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Nicotine Tob Res. 2014 Sep;16(9):1167-73. doi: 10.1093/ntr/ntu044. Epub 2014 Apr 1.

Prevalence and correlates of smokeless tobacco use among grade 8-11 school students in South Africa: a nationwide study.

Author information

  • 1Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa;
  • 2Health Promotion Research and Development Unit, Medical Research Council of South Africa, Cape Town, South Africa;
  • 3Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI;
  • 4Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa; rsewpaul@hsrc.ac.za.
  • 5ARCH Actuarial Consulting, Cape Town, South Africa;
  • 6Department of Health Education and Health Promotion, Maastricht University, Maastricht, the Netherlands.



Smokeless tobacco in South Africa is commonly used in the form of snuff or chewing tobacco. This paper reports its use among secondary school students and provides evidence of its association with demographic characteristics, tobacco smoking, and socioeconomic status.


Data were derived from a nationally representative study conducted in 2008 among 10,270 grade 8-11 students from 192 schools in South Africa. Data were collected with self-administered questionnaires. Multiple logistic regression analyses were used to examine correlates of past-month smokeless tobacco use.


Nationally, 12.4% of students used smokeless tobacco such as chewing tobacco or snuff in the month preceding the survey, with significantly higher rates among males (13.6%) than females (10.6%). Smokeless tobacco use differed between racial groups, with African (12.8%) and colored (11.7%) students having the highest rates of past-month use. Grade 8 students (15.3%) reported significantly higher rates of use than grade 11 students (9.1%). Current cigarette smokers (21.3%) reported a higher prevalence of smokeless tobacco use than noncurrent smokers (10.1%). Logistic regression of past-month smokeless tobacco use showed significant associations with race, grade, school socioeconomic level, urbanicity, current cigarette smoking, and having first smoked a cigarette before the age of 10 years.


These findings provide evidence for policy makers and program developers to develop targeted and tailored interventions for young people regarding smokeless tobacco use.

© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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