title: Association of snuff use with chronic bronchitis among South African women: implications for tobacco harm reduction.
abstract: 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.
  
  
  METHODS
  The study investigated a nationally representative sample of 4464 black South African women > or = 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.
  
  
  METHODS
  CB, defined as reporting a productive cough for > or = 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.
authors.affiliation: Department of Community Dentistry, School of Dentistry, Oral and Dental Hospital, University of Pretoria, P.O. Box 1266, Pretoria 0001, South Africa. lekan.ayoyusuf@up.ac.za
authors.forename: O A
authors.initials: OA
authors.lastname: Ayo-Yusuf
authors.forename: P S
authors.initials: PS
authors.lastname: Reddy
authors.forename: B W
authors.initials: BW
authors.lastname: van den Borne
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People / Q000208:ethnology*; D029481:Bronchitis, Chronic / Q000139:chemically induced* / Q000453:epidemiology; D003371:Cough / Q000139:chemically induced / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D040261:Harm Reduction; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D014504:Urban Health