title: A decade of tobacco control: the South African case of politics, health policy, health promotion and behaviour change.
abstract: BACKGROUND
  The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown.
  
  
  OBJECTIVE
  To describe the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners.
  
  
  METHODS
  Four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) were conducted in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. We assessed the prevalence of current smoking (having smoked a cigarette on ≥1 day in the 30 days preceding the survey) and smoking-related attitudes and behaviours.
  
  
  RESULTS
  Over the 12-year survey period current smoking among learners declined from 23.0% (1999) to 16.9% (2011) - a 26.5% reduction. Reductions in smoking prevalence were less pronounced amongst girls and amongst black learners. We observed an increase in smoking prevalence amongst learners between 2008 and 2011. Smoking-related attitudes and behaviours showed favourable changes over the survey period.
  
  
  CONCLUSIONS
  These surveys demonstrate that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth.
authors.affiliation: Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa. preddy@hsrc.ac.za.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Reddy
authors.forename: Shamagonam
authors.initials: S
authors.lastname: James
authors.forename: Ronel
authors.initials: R
authors.lastname: Sewpaul
authors.forename: Derek
authors.initials: D
authors.lastname: Yach
authors.forename: Ken
authors.initials: K
authors.lastname: Resnicow
authors.forename: Sibusiso
authors.initials: S
authors.lastname: Sifunda
authors.forename: Zanele
authors.initials: Z
authors.lastname: Mthembu
authors.forename: Anthony
authors.initials: A
authors.lastname: Mbewu
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D008297:Male; D011057:Politics; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires