'Roll-your-own' cigarette smoking in South Africa between 2007 and 2010

Background: The prevalence of smoking and consumption of cigarettes have decreased in South Africa over the last 20 years. This decrease is a result of comprehensive tobacco control legislation, particularly large cigarette tax increases. However, little attention has been given to the potential use of 'roll-your-own' cigarettes as cheaper alternatives, especially among the socio-economically disadvantaged population. This study therefore sought to determine socio-demographic correlates of 'roll-your-own' cigarette use among South African adults (2007-2010). Methods: This secondary data analysis used a merged dataset from two nationally representative samples of 2 907 and 3 112 South African adults (aged >= 16 years) who participated in the 2007 and 2010 annual South African Social Attitude Surveys respectively. The surveys used a face-to-face interviewer-administered questionnaire. The overall response rates were 83.1% for 2007 and 88.9% for 2010. Data elicited included socio-demographic data, current smoking status, type of tobacco products used, past quit attempts and self-efficacy in quitting. Data analysis included chi-square statistics and multi-variable adjusted logistic regression analysis. Results: Of the 1 296 current smokers in this study, 24.1% (n = 306) reported using roll-your-own cigarettes. Some of whom also smoked factory-made cigarettes. Roll-your-own cigarette smoking was most common among black Africans and was more common among male smokers than among female smokers (27% vs 15.8%; p < 0.01). Compared to smokers who exclusively used factory-made cigarettes, roll-your-own cigarette smokers were less confident that they could quit, more likely to be less educated, and more likely to reside in rural areas. The odds of use of roll-your-own cigarette were significantly higher in 2010 than in 2007 (OR = 1.24; 95% CI: 1.07-1.44). Conclusions: Despite an aggregate decline in smoking prevalence, roll-your-own cigarette smoking has increased and is particularly common among smokers in the lower socio-economic group. The findings also suggest the need for a more intensive treatment intervention to increase self-efficacy to quit among roll-your-own cigarette smokers.