Background The endgame literature recommends that, for a tobacco sales ban to be successful, several demand-side preconditions (eg, low prevalence and effective cessation support) should be in place. The South African Government imposed a ban on the sale of all tobacco and vaping products between 27 March and 17 August 2020, as part of the COVID-19 lockdown. Objectives To assess how cigarette smokers responded to the sales ban, to evaluate how the ban impacted the cigarette market in South Africa and to use the South African experience to inform endgame planning. Methods Regular preban cigarette smokers completed an online questionnaire from 4 to 19 June 2020 (n=23 631), in which they reported on their prelockdown cigarette smoking patterns, quitting behaviour (if relevant) and smoking behaviour during the ban. Results About 9% of prelockdown smokers in the sample successfully quit smoking. 93% of continuing smokers purchased cigarettes despite the sales ban. The average price of cigarettes increased by 250% relative to prelockdown prices. Most respondents purchased cigarettes through informal channels. Conclusions The demand-side preconditions for an effective sales ban were not in place in South Africa, making a sales ban inappropriate. The South African experience suggests that supply-side factors are also important in ensuring the success of a sales ban. These are: (1) the illicit market must be under control before implementing a sales ban; and (2) an effective sales ban needs to be synchronised with a ban on the manufacture, transport and distribution of cigarettes.

Introduction: African countries have among the lowest excise taxes in the world. This paper provides new evidence on the association between cigarette prices and youth smoking in 16 African countries. Aims and Methods: We use Global Youth Tobacco Survey (GYTS) cross-country data from approximately 67 500 participants. The relationship between prices and youth smoking in Africa is estimated using probit models for smoking participation and generalized linear models for conditional cigarette demand. Each model is estimated using local-brand and foreign-brand cigarette prices. Results: Higher prices are associated with lower demand across African countries, for both smoking prevalence and the intensity of cigarette consumption by smokers. The estimated price elasticity of participation is −0.70 [95% CI: −1.28 to −0.12] for local-brand cigarettes and −0.71 [95% CI: −0.98 to −0.44] for foreign-brand cigarettes. The price elasticity of conditional cigarette demand is −0.44 [95% CI: −0.76 to −0.12] for local brands and −0.75 [95% CI: −0.96 to −0.53] for foreign brands. The total price elasticity of demand for youth in our sample is −1.14 for local brands and −1.46 for foreign brands. Conclusions: Higher cigarette prices significantly decrease the likelihood of smoking and decrease the intensity of cigarette consumption among African youths. Increases in the excise tax that increase the retail price of cigarettes will play an important role in reducing youth tobacco use on the continent. Governments are encouraged to increase excise taxes in order to improve public health. Implications: Evidence on the association between cigarette prices and youth smoking in African countries is limited. The Global Youth Tobacco Survey (GYTS) was first introduced in 1999. In 2012, the Centers for Disease Control and Prevention revised the GYTS questionnaire, which removed some questions and introduced new questions into the survey. To the best of our knowledge, there are no published estimates of the relationship between cigarette prices and demand that have used this more recent individual-level GYTS data for African countries. In conducting this analysis, we add to the limited literature on the association between cigarette prices and youth smoking in Africa.

Introduction: Despite high levels of illicit trade in the tobacco market, the South African government banned the sale of tobacco products in March 2020 as part of its COVID-19 response. The ban lasted five months. We assess how the ban affected the cigarette market for a sample of smokers by comparing the price, consumption, and competitive landscapes before (March), during (May and June), and after (September) the ban. Methods: We conducted three online surveys of cigarette smokers, asking about smoking behavior before, during, and after the ban. We use descriptive statistics and OLS regressions to estimate the impact of the ban on the South African cigarette market, focusing on the price of cigarettes. Results: Most smokers continued smoking despite the sales ban. During the ban, prices increased by over 240%. Purchases shifted away from the normally dominant brands of the multinational tobacco companies to local/regional producers. The covariates of price changed substantially during the sales ban, the most pronounced being inter-provincial effects. After the ban, the market shifted back to its preban state, with an overall increase in price of 3.6%. Conclusions: Cigarette sales continued despite the sales ban, further entrenching an already large illicit market. Had the government substantially increased the excise tax, rather than banned the sale of tobacco products, it would have achieved a similar public health outcome, received more revenue, and presumably not further entrenched the illicit market. Implications: South Africa temporarily banned the sale of tobacco as part of its COVID-19 response. Despite the ban, the sale of cigarettes did not cease; rather, it caused major disruption to the cigarette market. The ban inadvertently benefited manufacturers who were previously disproportionately involved in illicit activities; these manufacturers increased their market share even after the ban was lifted. The ban may have further entrenched South Africa’s already large illicit market. Our results show that there are unintended consequences associated with a temporary ban on the sale of cigarettes.

