Cigarette smoking trends and social disparities among South African adults, 2003-2011

Introduction: Cigarette prices have almost doubled in South Africa within the past decade due to pricing/taxation policies. Little is known about the equity impact of these price increases in concert with other tobacco control policies. This study therefore examined trends in current cigarette smoking overall and by socioeconomic status (SES) in South Africa during 2003-2011. Methods: Data were obtained from the 2003 (n = 2,855), 2007 (n = 2,907), and 2011 (n = 3,003) South African Social Attitudes Survey. Educational attainment (> grade 12, grade 12, grade 1-11, or no education) was used as a proxy for SES, and all analyses were restricted to respondents aged ≥25 years. Trends in current cigarette smoking-defined as daily or some days use of cigarettes- during 2003-2011 were assessed with estimates of annual percentage change (APC), while smoking disparities were assessed with relative concentration index (RCI). Results: Although no significant change was observed in the overall prevalence of current smoking during 2003-2011, declines were observed among those with no education (APC = -8.2; p <.05 for linear trend). However, increased smoking was observed among the most educated women (from 4.0% in 2003 to 13.1% in 2011; p <.05 for linear trend). The RCI by educational status changed significantly during the study period, from 0.80 (2003) to 1.35 (2007) to 1.94 (2011). Conclusions: The policy environment in South Africa during 2003-2011 had a significant positive equity impact by SES, even though no aggregate change in smoking prevalence was observed. Intensified implementation of taxation measures as part of a comprehensive tobacco control may further reduce smoking disparities.