• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Utilisation of smoking cessation aids among South African adult smokers: findings from a national survey of 18 208 South African adults

    2021-04-06 08:51:14IsraelAgakuCatherineEgbeOlalekanAyoYusuf
    Family Medicine and Community Health 2021年1期

    Israel Agaku, Catherine Egbe, Olalekan Ayo- Yusuf

    ABSTRACT

    INTRODUCTION

    During 2016, 21.5% of South African adults smoked ciga—rettes.1About 20% of deaths from pulmonary tubercu—losis, and 8% of all deaths in South Africa are attributable to smoking.23Several of the 10 leading causes of death in South Africa (eg, tuberculosis, pneumonia, heart disease, cerebrovascular disease, diabetes, hypertensive disease and chronic respiratory disease) are caused, exacerbated or associated with smoking.245Quitting smoking reduces the risk for smoking— related morbidity and mortality. While several cessation aids exist in South Africa, including the national quit— line (011 720 3145) and clinical resources (eg, pharmacotherapy and cessa—tion counselling), the limited evidence to date reveals gaps in access and utilisation.67Only 29.3% of South African smokers received healthcare professional advice to quit smoking during 2012.8South Africa has progres—sively passed several policies over the past few decades to encourage smoking cessation.9—12However, smoking cessation medications are not included in the essential medicines list for South Africa, and therefore, all asso—ciated costs for these medications must be paid out— of— pocket, a challenge for individuals of low socioeconomic position.13—15Data are needed, not only on what smokers are using to quit smoking (ie, cessation aids), but also why smokers are trying to quit (ie, cessation triggers), as this could inform public health policies, programmes and practice.

    The Health Belief Model provides an appropriate frame—work through which to examine and address smoking cessation interventions in South Africa.16Applied to smoking cessation, this psychosocial model suggests that smokers will attempt to quit if they perceive themselves to be susceptible to smoking— attributable morbidity or mortality (eg, because of an underlying health condi—tion or a health scare), and believe that the benefits of smoking cessation (health and/or economic) outweigh any perceived downsides (eg, diminished smoking sensory experience). Other components of the model have some implications for clinical and public health practitioners. For example, cues to action may include advice or assis—tance from a healthcare provider to motivate quitting. Such cues may also include comprehensive smoke— free policies and other population— level educational interven—tions that have been demonstrated in previous research to be associated with quitting behaviour.4Perceived self— efficacy (belief in being able to quit successfully) is a very important component of the model as it offers insights into the smoker’s current stage of change (precontem—plation, contemplation, action, maintenance),17and may also have implications for usage of evidence— based cessation aids.18For example, smokers who are not confi—dent of their ability to quit successfully cold turkey may be more inclined to use smoking cessation aids as part of their quit attempt.

    To better understand these issues within the South African context, this study analysed a large sample of current combustible tobacco smokers to assess use of cessation aids as well as demographic and psychographic correlates of cessation behaviour. Specific research ques—tions were as follows: (1) What percentage of current combustible smokers have ever attempted to quit during their lifetime, and what types of cessation aids have they ever used? (2) What are barriers to smoking cessation among current combustible smokers who have never attempted to quit during their lifetime? A better under—standing of these issues is important for comprehensive tobacco prevention and control activities in South Africa.

    METHODS

    Data sources

    This was a cross— sectional, web— based survey of South African adults aged ≥18 years conducted in July 2018 (n=18 208). Online participants were recruited from the national consumer database for News24—South Afri—ca’s largest digital publisher. As an incentive, consenting participants were eligible for a raffle draw prize of R5000 for completing the survey. Survey completion rates among eligible individuals who clicked on the email invi—tations was 75.3% (20 383/27 087, online supplemental figure 1). For our main analyses, the denominator was current smokers of any combustible tobacco product (ie, cigarettes, cigars, pipes or roll— your— own (RYO) cigarettes; n=5657), who indicated they had not quit smoking at the time of the survey and smoked every day, some days, or rarely.

    Measures

    Current combustible tobacco use

    Current combustible tobacco smokers (n=5657) were defined as individuals who self— identified as being a regular user of any ‘smoke or smokeless’ product in general and reported using at least one combustible tobacco product at the time of the survey at any frequency (cigarettes, pipes, cigars and RYO tobacco). Those who answered ‘used but stopped’ to all of the combustible tobacco products assessed were excluded from the analyses.

    Quitting intentions, behaviours, attitudes and cessation aids

    Smokers were classified as having no quit intention if they indicated: ‘I’ve never tried to quit and don’t want to’ or ‘I’ve tried before and failed, so why try again?’ A past quit attempt was defined as a report by a smoker that they had made ≥one quit attempt in their lifetime, regardless of success. Participants were classified as having success—fully quit within the past year if they answered ‘less than a month’; ‘1—6 months’ or ‘6—12 months’ to the question ‘How long ago did you quit smoking?’ Triggers for past quit attempts (among those who had ever tried to quit) as well as potential/perceived triggers for future quit attempts (among those who had never tried to quit) were also assessed.

    We were interested in past use of evidence— based cessa—tion aids (among those who had ever tried to quit) as well as planned use (among those with quit intentions). The full list of response options for each assessed item in terms of ever or current use status was ‘never heard of’; ‘heard of, never used’, ‘use rarely/once off’, ‘use regularly’ and ‘used but stopped’. Usage, both ever (‘use rarely/once off’, ‘use regularly’ and ‘used but stopped’) and current (‘use rarely/once off’, ‘use regularly’), was determined for the following cessation aids: (1) ‘nicotine sprays’ (eg, Quit); (2) ‘nicotine gums’ (eg, Nicorette); (3) ‘pharmaceutical medication to stop smoking’ (eg, Zyban, Champix); (4) ‘smoking cessation programmes’ (eg, SmokEnders, Allan Carr) (ie, cessation counselling programmes). Responses (1) or (2) were classified as nicotine replacement therapy (NRT). Responses (1), (2) or (3) were classified as any medication. Any of aids (1) through (4) was classified as having used any cessation aid. Smokers were classified as being aware of each of the above interventions if they had ever used it, or ‘heard of, (but) never used’. Planned use of cessation aids was ascertained for ‘if/when (respondents) were ready to quit smoking; those answering ‘I would rely on willpower’ were classified as intending to quit cold turkey. Inveterate smokers were defined as current combustible smokers who had never made a quit attempt in their lifetime and had no intention to quit smoking.

    Sociodemographic and other characteristics

    These included race/ethnicity, gender, age, monthly personal income and self— rated health status.

    Analyses

    Calibration weights were developed using raking (itera—tive proportional fitting); population marginal distribu—tions on the weighting variables were derived from the 2017 South African census projections (ie, reference population). Weighting was done using three adjustment variables: age, gender and race/ethnicity. Percentages and bootstrapped CIs were calculated for descriptive analyses; non— overlap of CIs was used, along with X2tests, to determine whether prevalence estimates were significantly different from each other. Bootstrapping, a non— parametric approach, was used to compute CIs for prevalence estimates in the absence of non— probability— based sampling. Because of the large amount of descrip—tive data, we minimised the number of statistical subgroup comparisons to avoid type I statistical error. Instead, infer—ences regarding global differences were largely made conservatively based on presence or absence of overlap of the computed 95% CIs. Logistic regression analyses were used to explore correlates of reporting specific quit triggers among those who had made a past quit attempt; predictor variables assessed were race/ethnicity, gender, age, monthly personal income, self— rated health status and age at smoking initiation. We also modelled quit attempt as a function of reported reason for smoking behaviour, controlling for aforementioned independent variables. Statistical significance was assessed at p<0.05. All statistical analyses were performed with R V.3.6.1.

    SENSITIVITY ANALYSES

    The inherent limitations of the web survey in terms of potential measurement and selection biases led us to conduct sensitivity analyses to determine how certain key measures from the weighted analyses compared with those from a nationally representative household survey of South African adults—the 2017 South African Social Attitudes Surveys (SASAS). We compared the following indicators that were present in both surveys: (1) preva—lence of current any tobacco use and of current cigarette smoking; (2) percentage of smokers who made a quit attempt (lifetime quit attempt assessed in web survey vs past year quit attempt in SASAS) and (3) percentage of those who made a quit attempt that used any cessation aid.

    RESULTS

    Weighted distributions among all respondents overall revealed that most individuals (68.8%) were Black Afri—cans and women (52.2%). Other demographic charac—teristics are available in table 1. Overall, 72.0% of the population reported ever use prevalence of at least one tobacco product. Current use prevalence was as follows: any tobacco product (23.2%); any combustible tobacco product (22.4%) and cigarettes (22.1%); (table 1). Overall, 98.7% of current smokers of any combustible tobacco were current cigarette smokers.

    Significant differences in tobacco use prevalence were seen among all demographic groups assessed, as evidenced from non— overlap of CIs in table 1. Awareness of cessation aids was as follows among current combus—tible smokers: smoking cessation programmes, 50.8%; NRT, 92.1%; prescription cessation medication, 68.2%. Awareness of cessation aids was lowest among Black Afri—cans, men, and persons with little or no income (table 2).

    Differences in cessation behaviours and attitudes by demographic characteristics

    A past quit attempt was reported by 74.6% of all current combustible smokers (table 2). The proportion reporting a past quit attempt was highest and lowest among the following groups (all p<0.05): white group (79.0%) versus other race (71.1%); persons’ aged ≥66 years (82.4%) versus 18—25 years (67.4%); those earning monthly income of R30 001—50 000 (81.5%) versus undisclosed income (68.9%); and those reporting ‘bad’ (81.8%) versus ‘very good’ health (65.6%).

    Factors triggering a quit attempt also varied by subgroups (table 3). Men were less likely than womento attempt to quit because of family/partner pressure, including having kids (adjusted OR (AOR)=0.84), but more likely to attempt following advice from a health professional (AOR=1.24); a New Year’s Resolution (AOR=1.31); increasing cost of cigarettes (AOR=1.44); a health scare (AOR=1.61) and desire for a healthier lifestyle (AOR=1.70). Compared with Black Africans, all other race/ethnic groups had lower odds of attempting to quit because of a health scare but were all more likely (except Indians/Asians) to quit because of increasing cost of cigarettes. Interestingly, income status was not inde—pendently associated with having made a quit attempt because of increasing cost of cigarettes; it was however associated with attempting to quit on account of advice from a health professional. Smokers with suboptimal self— rated health reported higher odds of attempting to quit following advice from a health professional or after a health scare, compared with those reporting ‘very good’ health. Compared with those aged 18—25 years, the odds of attempting to quit because of public smoking banswere higher among those aged 56—65 years (AOR=2.33) and ≥66 years (AOR=3.61) (all p<0.05). Older adults aged 56—65 years were also more likely to attempt to quit after a specific health scare incident (AOR=2.21), but less likely to attempt out of a general desire to maintain a healthy lifestyle (AOR=0.47) (all p<0.05).

    Table 1 Ever* and current? use of tobacco products among South African adults, 2018 (n=18 208)

    Table 2 Awareness, intentions and behaviours of South African smokers in relation to smoking cessation among current smokers of any combustible tobacco product, 2018 (n=5657)

    Continued

    Table 2 Continued

    Continued

    Table 3 Correlates of specifci quit triggers among current smokers of any combustible tobacco product who have made a past quit attempt in their lifetime, South Africa, 2018 (n=4309)

    My healthcare provider (doctor/pharmacist) suggested I should quit 3.59 (2.24 to 5.77)*6.11 (3.66 to 10.20)*6.72 (3.49 to 12.91)*New Year’s Resolution 1.18 (0.86 to 1.62)0.90 (0.60 to 1.33)0.58 (0.29 to 1.17)Cost of cigarettes 1.26 (0.98 to 1.63)1.34 (0.98 to 1.82)0.83 (0.50 to 1.38)The law: I can’t smoke in so many public places now 1.70 (0.84 to 3.45)1.63 (0.71 to 3.71)2.73 (0.97 to 7.68)Wanted a healthy lifestyle 1.58 (1.23 to 2.04)*2.07 (1.50 to 2.86)*1.20 (0.74 to 1.96)Health scare 2.28 (1.65 to 3.17)*3.18 (2.19 to 4.61)*4.12 (2.43 to 6.98)*Family/partner pressure (including having kids)1.11 (0.85 to 1.43)1.05 (0.77 to 1.44)0.88 (0.53 to 1.45) Moderate Bad Very bad*Asterisks (*) indicate statistical significance at p<0.05.ZAR, South African rand.

    Use of different cessation aids among current combus—tible smokers who made a past quit attempt was as follows (table 4): any medication (ever use, 40.0%; current use, 28.0 %); counselling (ever use, 9.8%; current use, 7.1%); any cessation aid, that is, pharmacotherapy and/or coun—selling (ever use, 42.8%; current use, 31.0%). Online supplemental figure 2 shows the prevalence of ever use of different cessation aids among those who quit in the past year. Disparities existed in use of cessation aids among current combustible smokers who made a past quit attempt; current use of any cessation aid among white group (45.7%) was almost twofold higher than among Black Africans (24.6%) or coloured (24.3%). Similarly, current use of any cessation aid among those earning R30 001—50 000 monthly (46.1%) was approximately fourfold higher than those with no income (12.2%).

    Of current combustible smokers intending to quit, 66.7% indicated interest in using a cessation aid for future quitting and only 33.3% wanted to quit cold turkey. By specific aids, 24.7% of those planning to use any cessa—tion aid were interested in getting help from a pharma—cist, 44.6% from a doctor, 49.8% from someone who had successfully quit, 30.0% from a family member and 26.5% from web resources. Past use of any cessation aid was a determinant of planned use (AOR=1.67, p<0.05). Demo—graphic variations in planned and past utilisation of cessa—tion aids are highlighted in tables 2 and 4, respectively. Of all current combustible smokers regardless of past quit attempt, 27.1% reported current use of a smoking cessa—tion aid.

    Differences in cessation behaviours and attitudes by psychographic and other tobacco-use characteristics

    Among current combustible smokers who had made a quit attempt, ever e— cigarette users were more likely than never e— cigarette users to have ever used cessation counselling (AOR=1.92; 95% CI=1.55 to 2.37); NRT (AOR=1.73; 95% CI=1.50 to 1.99); prescription medica—tion (AOR=1.55; 95% CI=1.33 to 1.81) and any cessation aid (AOR=1.72; 95% CI=1.50 to 1.97), after adjusting for age, gender, race, income and heaviness of smoking. Among current combustible smokers, ever and current e— cigarette users were also more likely to report current use of cessation aids at the time of the survey (table 5). Figure 1 compares the number of different cessation aids ever used of the four specific aids assessed: nicotine patch, nicotine spray, prescription medication and cessation counselling. The results showed that among e— cigarette never users, the percentages that reported ever use of 0, 1, 2, 3 or all 4 cessation aids were 64.1%, 23.2%, 8.8%, 2.8% and 1.1%, respectively; the corresponding percent—ages among e— cigarette ever users were 49.4%, 26.3%,15.8%, 6.0% and 2.5% (p<0.05). Among all ever e— cig—arette users, 43.5% were current combustible tobacco smokers; of current e— cigarette users, 97.5% were current combustible tobacco smokers.

    Table 4 Ever and current use of cessation aids among South African current combustible tobacco smokers who have made a past quit attempt, 2018 (n=4309)

    Continued

    Table 5 Smoking cessation behaviours and attitudes among South African current combustible tobacco smokers who made a past quit attempt,* by e- cigarette use status,? 2018 (n=4309)

    Figure 1 Number of distinct cessation aids ever used by current combustible smokers who had made a quit attempt, overall and by e- cigarette use status. Denominator was smokers who had tried to quit at least once in their lifetime. Ever use of the assessed cessation aids was defined as use of the specified cessation aid at least once in a lifetime. Four distinct cessation aids were assessed including ‘nicotine sprays (eg, Quit)’; ‘nicotine gums (eg, Nicorette)’; ‘pharmaceutical medication to stop smoking (eg, Zyban, Champix)’ and ‘smoking cessation programmes (eg, SmokEnders, Allan Carr)’. E- cigarette never users defined as smokers who have never used e- cigarettes in their lifetime, not even once or twice. E- cigarette ever users defined as smokers who have used e- cigarettes at least once in their lifetime. E- cigarette current users defined as persons who indicated that they used at least one ‘smoke or smokeless’ tobacco product regularly and also indicated e- cigarette use at any frequency at the time of the survey.

    Among current combustible smokers, increasing cost of cigarettes predicted an attempt to quit cigarette smoking among e— cigarette ever versus never users (AOR=1.24; 95% CI=1.09 to 1.41). E— cigarette ever users were also more likely to attempt to quit smoking cigarettes because of advice from a doctor or pharmacist (AOR=1.21; 95% CI=1.02 to 1.44).

    Figure 2 Reason for smoking as a predictor of past quit attempts and future quit intentions among current smokers of combustible tobacco products. Note: solid=statistically significant; hollow=non- significant. ORs were computed adjusting for age, gender, race/ethnicity, income, self- rated health status and nicotine- dependence status. Quit attempters were smokers who had made at least one quit attempt in their lifetime. Smokers were classified as not having a quit intention if they indicated: ‘I’ve never tried to quit and don’t want to’ or ‘I’ve tried before and failed, so why try again?’

    Figure 3 Actual triggers of a past quit attempt among current combustible tobacco smokers who have attempted to quit, as well as potential (perceived) triggers among those who have never tried to quit. Health reasons among those who tried to quit include ‘health scare’ or ‘wanted a healthy lifestyle’. The response options analysed as ‘increasing age’ were slightly different for ever quit attempters (‘New Year’s Resolution’) versus never quit attempters (‘when I am older’).

    Among current combustible smokers overall, reasons for smoking predicted quit attempts (figure 2). The odds of making a quit attempt were higher among those who smoked to relieve stress (AOR=1.26); because they thought it was ‘cool’ (AOR=1.30) or because of peer pressure (AOR=1.35) (all p<0.05). Conversely, those who smoked because they enjoyed the smoking experience had lower odds of making a quit attempt (AOR=0.72) or intending to quit smoking (AOR=0.65) (all p<0.05). Reasons cited for smoking relapse included quitting is hard (56.9%), smoking is enjoyable (34.1%), low self— efficacy in quitting successfully (13.8%) or the perception that smoking is safe (1.2%). Similarly, the most commonly cited reason for having never made a quit attempt was that it is too hard to quit (57.1%) followed by enjoyment of smoking (49.2%); 4.4% had never attempted to quit because they perceived smoking to be safe.

    Among those who had never tried to quit smoking, inveterate smokers—comprising 6.1% of all current combustible smokers—differed from other non— attempters who otherwise had a quit intention in some respects (figure 3). Inveterate smokers were less likely to consider comprehensive smoke— free laws (3.7% vs 23.7%) or increasing cost of cigarettes (15.6% vs 27.0%) as things that could ever make them consider quitting (all p<0.05). No significant differences were observed by other factors.

    Results of sensitivity analyses

    The indicators compared between the web— based and the household— based surveys of South African adults showed very similar findings within weighted analyses (online supplemental figure 3). For example, current use of any tobacco product was 24.6% in the 2017 SASAS versus 23.2% in the web survey. Slightly wider differences were observed in quit attempts (60.6% for SASAS vs 74.6% in the web survey), consistent with differences in case defi—nition (past year quit attempts for SASAS vs lifetime quit attempts in the web survey).

    DISCUSSION

    Awareness of cessation aids among current combustible smokers varied by type of cessation aid: smoking cessation programmes, 50.8%; prescription cessation medication, 68.2% and NRT, 92.1%. Awareness of cessation aids was lowest among Black Africans, men and persons with little or no income. Of all current combustible smokers, 74.6% had ever attempted to quit and 42.8% of these quit attempters had ever used any cessation aid. Among past quit attempters, ever e— cigarette users were more likely than never e— cigarette users to have ever used any cessa—tion aid (50.6% vs 35.9%, p<0.05). Of current combus—tible smokers intending to quit, 66.7% indicated interest in using a cessation aid for future quitting and only 33.3% wanted to quit cold turkey.

    Despite high awareness of cessation aids among South African smokers, utilisation was low. Awareness and use were much lower for cessation counselling programmes and for prescription medications compared with NRT, possibly because of the ubiquitous display of NRT at retail outlets. Most NRT formulations, including oral spray and inhaler, can be purchased in South Africa as over— the— counter medication within pharmacies, super—markets or online. However, as our findings revealed, low— income smokers may face severe limitations in accessing these medications. A complete regimen of nicotine patch lasting up to 12 weeks long, one patch per day, for a heavy smoker (10+ cigarettes), could cost between R9070 ($605) and R21 580 ($1438), based on current retail prices in South Africa and recommended usage.15Including drugs for nicotine— dependence treatment on the South African Essential Drugs list,1314and expanding coverage for smoking cessation treatment within the National Health Insurance19may increase access and utilisation of evidence— based cessation aids among South African smokers.

    Current utilisation rates for cessation aids in our study were very similar to those reported in the USA, including for cessation counselling (7.1% vs 6.8%), any medi—cation use (28.0% vs 29.0%) and use of any cessation aid (31.0% vs 31.2%, South Africa vs the USA, respec—tively).20The pattern of disparities in access and use of cessation aids by socioeconomic status is also consistent with those reported elsewhere.621In our study, Black Africans reported greater interest in using cessation aids and higher intentions to quit, but reported lower past use of cessation aids, suggesting that the gap in utilisa—tion of cessation aids is largely driven by differences in socioeconomic status, rather than differences in interest or motivation. Increasing delivery of brief cessation counselling within all clinical settings (including public health facilities that serve low— income groups), as called for in Article 14 of the WHO Framework Convention on Tobacco Control,22can help smokers quit and improve their health.2324In addition, enhancing the effective—ness of clinical smoking cessation services (eg, the 5As) can help increase cessation. For example, our findings suggest that asking smokers the reason why they smoke could be potentially useful in assessing their willingness to quit. Certain life— changing moments, such as the diag—nosis of a serious condition associated with, or exacer—bated by smoking (eg, chronic obstructive pulmonary disease) can be leveraged to provide counselling and motivate quitting.25Our results showed that a health scare was associated with quitting, especially among those with poor health conditions. Notably, older adults were less likely to make a quit attempt just for maintaining a healthy lifestyle but were more likely to do so on account of a health scare.

    South Africa has not officially adopted tobacco harm reduction, however, some in the public health commu—nity have argued for the effectiveness of this strategy among ‘inveterate’ smokers who are unwilling or unable to quit.26The potential viability of a harm reduction approach, from a public health context, however rests on assumptions that: (1) there is a large pool of invet—erate smokers; (2) that these smokers will be interested in switching to, and exclusively using ‘reduced— risk’ prod—ucts which would help them quit; and (3) that a regu—lated climate exists to prevent unwanted consequences among youth. Our findings however disprove several of these assumptions within the South African context. Only about 6% of current combustible smokers were consid—ered ‘inveterate’, and even these were open to quitting for health reasons (50%), family considerations (29%), increasing age (24%) and increasing costs of cigarettes (15.6%).

    As the tobacco market and regulatory landscapes in South Africa continue to evolve rapidly, regula—tion of novel products is critical to minimise potential population— level harms, including relapse and perpetu—ation of smoking behaviour among smokers. Deeming and regulating e— cigarettes as tobacco products under the proposed legislation may benefit public health,1127not only in South Africa, but regionally as well, given the leadership role South Africa plays in the region. These findings can help inform comprehensive tobacco preven—tion and control efforts, including restricting unsubstanti—ated marketing claims of e— cigarettes as effective smoking cessation aids within South Africa.

    Socioeconomic status was not a significant predictor of quitting on account of ‘increasing cigarette cost’, possibly because of the use of price— minimising strategies by smokers, including buying cheap brands, single sticks or switching to cheaper RYO cigarettes.2829Policies that address cross— product price inequalities can help reduce demand and use of tobacco products.30We also found that older adults, who had the lowest smoking preva—lence, were the only demographic group to attempt to quit smoking in response to public bans on smoking, suggesting limited compliance. Stronger enforcement of policies that prohibit smoking in public places may prevent relapse by reducing social cues and denormal—ising smoking.3132

    More robust epidemiological studies that address threats to internal validity are needed to test some of the hypothesis generated from our study. For example, our results suggested that claims of e— cigarettes being effective cessation aids may be probably overstated in the South African context, given the observation that smokers who used e— cigarettes were more likely than non— e— cigarette users to have used other cessation aids. Clinical or real— world effectiveness trials are needed to evaluate the inde—pendent effect of e— cigarettes on smoking cessation in South Africa.

    This study is not without limitations. First, it is impos—sible to determine temporality with the cross— sectional design (eg, order of using e— cigarettes and evidence— based cessation aids). Second, triggers of past quit attempt could have varied for individuals with multiple quit attempts as could also the types of cessation aids used. Third, the self— reported measures are subject to misreporting. Finally, despite the use of calibration weights, the weighted sample may still not be entirely representative of the South African adult population because adjustments were only made for a few variables for which information was available in the dataset. We however found that compar—ison of results with 2017 SASAS, a household— based survey, yielded similar results on assessed indicators.

    CONCLUSION

    Most smokers were interested in quitting, but only about one— third of smokers who had tried to quit had ever used any cessation aid; NRT was the most used cessation aid. Disparities existed in the use of any cessation aid, with utilisation being least among Black Africans and indi—viduals of low socioeconomic position. Smokers who tried to quit and used e— cigarettes reported higher use of pharmacological cessation aids and counselling than non— e— cigarette users. Intensified implementation of comprehensive tobacco prevention and control strat—egies that include barrier— free access to cessation aids, price increases on tobacco products, comprehensive smoke— free laws and mass media educational campaigns that warn of the dangers of tobacco use may accelerate cessation rates among South African adults.

    ContributorsIA conceptualised and designed the study and drafted the initial manuscript. CE and OA- Y helped conceptualise the study and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    FundingThe African Capacity Building Foundation Grant number 333.

    Competing interestsNone declared.

    Patient consent for publicationNot required.

    Ethics approvalThe study was approved by the University of Pretoria’s Faculty of Health Sciences’ Ethics Review (no. 39/2019).

    Provenance and peer reviewNot commissioned; externally peer reviewed.

    Data availability statementRequests for data should be sent to the corresponding author and will be considered on a case- by- case basis.

    Supplemental materialThis content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer- reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

    Open accessThis is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.