The WHO has highlighted that: "promotion of e-cigarettes has led to marked increases in e-cigarette use by children and adolescents." The long-term neuropsychiatric and psychological consequences of substance abuse in adolescence is well recognised. Limited data exists on the adolescent burden of vaping-related nicotine addiction and behavioural and/or psychological dependence to guide pharmacological or behavioural interventions to stop electronic cigarette usage. A self-administered brief electronic survey was provided to a large, sample of high school students from January to October 2023 in South Africa. Questions on vaping usage, initiation, reasons for continuation and indicators of physical and psychological dependence were asked. A mixed methods approach was used to obtain and analyse quantitative and qualitative responses. 25,149 students from 52 South Africa schools completed the survey. 45.8% identify as female, 51.7% male, 0.3% transgender, 2.1% do not identify with a gender. Current vaping was reported by 16.83% (95% CI: 16.47-17.30), with 36.71% reporting ever using a vaping product (95% CI: 26.06-37.36). The odds of vaping increased by grade but not with increasing school affluence. 47% vaped within the first hour of waking suggesting high nicotine addiction. Vaping initiation reasons of: 'social influences' and 'curiosity', changed significantly to ongoing motivations of: 'enjoyment', 'managing mental distress' and 'addiction' to nicotine. Paired quantitative/qualitative responses regarding stress and dependence showed inconsistencies at the individual student level. Vaping in the schools surveyed was high and increased by grade but was not associated with school level affluence. Drivers for vaping initiation change significantly to persistence drivers with significant nicotine addiction. Adolescent perceptions (qualitative/quantitative) are frequently incongruent suggesting that mixed methods evaluations are required to understand individual level drivers of vaping. Urgent interventions tailored to this population are required. Nicotine addiction may require "off-label" pharmacotherapies alongside tailored behavioural interventions utilising the expressed concerns, psychological and dependence measures elicited from adolescents. This study was funded in part by research grant from the Cambridge-Africa ALBORADA Research Fund G12753.

Background Despite growing concern over tobacco use in sub-Saharan Africa, evidence on the association between cigarette prices and adult smoking behaviour in the region is limited. Objectives To provide new evidence on the association between cigarette prices and adult smoking in eight sub-Saharan African countries. Methods The analysis uses data from 51 270 individuals taken from the Global Adult Tobacco Survey, which was conducted in eight African countries during 2012–2018. The relationship between prices and smoking is estimated using probit models for smoking participation and generalised linear models for conditional cigarette demand. Results Higher prices are significantly associated with lower cigarette demand across African countries. The estimated price elasticity of participation is –0.362 (95% CI –0.547 to –0.177). The price elasticity of conditional cigarette demand is –0.133 (95% CI –0.194 to –0.072) for people who have just started smoking. The estimated total price elasticity of cigarette demand by new adult smokers is –0.495. The absolute value of the conditional demand elasticity becomes smaller by 0.004 units for each additional year that a person smokes. For the average smoker in the sample, with a smoking duration of 18.07 years, the total elasticity estimate is –0.422. Conclusions Higher cigarette prices significantly decrease the likelihood of smoking and decrease the intensity of cigarette consumption among African adults. Increases in the excise tax that increase the retail price of cigarettes will play an important role in reducing adult tobacco use on the continent. Governments are encouraged to increase excise taxes to improve public health.

Introduction: In response to COVID-19, the South African government banned the sale of tobacco products for 20 weeks. Before the ban, the illicit cigarette market was well-entrenched and smoking cessation services were not widely available. Several surveys conducted to ascertain cigarette...