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Adegbile OE, Adeniji OD, Amzat J, Kanmodi KK. E-cigarettes in Nigeria: A scoping review of evidence. Health Sci Rep 2024; 7:e2074. [PMID: 38660005 PMCID: PMC11040567 DOI: 10.1002/hsr2.2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims E-cigarettes will continue to be a public health issue in Nigeria. To curb the growing menace of the e-cigarette use in Nigeria through evidence-based approach, it is crucial to first map the empirical research landscape of e-cigarettes in Nigeria. No known study has mapped the existing empirical evidence and gaps concerning e-cigarettes in Nigeria; hence, this scoping review was conducted. Methods This scoping review adopted the research design by Arksey and O'Malley. Four databases (PubMed, SCOPUS, CINAHL Complete, and APA PsycINFO) were searched to retrieve literature on e-cigarettes in Nigeria. With the aid of Rayyan web application, all retrieved literature were deduplicated and screened based on the review's eligibility criteria. Only those peer-reviewed journal papers meeting the inclusion criteria were included in the review. Relevant data from the included papers were charted, collated, and summarized. Results A total of six papers were included in this review. The reviewed papers reported a lifetime prevalence of e-cigarette use (or vaping) ranging from 5.8% to 19.8%, with a current e-cigarette use prevalence of 11.8%, among different population groups in Nigeria. The major determinants of e-cigarette use, as reported in these articles, include being a youth, having a health condition, severe anxiety, tobacco use, peer influence, and current alcohol use. Dry mouth and oral lesions (gingival inflammation and oral ulcers) were also identified to be the medical conditions associated with e-cigarette use in Nigeria. Lastly, one of the included papers identified a lack of clear regulation on e-cigarettes in Nigeria. Conclusion There is an urgent need for more scientific investigations on the sociodemographic, economic, health, and regulatory landscape of e-cigarettes in Nigeria, as robust empirical evidence is needed for the effective planning, implementation, and evaluation of evidence-based policies and interventions on e-cigarettes control and regulation in Nigeria.
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Affiliation(s)
- Oluwatobi E. Adegbile
- Department of Biostatistics and EpidemiologyEast Tennessee State UniversityJohnson CityTennesseeUSA
- Campaign for Head and Neck Cancer Education (CHANCE) ProgrammeCephas Health Research Initiative IncIbadanNigeria
| | - Oluwatomilayo D. Adeniji
- Campaign for Head and Neck Cancer Education (CHANCE) ProgrammeCephas Health Research Initiative IncIbadanNigeria
- Department of Community and Behavioral HealthEast Tennessee State UniversityJohnson CityTennesseeUSA
| | - Jimoh Amzat
- Department of SociologyUsmanu Danfodiyo UniversitySokotoNigeria
- Department of SociologyUniversity of JohannesburgJohannesburgSouth Africa
| | - Kehinde K. Kanmodi
- Campaign for Head and Neck Cancer Education (CHANCE) ProgrammeCephas Health Research Initiative IncIbadanNigeria
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- School of DentistryUniversity of RwandaKigaliRwanda
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
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Agaku IT, Sulentic R, Dragicevic A, Njie G, Jones CK, Odani S, Tsafa T, Gwar J, Vardavas CI, Ayo-Yusuf O. Gender differences in use of cigarette and non-cigarette tobacco products among adolescents aged 13-15 years in 20 African countries. Tob Induc Dis 2024; 22:TID-22-20. [PMID: 38259662 PMCID: PMC10801700 DOI: 10.18332/tid/169753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/10/2023] [Accepted: 07/18/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Examining gender differences in youth tobacco use is important as it aligns tobacco control within the context of broader human development goals seeking to eliminate gender inequalities. In this study, we examined gender differences in adolescent use of cigarettes, smokeless tobacco, shisha, and e-cigarettes in Africa. METHODS This was a cross-sectional study using data from the Global Youth Tobacco Survey. Our analytical sample comprised 56442 adolescents aged 13-15 years from 20 African countries. Weighted, country-specific prevalence estimates were computed overall and by gender. