title: Prevalence and correlates of smokeless tobacco use among grade 8-11 school students in South Africa: a nationwide study.
abstract: BACKGROUND
  Smokeless tobacco in South Africa is commonly used in the form of snuff or chewing tobacco. This paper reports its use among secondary school students and provides evidence of its association with demographic characteristics, tobacco smoking, and socioeconomic status.
  
  
  METHODS
  Data were derived from a nationally representative study conducted in 2008 among 10,270 grade 8-11 students from 192 schools in South Africa. Data were collected with self-administered questionnaires. Multiple logistic regression analyses were used to examine correlates of past-month smokeless tobacco use.
  
  
  RESULTS
  Nationally, 12.4% of students used smokeless tobacco such as chewing tobacco or snuff in the month preceding the survey, with significantly higher rates among males (13.6%) than females (10.6%). Smokeless tobacco use differed between racial groups, with African (12.8%) and colored (11.7%) students having the highest rates of past-month use. Grade 8 students (15.3%) reported significantly higher rates of use than grade 11 students (9.1%). Current cigarette smokers (21.3%) reported a higher prevalence of smokeless tobacco use than noncurrent smokers (10.1%). Logistic regression of past-month smokeless tobacco use showed significant associations with race, grade, school socioeconomic level, urbanicity, current cigarette smoking, and having first smoked a cigarette before the age of 10 years.
  
  
  CONCLUSIONS
  These findings provide evidence for policy makers and program developers to develop targeted and tailored interventions for young people regarding smokeless tobacco use.
authors.affiliation: Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa;
authors.forename: Priscilla S
authors.initials: PS
authors.lastname: Reddy
authors.affiliation: Health Promotion Research and Development Unit, Medical Research Council of South Africa, Cape Town, South Africa;
authors.forename: Shamagonam
authors.initials: S
authors.lastname: James
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI;
authors.forename: Ken
authors.initials: K
authors.lastname: Resnicow
authors.affiliation: Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa; rsewpaul@hsrc.ac.za.
authors.forename: Ronel
authors.initials: R
authors.lastname: Sewpaul
authors.affiliation: ARCH Actuarial Consulting, Cape Town, South Africa;
authors.forename: Pardon
authors.initials: P
authors.lastname: Masuka
authors.affiliation: Department of Health Education and Health Promotion, Maastricht University, Maastricht, the Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: van den Borne
mesh_terms: D000293:Adolescent; D044383:Black People; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D013334:Students / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D064424:Tobacco Use / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*; D044465:White People