Re-emergence of Traditional Tobacco Products Usage in South Africa: an Unintended Consequence of Existing Tobacco Control Policy

South Africa has made observable and globally acknowledged successes in tobacco control. This paper examines a decade of the response to tobacco control policy in South Africa. It draws on previously published data and preliminary results from a recently conducted national survey of patterns and forms of tobacco products used in South Africa. Results suggest that smoking prevalence has decreased from 34% in 1993 to 21.4% in 2003, albeit a slower decline in the last five years among males. Similarly, smokeless tobacco (snuff) use has decreased from 12.6% in 1998 to 8.4% in 2003 among black South African women, and from 18.2% in 1999 to 14.5% in 2002 among adolescents. This is despite the lack of excise tax on snuff. However, the use of snuff, previously used only by the elders, remains high among adolescents. The use of hand-rolled smoked-tobaccos accounted for 19% of total tobacco consumption and it is especially common among the socially disadvantaged group in South Africa. The continued prominence of the use of traditional nicotine-delivery vehicles – snuff and hand-rolled smoked tobaccos may represent consumers’ method for compensating for the increases in cigarette prices. Indeed, an unintended consequence of the existing policy environment. The study highlights the need to establish culturally relevant tobacco cessation services and suggests the need for a combination of tax reform and product regulation.