    一本久久中文字幕| 99久久久亚洲精品蜜臀av| 亚洲熟女毛片儿| 精品久久久久久,| 国产亚洲欧美在线一区二区| 可以在线观看的亚洲视频| 精品一区二区三区av网在线观看| 黄色成人免费大全| 久久精品aⅴ一区二区三区四区| 日本免费a在线| 午夜激情福利司机影院| 精品一区二区三区av网在线观看| 久久久久久人人人人人| 亚洲无线在线观看| 制服诱惑二区| 亚洲第一电影网av| 女同久久另类99精品国产91| 美女高潮喷水抽搐中文字幕| 国产欧美日韩一区二区精品| 免费一级毛片在线播放高清视频| 久久久久久人人人人人| 中文字幕熟女人妻在线| 亚洲一区高清亚洲精品| 看黄色毛片网站| 亚洲中文字幕日韩| 黄片小视频在线播放| 中亚洲国语对白在线视频| 欧美另类亚洲清纯唯美| 亚洲专区国产一区二区| 88av欧美| 男人舔女人的私密视频| 国产午夜精品久久久久久| 香蕉国产在线看| 亚洲av成人精品一区久久| 亚洲熟女毛片儿| 国产精品一及| 日本一二三区视频观看| 久久热在线av| 精品国产超薄肉色丝袜足j| 午夜免费观看网址| 在线观看免费日韩欧美大片| 精品国产乱子伦一区二区三区| 精品久久久久久久毛片微露脸| 日韩大码丰满熟妇| 50天的宝宝边吃奶边哭怎么回事| 国产高清视频在线播放一区| 国产精品爽爽va在线观看网站| 操出白浆在线播放| 波多野结衣巨乳人妻| 国产爱豆传媒在线观看 | 免费看日本二区| 午夜日韩欧美国产| 国产成人系列免费观看| 欧美日韩乱码在线| 蜜桃久久精品国产亚洲av| 又黄又爽又免费观看的视频| 免费在线观看完整版高清| 搡老妇女老女人老熟妇| 成人午夜高清在线视频| 热99re8久久精品国产| 久久人妻av系列| 色综合婷婷激情| 亚洲欧美精品综合一区二区三区| 99久久久亚洲精品蜜臀av| 两个人免费观看高清视频| 国产黄a三级三级三级人| 免费搜索国产男女视频| 国产熟女午夜一区二区三区| 日本撒尿小便嘘嘘汇集6| 在线看三级毛片| 久久精品国产99精品国产亚洲性色| 伦理电影免费视频| 日日爽夜夜爽网站| 欧美绝顶高潮抽搐喷水| 久久精品91蜜桃| 亚洲美女黄片视频| 久久婷婷人人爽人人干人人爱| 免费高清视频大片| 欧美日韩乱码在线| 好男人在线观看高清免费视频| 精品日产1卡2卡| 天堂av国产一区二区熟女人妻 | 亚洲全国av大片| 国产av不卡久久| 国产真实乱freesex| 天堂av国产一区二区熟女人妻 | 制服诱惑二区| 日韩欧美在线乱码| avwww免费| 亚洲精品久久国产高清桃花| 国产精品电影一区二区三区| 巨乳人妻的诱惑在线观看| 黄频高清免费视频| 制服人妻中文乱码| 色哟哟哟哟哟哟| 国产精品九九99| 美女 人体艺术 gogo| 一级毛片高清免费大全| 国产一区二区在线观看日韩 | 丁香欧美五月| 91国产中文字幕| 免费在线观看日本一区| 2021天堂中文幕一二区在线观| 亚洲av日韩精品久久久久久密| 精品一区二区三区四区五区乱码| 久久精品亚洲精品国产色婷小说| 国产av一区二区精品久久| 日韩高清综合在线| 波多野结衣巨乳人妻| 最好的美女福利视频网| cao死你这个sao货| 窝窝影院91人妻| 国产精品影院久久| 一个人观看的视频www高清免费观看 | av视频在线观看入口| 久久久久国产一级毛片高清牌| 国产熟女xx| 午夜影院日韩av| 成人午夜高清在线视频| 亚洲 欧美一区二区三区| www.自偷自拍.com| 69av精品久久久久久| 正在播放国产对白刺激| 日韩欧美国产一区二区入口| 一级片免费观看大全| 国产又黄又爽又无遮挡在线| 少妇粗大呻吟视频| 欧美日韩乱码在线| 欧美一级a爱片免费观看看 | 黄色a级毛片大全视频| 欧美一区二区精品小视频在线| 亚洲人成77777在线视频| 久久草成人影院| 黑人巨大精品欧美一区二区mp4| 免费高清视频大片| 久久草成人影院| 变态另类成人亚洲欧美熟女| 中文字幕熟女人妻在线| 国产又黄又爽又无遮挡在线| 日韩成人在线观看一区二区三区| 成人手机av| 看片在线看免费视频| 最好的美女福利视频网| 丝袜人妻中文字幕| 好看av亚洲va欧美ⅴa在| 日韩 欧美 亚洲 中文字幕| 午夜福利在线观看吧| 亚洲av成人精品一区久久| 男人舔奶头视频| 两个人视频免费观看高清| xxx96com| 国产一区在线观看成人免费| 十八禁人妻一区二区| 国产av麻豆久久久久久久| 亚洲成人精品中文字幕电影| 日韩大码丰满熟妇| 国产主播在线观看一区二区| 日韩av在线大香蕉| 国产av麻豆久久久久久久| 在线视频色国产色| 欧美成狂野欧美在线观看| 中文字幕高清在线视频| 久久精品aⅴ一区二区三区四区| 亚洲精品久久国产高清桃花| 欧美成人免费av一区二区三区| 国产激情偷乱视频一区二区| 精品少妇一区二区三区视频日本电影| 免费看a级黄色片| 人成视频在线观看免费观看| 丁香六月欧美| 两个人免费观看高清视频| 欧美人与性动交α欧美精品济南到| 在线国产一区二区在线| 亚洲精品在线观看二区| av超薄肉色丝袜交足视频| 看免费av毛片| 国内揄拍国产精品人妻在线| 99精品久久久久人妻精品| 99国产精品99久久久久| 国产精品香港三级国产av潘金莲| 无人区码免费观看不卡| 成人特级黄色片久久久久久久| 欧美一区二区国产精品久久精品 | 在线观看舔阴道视频| 亚洲成人精品中文字幕电影| 欧美黑人巨大hd| 又爽又黄无遮挡网站| 国产亚洲精品久久久久久毛片| 国产一区二区激情短视频| 欧美一级毛片孕妇| 999精品在线视频| 欧美日韩乱码在线| 黄色毛片三级朝国网站| 久久婷婷人人爽人人干人人爱| 免费在线观看黄色视频的| 99国产精品一区二区三区| 香蕉av资源在线| 中文字幕精品亚洲无线码一区| 又黄又爽又免费观看的视频| 中文字幕熟女人妻在线| 人妻丰满熟妇av一区二区三区| 2021天堂中文幕一二区在线观| 久久久久国内视频| 搞女人的毛片| 长腿黑丝高跟| 