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to examine whether correlates of tobacco use differed between boys and girls. RESULTS Ever cigarette smoking prevalence was significantly higher among boys than girls in 16 of the 20 countries, but a significantly higher percentage of girls reported earlier age of cigarette smoking initiation than boys within pooled analysis. Some of the largest gender differences in current cigarette smoking were seen in Algeria (12.2% vs 0.8%, boys and girls, respectively), Mauritius (21.2% vs 6.6%), and Madagascar (15.0% vs 4.1%). Current use of e-cigarettes, shisha, and smokeless tobacco was generally comparable between boys and girls where data existed. Among girls, higher levels of reported exposure to tobacco advertisement were positively associated with shisha smoking whereas perceived tobacco harm was inversely associated with current cigarette and shisha smoking. Among boys, perceived social acceptability of smoking at parties was associated with an increased likelihood of cigarette smoking (APR=2.27; 95% Cl: 1.20-4.30). CONCLUSIONS The prevalence of cigarette smoking among boys was higher than that of girls in many countries. However, girls who smoke tend to start at an earlier age than boys. Differential gender patterns of cigarette and non-cigarette tobacco product use among youth may have implications for future disease burden. As the tobacco control landscape evolves, tobacco prevention efforts should focus on all tobacco products, not just cigarettes.
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Affiliation(s)
- Israel T. Agaku
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Rose Sulentic
- Centers for Disease Control and Prevention Foundation, Atlanta, United States
| | - Adriana Dragicevic
- Centers for Disease Control and Prevention Foundation, Atlanta, United States
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Gibril Njie
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Candace K. Jones
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Satomi Odani
- Osaka International Cancer Institute, Cancer Control Center, Osaka, Japan
| | - Tina Tsafa
- Department of Mass Communication, Benue State University, Makurdi, Nigeria
| | - Joy Gwar
- Department of Clinical Psychology, Federal Medical Centre Makurdi, Makurdi, Nigeria
| | - Constantine I. Vardavas
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, United States
| | - Olalekan Ayo-Yusuf
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Shamhuyenhanzva RM, Muposhi A, Hungwe DR. A downstream social norms approach for curtailing e-cigarette waste: Promising social marketing interventions from consumer interactions. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2023; 41:1238-1245. [PMID: 36922705 DOI: 10.1177/0734242x231160083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Irresponsibly disposed electronic cigarette (e-cigarette) waste poses significant public health and environmental harm. This study explores downstream social marketing interventions that can be used to curtail the growth of e-cigarette waste in South Africa through the lenses of the social norms approach. This study harnesses the power of social marketing to identify downstream interventions that can be used by marketers to curb the problem of e-cigarette waste. An exploratory research design and a qualitative method were employed. Six virtual focus groups were conducted to collect cross-sectional data from South African electronic cigarette users. Reciprocal altruism, social orientation value, moral licensing and ecological beliefs were found to be the main normative influences that characterise e-cigarette waste. The results support the proposition that social marketers should employ a downstream approach to develop interventions to curtail the growth of e-cigarette waste. Such measures are envisaged to complement upstream initiatives. This study offers new insights on how to manage e-cigarette waste in the context of an emerging market.
