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Association of snuff use with chronic bronchitis among South African women: implications for tobacco harm reduction
  1. Olalekan A Ayo-Yusuf1,4 (lekan.ayoyusuf{at},
  2. Priscilla S Reddy2 (priscilla.reddy{at},
  3. Bart W Van den Borne3 (b.vdborne{at}
  1. 1 University of Pretoria, South Africa;
  2. 2 Health Promotion Research and Development Group, Medical Research Council, Cape Town., South Africa;
  3. 3 Department of Health Education and Health Promotion, Maastricht University, Maastricht, Netherlands


    Objective: Nasal use of snuff is the predominant form of tobacco use among black South African women. This study examines the association between snuff use and chronic bronchitis (CB) among black South African women.

    Design: The study investigates a nationally representative sample of 4,464 black women ≥25 years old who participated in the 1998 South African Demographic and Health Survey. Data on participants’ tobacco use patterns, medical history and other relevant factors were obtained through an interviewer-administered questionnaire. Peak expiratory flow rates (PEFR) were also measured. Data analysis included chi-square statistics, t-tests and multiple logistic regression analysis.

    Outcome measure: CB, defined as reporting a productive cough for ≥3months/year for at least two successive years.

    Results: The prevalence of current snuff use was 16.1% (n=719). Compared to non-users of snuff, snuff users were not only more likely to present with a history of tuberculosis (TB) (23.3% vs. 15.9%; p=0.06), but they were also more likely to present with CB (5.3% vs. 2.8%; p<0.01) and a lower PEFR (275L/min vs. 293L/min; p<0.01). Significant determinants of CB included snuff use >8 times/day (OR 2.86, 95% CI 1.17, 7.02), a history of TB (OR 7.23, 95% CI 4.02, 13.03), current smoking (OR 2.84, 95% CI 1.60, 5.04) and exposure to smoky cooking fuels (OR 1.98, 95% CI 1.32, 2.96).

    Conclusions: These data suggest that snuff use, in the form predominantly used in South Africa, increases the risk of CB. This challenges the idea that snuff may be a much less harmful alternative to smoking in South Africa.

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    • 4 Corresponding author.

      E-mail lekan.ayoyusuf{at}

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