国产片内射在线| 成人国产一区最新在线观看| 高清毛片免费观看视频网站| 国产精品国产高清国产av| 国产黄a三级三级三级人| 人妻久久中文字幕网| 12—13女人毛片做爰片一| 国产成人精品无人区| 亚洲精品av麻豆狂野| av在线播放免费不卡| 在线观看日韩欧美| 日本成人三级电影网站| 午夜亚洲福利在线播放| 午夜日韩欧美国产| 哪里可以看免费的av片| 伦理电影免费视频| 亚洲国产看品久久| 欧美色欧美亚洲另类二区| 亚洲人成网站在线播放欧美日韩| 一夜夜www| 久久人妻av系列| 色在线成人网| av福利片在线| 国产亚洲av高清不卡| 亚洲狠狠婷婷综合久久图片| 国产精品一区二区免费欧美| 巨乳人妻的诱惑在线观看| 嫁个100分男人电影在线观看| 中文资源天堂在线| 欧美黄色片欧美黄色片| 老司机午夜十八禁免费视频| 色哟哟哟哟哟哟| 嫩草影院精品99| 人妻久久中文字幕网| 久久久久久人人人人人| 神马国产精品三级电影在线观看 | 国产高清视频在线观看网站| 亚洲性夜色夜夜综合| 女警被强在线播放| 在线国产一区二区在线| 长腿黑丝高跟| 国产人伦9x9x在线观看| 亚洲片人在线观看| 首页视频小说图片口味搜索| 大型黄色视频在线免费观看| 午夜精品在线福利| 欧美激情久久久久久爽电影| 香蕉丝袜av| 男女那种视频在线观看| 少妇被粗大的猛进出69影院| 精品欧美一区二区三区在线| 亚洲美女黄片视频| 很黄的视频免费| 久久久久久免费高清国产稀缺| 亚洲av第一区精品v没综合| 中文字幕久久专区| 99热只有精品国产| 欧美国产日韩亚洲一区| 男人舔女人下体高潮全视频| 99久久综合精品五月天人人| 此物有八面人人有两片| 在线观看日韩欧美| 女同久久另类99精品国产91| 国产视频内射| 一二三四在线观看免费中文在| 国产一区二区在线av高清观看| 国产精品久久电影中文字幕| 成人三级黄色视频| 免费在线观看成人毛片| 久久久久久人人人人人| 真人一进一出gif抽搐免费| 曰老女人黄片| 日本a在线网址| 国产激情欧美一区二区| 天堂动漫精品| 色尼玛亚洲综合影院| 欧美日本亚洲视频在线播放| 久99久视频精品免费| 欧美日韩精品网址| 淫秽高清视频在线观看| 国产激情欧美一区二区| 国产精品久久久久久精品电影| e午夜精品久久久久久久| 国产一级毛片七仙女欲春2| 69av精品久久久久久| 亚洲中文日韩欧美视频| 国产一区二区激情短视频| 中文在线观看免费www的网站 | 最新美女视频免费是黄的| 婷婷精品国产亚洲av在线| 一个人免费在线观看电影 | 香蕉av资源在线| 亚洲欧美日韩高清专用| 搞女人的毛片| 99热只有精品国产| 首页视频小说图片口味搜索| 一区二区三区激情视频| 亚洲人成77777在线视频| 亚洲精品国产一区二区精华液| 国产午夜福利久久久久久| 国产精品av久久久久免费| 欧洲精品卡2卡3卡4卡5卡区| 成人av一区二区三区在线看| 人成视频在线观看免费观看| 久久精品国产综合久久久| 草草在线视频免费看| av福利片在线| 黑人巨大精品欧美一区二区mp4| or卡值多少钱| 国产aⅴ精品一区二区三区波| 婷婷精品国产亚洲av在线| 这个男人来自地球电影免费观看| 中文字幕高清在线视频| 男女做爰动态图高潮gif福利片| 可以在线观看的亚洲视频| 又黄又爽又免费观看的视频| 国产精品日韩av在线免费观看| 亚洲男人的天堂狠狠| 三级国产精品欧美在线观看 | 亚洲av电影在线进入| 亚洲第一电影网av| 亚洲精品一区av在线观看| 成年人黄色毛片网站| 中文资源天堂在线| 欧美黄色片欧美黄色片| 成人手机av| 丁香六月欧美| 最好的美女福利视频网| 精品久久久久久久末码| 窝窝影院91人妻| 美女免费视频网站| 欧美zozozo另类| 天堂影院成人在线观看| 999精品在线视频| 男女之事视频高清在线观看| 欧美另类亚洲清纯唯美| 欧美一区二区精品小视频在线| 性色av乱码一区二区三区2| 久久人妻av系列| 国产av在哪里看| a在线观看视频网站| netflix在线观看网站| 久久这里只有精品中国| 99精品久久久久人妻精品| 在线十欧美十亚洲十日本专区| 亚洲,欧美精品.| 精品无人区乱码1区二区| 老熟妇乱子伦视频在线观看| 国产精品日韩av在线免费观看| 成人亚洲精品av一区二区| 久久婷婷成人综合色麻豆| 淫秽高清视频在线观看| 级片在线观看| 午夜影院日韩av| 这个男人来自地球电影免费观看| 黑人操中国人逼视频| 午夜免费观看网址| 亚洲成人久久爱视频| 日韩精品中文字幕看吧| 精品久久久久久久毛片微露脸| 久久热在线av| 老汉色av国产亚洲站长工具| 国产1区2区3区精品| 床上黄色一级片| 国产99久久九九免费精品| 五月玫瑰六月丁香| 正在播放国产对白刺激| 国产精品久久久久久精品电影| 久久伊人香网站| 免费av毛片视频| 最新美女视频免费是黄的| 日韩欧美三级三区| 精品久久蜜臀av无| 一区福利在线观看| 久久伊人香网站| 免费av毛片视频| 制服人妻中文乱码| 亚洲精品美女久久av网站| 国产精品电影一区二区三区| 五月玫瑰六月丁香| 一级毛片高清免费大全| 欧美性猛交黑人性爽| 99国产精品99久久久久| 香蕉丝袜av| 日本熟妇午夜| 国产精品 国内视频| 国语自产精品视频在线第100页| 男女视频在线观看网站免费 | 国产欧美日韩一区二区精品| 日韩精品青青久久久久久| 中文字幕精品亚洲无线码一区| 99国产极品粉嫩在线观看| x7x7x7水蜜桃| 一级a爱片免费观看的视频| 欧美另类亚洲清纯唯美| 国产精品免费一区二区三区在线| 亚洲 欧美一区二区三区| 久久久久久久午夜电影| 又黄又粗又硬又大视频| av超薄肉色丝袜交足视频| 精品不卡国产一区二区三区| tocl精华| 久久欧美精品欧美久久欧美| 久久久久国产一级毛片高清牌| avwww免费| 黄色丝袜av网址大全| 国产91精品成人一区二区三区| 男女那种视频在线观看| 琪琪午夜伦伦电影理论片6080| 精品高清国产在线一区| 一夜夜www| 国产黄片美女视频| 午夜精品在线福利| 国产精品影院久久| 精品日产1卡2卡| 99久久精品热视频| 一级毛片女人18水好多| 色综合站精品国产| 国产精品亚洲美女久久久| 制服丝袜大香蕉在线| 国产成+人综合+亚洲专区| 国产高清有码在线观看视频 | 51午夜福利影视在线观看| 免费无遮挡裸体视频| 久久久久九九精品影院| 久久久久久人人人人人| 女人被狂操c到高潮| 一a级毛片在线观看| 级片在线观看| 国产黄a三级三级三级人| 国产成人精品久久二区二区免费| 制服丝袜大香蕉在线| 亚洲一区中文字幕在线| 久99久视频精品免费| 国产99白浆流出| bbb黄色大片| 日韩欧美国产一区二区入口| 亚洲av电影不卡..