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Affiliation(s)
- Roy Malon Shamhuyenhanzva
- Department of Marketing, Retail Business and Sport Management, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Asphat Muposhi
- Department of Information and Marketing Sciences, Midlands State University, Gweru, Zimbabwe
| | - Delight Rufaro Hungwe
- Department of Information and Marketing Sciences, Midlands State University, Gweru, Zimbabwe
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Ayo-Yusuf O, Nkosi L, Agaku I. E-cigarette Use and Regulation in South Africa: a Synthesis of Evidence in Response to Industry Efforts to Undermine Product Regulation. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Agaku IT, Nkosi L, Erim D. Estimating the Impact of COVID-19 on Changes in Volume Sales of Cigars, Smokeless Tobacco Products, Pipe, and Roll-your-own Tobacco in the United States. Nicotine Tob Res 2022; 25:318-324. [PMID: 35931420 PMCID: PMC9384638 DOI: 10.1093/ntr/ntac191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 06/29/2022] [Accepted: 08/03/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION We examined the potential impact of COVID-19 on trends in volume sales of non-cigarette combustible and smokeless tobacco products in the United States. AIMS AND METHODS We analyzed monthly national sales for cigars, smokeless tobacco, pipe, and roll-your-own tobacco during June 2019-June 2021. Data were from the U.S Department of the Treasury. Interrupted time-series were used to measure associations of the COVID-19 "shock" (taken as June 2020 or 6 months after the first diagnosis of COVID-19 in the United States) and volume sales. Negative binomial regression was used to evaluate associations between volume sales and changes in community mobility. RESULTS Within interrupted time-series analysis, the shock of the COVID-19 pandemic was associated with an initial increase in the number of little cigars sold by 11.43 million sticks (p < .01), with no significant sustained change in trend. The COVID-19 shock was also associated with an initial increase in large cigar volume sales by 59.02 million sticks, followed by a subsequent decrease by 32.57 million sticks per month (p = .005). Every 10% reduction in mobility to retail stores was significantly associated with reduced volume sales of little cigars (IRR = 0.84, 95% CI, 0.71 to 0.98) and large cigars (IRR = 0.92, 95% CI, 0.88 to 0.96). Other findings were statistically nonsignificant. CONCLUSIONS COVID-19 was associated with increased volume sales for cigars and there was a significant association between reduced mobility to points of sale and reduced cigar volume sales. Intensified efforts are needed to prioritize evidence-based tobacco prevention and control efforts amidst the pandemic.
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Affiliation(s)
- Israel T Agaku
- Corresponding Author: Israel Agaku, PhD, Harvard School of Dental Medicine, Boston, MA Tel: +1 (404) 580-3276;
| | - Lungile Nkosi
- Sefako Makgatho Health Sciences University (SMU), Pretoria, South Africa
| | - Daniel Erim
- Lineberger Comprehensive Cancer Center, University of North Carolina, USA
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Soepnel LM, Kolkenbeck-Ruh A, Crouch SH, Draper CE, Ware LJ, Lye SJ, Norris SA. Prevalence and socio-structural determinants of tobacco exposure in young women: Data from the Healthy Trajectories Initiative (HeLTI) study in urban Soweto, South Africa. Drug Alcohol Depend 2022; 232:109300. [PMID: 35042098 DOI: 10.1016/j.drugalcdep.2022.109300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/20/2021] [Accepted: 01/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Tobacco use is a major public health risk worldwide, which has increased on the African continent over the past 40 years. Socio-economic factors impact tobacco use and exposure, but little is known about the scope of this problem in young women living in an urban, historically disadvantaged township in contemporary South Africa. This study aimed to identify the prevalence of tobacco use in a cohort of young South African women using serum cotinine, and to assess the association between a number of socio-economic and social factors and tobacco use in this setting. METHODS Secondary analysis was conducted on cross-sectional data from the Healthy Life Trajectories Initiative (HeLTI) study. Serum cotinine was measured and a cut-off of ≥ 10 ng/mL was classified as tobacco use. Household socio-economic, socio-demographic and health information were collected by an interviewer-administered questionnaire. RESULTS Cotinine data was available for 1508 participants, of whom 29.2% (n = 441) had cotinine levels indicative of tobacco use. In regression analyses, moderate to severe socio-economic vulnerability (score 2-3 OR 1.66, p = 0.008; score ≥4: OR 1.63, p = 0.026) and multiparity (OR 1.74, p = 0.013) were associated with tobacco use. In addition, alcohol dependence (OR 3.07, p < 0.001) and drug use (OR 4.84, p < 0.001) were associated with tobacco use. CONCLUSION Young women with multiple children, moderate to severe socio-economic vulnerability, and alcohol and drug use were identified as more likely to use tobacco, indicating the need for targeted anti-tobacco interventions to curb the impact of tobacco on the growing burden of noncommunicable diseases in this setting.
