yusuf, O. A. A., 2018.

Tobacco Induced Diseases, 16(1), 522.

The study determines the most current prevalence and trends in Roll Your Own (RYO) smoking in the African context. Secondary analysis of merged data was obtained from adults >15 years, who participated in the South African Social Attitude Survey (SASAS) during 2007, 2011 and 2016. Among the general population, the prevalence of current RYO smoking was 4.2%, 5.3% and 5.3% during 2007, 2011 and 2016 respectively. The prevalence of use of RYO among factory-manufactured cigarette (FMC) smokers significantly increased from 14% in 2007 to 24.1% in 2016. Over the study period, RYO smoking was most prevalent among male, coloureds, rural residents and those with less than Grade 12 education. Roll your own smoking remains most common among those of lower socioeconomic status and concurrent use of roll your own with factory manufactured cigarettes has increased. Roll your own smoking may be associated with reduced likelihood of quitting smoking, therefore there is need for targeted interventions.

Pattern of smokeless tobacco use and cigarette smoking among adult South Africans during 2007-2016

Ezeh, C., and Ayo-Yusuf, O. A., 2018.

This study sought to report the pattern of cigarette smoking and smokeless tobacco (SLT) use in South Africa and is representative of South African adults over the age of 16 years who participated in the South African Social Attitude Surveys (SASAS). The study concluded that the promotion of snuff as harm reduction alternative products in South Africa does not appear to have been associated with significant reduction in smoking, but might have resulted in significant increase in snuff use in recent times.

The effect of smokeless tobacco use and exposure to cigarette promotions on smoking intention among youths in Ghana

Cadmus, E.O. and Ayo-Yusuf, O.A., 2018.

Cogent Medicine5(1), p.1531459.

Tobacco use is one of the major preventable causes of death globally and it is initiated early in adolescence. Recent restrictions and bans on public smoking has led to the marketing of smokeless tobacco as an acceptable, affordable and safer alternative to smoking with increased prevalence of its use. Furthermore, advertising and other promotional activities by tobacco companies have been shown to influence the initiation and continued use of tobacco among adolescents. There are however, conflicting evidence with regard the effect of the use of smokeless tobacco and smoking intention in the future. Most of the studies conducted in this regard, have been in high-income countries and did not control for the influence of exposure of youths to cigarette marketing. Therefore, this study sought to establish the impact of exposure to cigarette advertisements on smokeless tobacco users and its effect on smoking intention among youths in Ghana

Tobacco use among people living with HIV: analysis of data from demographic and health surveys from 28 low-income and middle-income countries

Mdege, N.D., Shah, S., Ayo-Yusuf, O.A., Hakim, J. and Siddiqi, K., 2017.

The Lancet Global Health, 5(6), pp. e578-e592.

The study assessed the prevalence of tobacco use among people living with HIV in Low and Middle Income Countries (LMICs). An assessment of Demographic and Health Survey data collected between 2003 and 2014 from 28 LMICs where both tobacco use and HIV test data were made publicly available was done. The study found a higher prevalence in HIV-positive men of any tobacco use and tobacco smoking than in HIV-negative men. It also found a higher prevalence in HIV-positive women of any tobacco use, tobacco smoking, smokeless tobacco use than in HIV-negative women. It concludes that the high prevalence of tobacco use in people living with HIV in LMICs needs targeted policy, practice, and research action to promote tobacco cessation and to improve the health outcomes in this population.

The relationship between secondhand smoke exposure, pro-tobacco social influences, and smoking susceptibility among nonsmoking Zambian adolescents

Agaku, I.T., Maliselo, T. and Ayo-Yusuf, O.A., 2015.

Substance use & misuse, 50(3), pp.387-393./p>

The study tested the hypothesis that the extent of secondhand smoke (SHS) exposure among non smoking adolescents would be associated with their overall exposure to pro-tobacco social influences using results from the 2011 Zambia Global Youth Tobacco Survey. The results show that the odds of SHS exposure increased with increasing exposure to pro-tobacco advertisements. The gap in SHS exposure between nonsmokers with low versus high smoking susceptibility was attributed to differences in parental or peer smoking. The study concludes that there is need to denormalise tobacco so as to reduce youth inclination to tobacco use.

