Changes in tobacco use in rural South Africa during the 2020 tobacco sales ban: an analysis of current and previous behaviours using cross-sectional data.

Background: As part of its COVID-19 response, South Africa banned tobacco sales between March and August 2020. We examined self-reported tobacco use before, during and after the ban among a rural South African population with high HIV prevalence.

Methods: Between May 2021 and November 2022, we conducted a telephonic survey on tobacco use among a purposively selected subset of a population-based cohort in rural KwaZulu-Natal. We compared the prevalence and characteristics of people who retrospectively reported tobacco use (combustible, smokeless and/or electronic cigarettes) before, during and after the ban. Multiple logistic regression assessed predictors of tobacco use during and after the ban.

Results: Of 1448 people eligible, 752 (51.9%) completed the survey. Among 449 people who used tobacco before the ban, 118 (26.3%, 95% CI 22.2% to 30.4%) reported abstinence during the ban, of whom 103 (87.3%, 95% CI 81.3% to 93.3%) relapsed afterwards. Of the 39 people (8.7%, 95% CI 6.1% to 11.3%) abstinent after the ban, most had used tobacco during the ban and quit afterwards. People with HIV were more likely than people without HIV to stop during the ban (adjusted OR (aOR) 1.57, 95% CI 1.01 to 2.44, p=0.046). For each unit increase in daily combustible tobacco use before the ban, individuals were less likely to stop using tobacco during the ban (aOR 0.92, 95% CI 0.88 to 0.97, p<0.001).

Conclusions: South Africa's 2020 tobacco sales ban, prompted by the COVID-19 pandemic, was associated with a 26% decrease in retrospectively reported tobacco use prevalence among a rural cohort. Tobacco use largely, but not completely, rebounded after the ban.