在线观看| 久久这里只有精品中国| 亚洲av成人精品一区久久| 久久久久久久午夜电影| 男男h啪啪无遮挡| 性色av乱码一区二区三区2| 777久久人妻少妇嫩草av网站| 亚洲五月婷婷丁香| 男人舔奶头视频| 国产单亲对白刺激| 丰满的人妻完整版| 国产探花在线观看一区二区| 成在线人永久免费视频| 欧美日韩精品网址| 欧美色视频一区免费| 久久欧美精品欧美久久欧美| 欧美另类亚洲清纯唯美| 天堂动漫精品| 国产伦在线观看视频一区| 男女视频在线观看网站免费 | 桃色一区二区三区在线观看| 欧美黑人精品巨大| 一级毛片女人18水好多| 在线观看美女被高潮喷水网站 | 国产高清有码在线观看视频 | 夜夜爽天天搞| 三级国产精品欧美在线观看 | 超碰成人久久| 这个男人来自地球电影免费观看| 麻豆一二三区av精品| 99久久精品热视频| 亚洲精品国产一区二区精华液| 在线视频色国产色| 亚洲免费av在线视频| 婷婷精品国产亚洲av在线| 无人区码免费观看不卡| 欧美+亚洲+日韩+国产| 午夜精品久久久久久毛片777| 精品国产亚洲在线| 桃红色精品国产亚洲av| 黑人巨大精品欧美一区二区mp4| 亚洲精华国产精华精| 亚洲av五月六月丁香网| 一夜夜www| 两性午夜刺激爽爽歪歪视频在线观看 | 精品免费久久久久久久清纯| 久久中文字幕人妻熟女| 看片在线看免费视频| 90打野战视频偷拍视频| 亚洲av成人一区二区三| 精品久久久久久久毛片微露脸| 91在线观看av| 欧美性猛交╳xxx乱大交人| 亚洲一区二区三区不卡视频| 最近视频中文字幕2019在线8| 免费在线观看日本一区| 国产精品一及| 正在播放国产对白刺激| 丰满的人妻完整版| 亚洲天堂国产精品一区在线| 国产精品久久久久久精品电影| 成人18禁在线播放| 他把我摸到了高潮在线观看| 欧美大码av| 深夜精品福利| 两个人看的免费小视频| 丰满人妻一区二区三区视频av | 99re在线观看精品视频| 亚洲欧美精品综合久久99| 五月伊人婷婷丁香| 特大巨黑吊av在线直播| 色噜噜av男人的天堂激情| 99久久综合精品五月天人人| 99re在线观看精品视频| 国产激情久久老熟女| 中文字幕人妻丝袜一区二区| 两性午夜刺激爽爽歪歪视频在线观看 | 在线国产一区二区在线| 午夜福利在线观看吧| 97碰自拍视频| 国产久久久一区二区三区| 亚洲中文av在线| 老熟妇乱子伦视频在线观看| 国产精品美女特级片免费视频播放器 | 国产私拍福利视频在线观看| 亚洲av成人一区二区三| 又大又爽又粗| 99国产极品粉嫩在线观看| 国产av一区在线观看免费| 淫秽高清视频在线观看| 麻豆成人av在线观看| 国内精品久久久久久久电影| 精品国产美女av久久久久小说| 亚洲午夜理论影院| 麻豆av在线久日| 男人舔女人的私密视频| 日本三级黄在线观看| 欧美日韩中文字幕国产精品一区二区三区| 国产精品98久久久久久宅男小说| 久久这里只有精品19| 免费av毛片视频| 国产熟女xx| 亚洲五月婷婷丁香| 国产成人系列免费观看| 免费在线观看日本一区| 国产精品久久久久久人妻精品电影| 国产爱豆传媒在线观看 | 一二三四社区在线视频社区8| 不卡av一区二区三区| 最近在线观看免费完整版| 国产在线观看jvid| 窝窝影院91人妻| 母亲3免费完整高清在线观看| 欧美+亚洲+日韩+国产| 丰满人妻熟妇乱又伦精品不卡| 视频区欧美日本亚洲| 国产精品99久久99久久久不卡| 精品一区二区三区四区五区乱码| 久久精品国产清高在天天线| 在线观看舔阴道视频| 久久性视频一级片| 精华霜和精华液先用哪个| 国内精品久久久久精免费| а√天堂www在线а√下载| 亚洲成人久久性| 亚洲精品国产一区二区精华液| 亚洲av日韩精品久久久久久密| 女同久久另类99精品国产91| 亚洲免费av在线视频| 男女床上黄色一级片免费看| 超碰成人久久| 操出白浆在线播放| 国产精品久久久人人做人人爽| 女人爽到高潮嗷嗷叫在线视频| 国产亚洲av嫩草精品影院| 国产真人三级小视频在线观看| 日日爽夜夜爽网站| 一级片免费观看大全| 亚洲真实伦在线观看| 久久久久久久久免费视频了| 亚洲欧美一区二区三区黑人| 天天躁夜夜躁狠狠躁躁| 亚洲欧洲精品一区二区精品久久久| 欧美性猛交╳xxx乱大交人| 国产一级毛片七仙女欲春2| 精品欧美一区二区三区在线| 久久久久久久午夜电影| 全区人妻精品视频| 可以免费在线观看a视频的电影网站| 哪里可以看免费的av片| 欧美不卡视频在线免费观看 | 日韩精品免费视频一区二区三区| 波多野结衣巨乳人妻| 桃红色精品国产亚洲av| 国产真人三级小视频在线观看| 亚洲中文日韩欧美视频| 91国产中文字幕| 男女下面进入的视频免费午夜| 日韩欧美在线乱码| 午夜精品在线福利| 亚洲美女视频黄频| 搡老熟女国产l中国老女人| 欧美人与性动交α欧美精品济南到| 一区福利在线观看| 搡老熟女国产l中国老女人| 久久香蕉激情| 国产欧美日韩一区二区三| 日本熟妇午夜| 精品无人区乱码1区二区| 亚洲18禁久久av| 国产精品免费视频内射| 狂野欧美激情性xxxx| 九九热线精品视视频播放|