Age at the onset of tobacco smoking in South Africa: a discrete-time survival analysis of the prognostic factors
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(2020) 78:128
RESEARCH
Open Access
Age at the onset of tobacco smoking in South Africa: a discrete-time survival analysis of the prognostic factors Adeniyi Francis Fagbamigbe1,2,3* , Rachana Desai4, Ronel Sewpaul5, Ngianga-Bakwin Kandala6, Derrick Sekgala5 and Priscilla Reddy5,7
Abstract Background: While knowledge of onset of smoking tobacco, and associated risk factors can aid the formulation of evidence-based policy and interventions, such information is scarce in South Africa. We assessed age at onset of tobacco smoking in South Africa and identified its risk factors. Methods: We analysed data of 15,316 respondents aged 15–98 years from the 2012 South African National Health and Nutrition Examination Survey. Descriptive statistics and survival analysis techniques were used alongside weighted percentages. Results: Overall lifetime prevalence of smoking was 20.5%. Among the 3360 ever-smoked respondents, the overall median age at smoking onset was 18 years (Inter-quartile range (IQR) =5) with 2% starting before age 10 while 60% had smoked before age 20. Likelihood of tobacco smoking was higher among adolescents ( = 60 years, thrice higher among males, 29% higher among urban dwellers and thrice higher in Western Cape and Free State than in North West Province. The onset of tobacco smoking was earlier among males, wealthier and “coloured” people from Northern and Eastern Capes. Conclusion: The onset of tobacco smoking peaked at 15–22 years and varied by province, sex, location, race and other characteristics. The age restrictions on smoking in South Africa has changed over time, coupled with the recent open and electronic advertisement of tobacco, and social media could have influenced the earlier onset of tobacco smoking in South Africa. Stricter regulations on tobacco-related advertisement and sales should be implemented. Keywords: Tobacco smoking, South Africa, Birth cohorts, Sex, Race, Tobacco advertisement
Background Tobacco use is responsible for over 8 million deaths every year and this figure is projected to rise to approximately 10 million deaths per year by 2030 [1] and has been ranked as one of the leading causes of * Correspondence: [email protected]; [email protected] 1 Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria 2 Division of Population and Behavioural Sciences, School of Medicine, St Andrews University, Fife, UK Full list of author information is available at the end of the article
preventable deaths globally [2]. According to the WHO, the average global tobacco smoking among populations aged 15 years and older was 21% [3]. Moreover, South Africans aged 15 years and older reported past month tobacco smoking as high as 31.4% [4]. Tobacco use is a risk factor to a range of disability and diseases such as lung cancer, stroke, heart disease and chronic respiratory disease [5, 6]. An important determinant of smoking behaviours in later life is the age of smoking onset. Research across the
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