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Affiliation(s)
- Larske M Soepnel
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3 Wits, Johannesburg 2050, South Africa; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Huispost nr. Str. 6.131, P.O. Box 85500, Utrecht 3508 GA, The Netherlands.
| | - Andrea Kolkenbeck-Ruh
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3 Wits, Johannesburg 2050, South Africa
| | - Simone H Crouch
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3 Wits, Johannesburg 2050, South Africa
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3 Wits, Johannesburg 2050, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3 Wits, Johannesburg 2050, South Africa; DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, 27 St Andrew's Road, Education Campus, Johannesburg 2193, South Africa
| | - Stephen J Lye
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3 Wits, Johannesburg 2050, South Africa; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Department of Obstetrics and Gynecology, Department of Physiology and Medicine, University of Toronto, 600 University Ave., Toronto M5G 1×5, ON, Canada
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3 Wits, Johannesburg 2050, South Africa; School of Health and Human Development, University of Southampton, University Road, Southampton SO17 1BJ, UK
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O'Connor R, Schneller LM, Felicione NJ, Talhout R, Goniewicz ML, Ashley DL. Evolution of tobacco products: recent history and future directions. Tob Control 2022; 31:175-182. [PMID: 35241585 DOI: 10.1136/tobaccocontrol-2021-056544] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022]
Abstract
Declines in cigarette smoking prevalence in many countries and the consolidation of the tobacco industry have prompted the introduction of other forms of nicotine delivery. These include electronic nicotine delivery systems (ENDS), heated tobacco products (HTPs) and oral nicotine products (ONPs). Evolving over time, some of these products now deliver nicotine at levels comparable to cigarettes and may serve as effective substitutes for smokers. However, certain products, especially ENDS like JUUL, have also appealed to youth and non-smokers, prompting concerns about expanding nicotine use (and potentially nicotine addiction). The tobacco industry could shift away from primarily promoting cigarettes to promoting ENDS, HTPs and/or ONPs, though at this time it continues to heavily promote cigarettes in low and middle-income countries. Differing regulatory regimes may place upward and downward pressures on both cigarettes and these newer products in terms of population use, and may ultimately drive the extent to which cigarettes are or are not displaced by ENDS, HTPs and/or ONPs in the coming decade.
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Affiliation(s)
- Richard O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA richard.o'
| | - Liane M Schneller
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Nicholas J Felicione
- Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Reinskje Talhout
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Erinoso O, Oyapero A, Amure M, Osoba M, Osibogun O, Wright K, Osibogun A. Electronic cigarette use among adolescents and young adults in Nigeria: Prevalence, associated factors and patterns of use. PLoS One 2021; 16:e0258850. [PMID: 34679087 PMCID: PMC8535460 DOI: 10.1371/journal.pone.0258850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) have emerged in the Nigerian market, and if used without supervision, may have damaging effects on the physical and mental health of users. Therefore, there is a need to determine the patterns of use, especially among adolescents and young adults. This study aims to assess the prevalence and factors associated with electronic cigarette use, as well as the relationship between their use and anxiety among adolescents and young adults in Lagos, Nigeria. METHOD An online cross-sectional study among participants aged between 15-35 years. The survey had three sections: sociodemographic information, the pattern of e-cigarette use, and a 7-item Generalized Anxiety Disorder (GAD-7) scale. Bivariate and multivariable logistic regression analysis was used to identify factors associated with e-cigarette use. P-values <0.05 were considered significant. Statistical analysis was done using STATA-15.0 software. RESULTS Data from a total of 949 respondents was analysed. Participants had a mean age of 23.36 years (±3.97) and were predominantly female (55.64%). The prevalence of e-cigarette ever-use was 7.9% (95% CI: 5.8,10.0). Older age and being male were independently associated with higher odds of e-cigarette use. After adjusting for age and sex, alcohol use (p<0.001), friend's use (p<0.001), and other tobacco product or substance use (p:0.05) remained significantly associated with higher odds of e-cigarette use. There was no association between anxiety levels and e-cigarette use. CONCLUSION These findings suggest a higher likelihood of e-cigarette use among alcohol consumers, poly-tobacco or substance users and individuals with friends who use e-cigarettes. Health providers and policy makers in Nigeria might consider preventive measures aimed at young adults with the identified risk factors, as well as close monitoring of trends in e-cigarette use in the coming years.