Cigarette smoking trends and social disparities among south African adults, 2003–2011

Ayo-Yusuf, O.A., Olutola, B.G. and Agaku, I.T., 2015

Nicotine & Tobacco Research, 17(8), pp.1049-1055.

The study examined trends in current cigarette smoking overall and by socioeconomic status (SES) in South Africa during 2003–2011. Data were obtained from the 2003, 2007 and 2011 South African Social Attitudes Survey. No significant change was observed in the overall prevalence of current smoking during 2003–2011, although declines were observed among those with no education. However, increased smoking was observed among the most educated women. Results showed the need for intensified implementation of taxation measures as part of a comprehensive tobacco control to further reduce smoking differences.

Sociodemographic correlates of exclusive and concurrent use of smokeless and smoked tobacco products among Nigerian men

Ayo-Yusuf, O.A., Odukoya, O.O. and Olutola, B.G., 2014.

Nicotine & tobacco research, 16(6), pp.641-646.

This study sought to determine the sociodemographic correlates of exclusive and dual use of smokeless tobacco and smoking and to explore the association between smokeless tobacco use and the amount of cigarettes smoked per day. Data was obtained from the Nigerian demographic and health survey (NDHS) and is representative of men aged 15-19 (N=1543) who participated in the 2008 Nigerian Demographic and Health Survey (NDHS). The study shows that 12.2% (n = 1,842) of the respondents were tobacco users, out of which 24.5% (n = 477) used smokeless tobacco only and 69% (n = 1,236) were exclusive smokers, and 6.5% (n = 129) used both. This study also found that number of cigarettes smoked per day was not different among dual users in comparison to exclusive smokers. Dual users were also more likely to self-identify as traditionalists rather than self-identifying as practicing Islam or Christianity.

Exposure to secondhand smoke and voluntary adoption of smoke-free home and car rules among non-smoking South African adults

Ayo-Yusuf, O.A., Olufajo, O. and Agaku, I.T., 2014.

BMC public health, 14(1), p.580.

This study assessed exposure to second hand smoke (SHS) from several sources among non-smoking adults to determine the effectiveness of existing smoke-free policies and adoption of smoke-free rules in South Africa. The analyses evaluated the presence of smoke-free rules in South Africa, the prevalence and correlates of second hand smoke in public spaces amongst non-smokers in an adult population older than 16 who took part in the 2010 South African Social Attitudes Survey. The study shows that overall, 55.9% of all non-smokers reported exposure to SHS from at least one source (i.e., in the home, workplace or at a hospitality venue). The majority of non-smoking South African adults knew about the harmfulness of SHS exposure, with over two-thirds having implemented smoke-free rules in their cars and homes, over half still reported SHS exposure from several sources, particularly from public areas. This emphasises the need for comprehensive smoke-free laws that prohibit smoking in all indoor areas without exemptions. In addition, strong enforcement of such laws may help increase compliance and denormalize smoking.

Permissiveness toward tobacco sponsorship undermines tobacco control support in Africa

Ayo-Yusuf, O.A., Olutola, B.G. and Agaku, I.T., 2014.

Health promotion international, 31(2), pp.414-422.

This study assessed the impact of school personnel’s permissiveness toward tobacco industry sponsorship activities on their support for complete bans on tobacco advertisements, comprehensive smoke-free laws and increased tobacco prices. Data was collected from the Global School Personnel Survey in 29 African countries (n = 17 929).  The results show great support for tobacco control policies among all countries with the median of prevalence of support for complete ban on tobacco advertisements (84.9%); comprehensive smoke-free laws (92.4%) and tobacco price increases (80.8%). School personnel who believed that the tobacco industry should be allowed to sponsor school events were significantly less likely to support complete bans on tobacco advertisements and comprehensive smoke-free laws. In contrast, support for complete tobacco advertisement bans was more likely among those who believed that the tobacco industry encourages youths to smoke, and among those who taught about health sometimes compared with those who did not teach about health at all. The findings showed the need to educate school staffs on tobacco industry’s strategies to undermine tobacco control policies. Support from schools may assist reduce susceptibility, experimentation and use of tobacco products by youth.

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