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Unveiling the Smoke Screen: Tobacco Use in South Africa

Updated: Jan 27

Unveiling Tobacco Use in South Africa: Challenges, Youth Targeting, and the Path to a Smoke-Free Future

This article explores the formidable challenge of tobacco use in South Africa, covering prevalence, mortality, youth targeting, and the path towards a smoke-free future. With approximately 22% of the population affected, tobacco-induced diseases claim 42,100 lives annually. Prenatal and childhood exposure pose serious health risks, while the tobacco industry strategically targets youth. The article discusses the regulation of electronic cigarettes and emphasizes the need for innovative strategies, effective policy implementation, and ongoing research to combat tobacco-related challenges. It concludes with a call to action for a smoke-free future prioritizing the nation's health and well-being.



Tobacco use in South Africa stands as a formidable public health challenge, casting a long shadow over the nation's well-being. This article delves into the prevalence of tobacco use, the dire consequences on mortality and diseases, the alarming impact on prenatal and childhood health, the insidious targeting of youth by the tobacco industry, the evolving realm of electronic cigarettes, and the persistent challenges that demand innovative solutions for a smoke-free future.


Tobacco use asserts its dominance, gripping approximately 22% of South Africa's population. Cigarette smoking, a significant contributor, accounts for 21.5% of the populace (SAMRC 2016). The prevalence of this habit goes beyond personal choices, translating into a pressing public health issue with far-reaching consequences.

Mortality and Diseases

Annually, tobacco-induced diseases claim the lives of about 42,100 South Africans, unleashing a spectrum of afflictions such as chronic obstructive pulmonary disease (COPD), various cancers, diabetes, cardiovascular diseases, asthma, and other non-communicable diseases (WHO 2021). Second-hand tobacco smoke exposure exacerbates the toll, with 48% of non-smokers in South Africa facing the risk in public places and at home (Ngobese et al 2020). Tobacco smoking not only worsens communicable diseases like tuberculosis, HIV, and COVID-19 but also amplifies the silent killers lurking in the shadows.

Prenatal and Childhood Exposure

The Drakenstein Child Health Study paints a concerning picture, revealing that 18% of infants at birth show signs of active smoking, while 30% bear the burden of second-hand smoke exposure (Vanker et al. 2018). Prenatal exposure wreaks havoc on pregnancy and birth outcomes, leading to a myriad of issues such as intrauterine growth retardation, low birth weight, preterm birth, congenital malformations, stillbirth, and impaired lung growth in early life (Berlin et al. 2018; Westwood et al. 2021). Children exposed to second-hand smoke face heightened risks, including Attention Deficit Hypersensitivity Disorder (ADHD), asthma, wheezing, and an increased cancer risk (Burke et al. 2012).

Youth Targeting by the Tobacco Industry

Young South Africans find themselves in the crosshairs of both the tobacco and electronic cigarette industry. A 2021 study exposes the calculated tactics, with nearly 50% of identified electronic cigarette shops strategically positioned within a 5km radius of higher educational institutions. This proximity correlates with increased e-cigarette use among young adults aged 18–29 years (Agaku et al. 2021), painting a grim picture of the youth's vulnerability to the tobacco industry's manipulative strategies.

Regulation of Electronic Cigarettes

The current tobacco law in South Africa fails to regulate electronic cigarettes. However, a potential turning point lies in a new tobacco bill, unveiled for public comment in 2018, which aims to bring e-cigarettes under regulatory scrutiny once passed. The unfolding narrative of electronic cigarettes adds complexity to the battle against tobacco, demanding careful consideration and effective regulation.

Challenges and Future Directions

Despite past efforts to curb tobacco use, challenges persist, necessitating innovative strategies to navigate the evolving tobacco consumption landscape. The way forward involves a multi-faceted approach, incorporating ongoing research, effective policy implementation, and targeted interventions. Tackling tobacco-related morbidity and mortality in South Africa requires a concerted effort, a call to action for a smoke-free future that prioritizes the nation's health and well-being.

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