Association of snuff use with chronic bronchitis among South African women: implications for tobacco harm reduction

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 investigated a nationally representative sample of 4464 black South African 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(2) statistics, Student t tests and multiple logistic regression analysis. Outcome measure: CB, defined as reporting a productive cough for >= 3 months/ year for at least 2 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 ( 275 litres/ min vs 293 litres/ min; p<0.01). Significant determinants of CB included snuff use >8 times/ day ( odds ratio ( OR) 2.86, 95% CI 1.17 to 7.02), a history of TB ( OR 7.23, 95% CI 4.02 to 13.03), current smoking ( OR 2.84, 95% CI 1.60 to 5.04) and exposure to smoky cooking fuels ( OR 1.98, 95% CI 1.32 to 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.