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Affiliation(s)
- Olufemi Erinoso
- Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Afolabi Oyapero
- Department of Preventive Dentistry, Lagos State University College of Medicine, Lagos, Nigeria
| | - Mary Amure
- Department of Preventive Dentistry, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Moyosoore Osoba
- African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun State, Nigeria
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - Kikelomo Wright
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
| | - Akin Osibogun
- Department of Community Health and Primary Health Care, College of Medicine, University of Lagos, Lagos, Nigeria
- * E-mail:
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Agaku IT, Egbe CO, Ayo-Yusuf OA. E-cigarette advertising exposure among South African adults in 2017: findings from a nationally representative cross-sectional survey. BMJ Open 2021; 11:e048462. [PMID: 34400455 PMCID: PMC8370548 DOI: 10.1136/bmjopen-2020-048462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In South Africa, the Control of Tobacco and Electronic Delivery Systems Bill seeks to regulate e-cigarettes as tobacco products, including their advertising, promotion and sponsorship. Population data on e-cigarette advertising in South Africa are needed to inform public health programs, practice and policy. We examined self-reported e-cigarette advertising exposure during 2017. DESIGN: Cross-sectional. SETTING Household-based survey. PARTICIPANTS 3063 individuals who participated in the 2017 South African Social Attitudes survey, a nationally representative, in-person survey of the non-institutionalised civilian adult population aged ≥16 years EXPOSURE: 'In the past 12 months, have you seen advertisements or promotions for e-cigarettes (including e-shisha, e-pipe) on any of the following media: newspapers/magazines, billboards, in the malls or any other source?' MAIN OUTCOMES Beliefs and attitudes regarding e-cigarettes. FINDINGS Participants' mean age was 37.7 years. Overall, 20.1% reported exposure to e-cigarette advertisements. By age, exposure was most prevalent among those aged 16-19 years (24.6%). Top sources of exposure among those exposed were stores, 40.7%; malls, 30.9%; and television, 32.5%. Of those aware of e-cigarettes, 61.2% believed 'e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes'; 62.7% believed that 'e-cigarette advertisements and promotions may make ex-smokers think of starting smoking cigarettes again'; and 59.5% supported the statement that 'e-cigarette smoking should be banned indoors just as traditional cigarette smoking'. Notably, teens aged 16-19 reported the lowest prevalence (49.0%) of those believing that 'e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes', whereas this percentage was highest among those aged 55-64 years (73.2%). CONCLUSION Comprehensive regulatory efforts are needed to address e-cigarette advertising, marketing and sponsorship in order to protect public health. The urgent enactment of the new tobacco control legislation, The Control of Tobacco Products and Electronic Delivery Systems Bill, can help reduce youth exposure to e-cigarette advertising in South Africa.
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Affiliation(s)
- Israel Terungwa Agaku
- School of Health System & Public Health, University of Pretoria, Pretoria, South Africa
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Olalekan A Ayo-Yusuf
- School of Health System & Public Health, University of Pretoria, Pretoria, South Africa
- Africa Centre for Tobacco Industry Monitoring and Policy Research, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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