World No Tobacco Day is observed every year on 31 May to raise awareness of the harmful effects of tobacco use. This year, the campaign aims to reveal the tactics employed by the tobacco and nicotine industries to make their products appealing, especially to young people.

“Tobacco use is responsible for 8 million deaths globally every year and more than 30 000 deaths in South Africa annually,” says Professor Lekan Ayo-Yusuf, Head of the School of Health Systems and Public Health at the University of Pretoria (UP). He is also a member of the World Health Organisation (WHO) Tobacco Products Regulations Scientific Group; Director of the National Council Against Smoking; and founder of the African Centre for Tobacco Industry Monitoring and Policy research (ATIM) at UP.

“In all its forms, tobacco use has been shown to cause various life-threatening conditions, including different forms of cancer, such as oral and lung cancer, and heart diseases,” he adds. “Nicotine also reduces the ability of immune cells in the lungs to fight infections like tuberculosis (TB), which is why one out of 10 deaths from TB is related to smoking. We have to regulate the use of all tobacco and nicotine products in the interests of public health.”

Prof Ayo-Yusuf explains that South Africa and sub-Saharan Africa as a whole is facing a growing tobacco epidemic, fuelled by product manipulation, aggressive marketing by the tobacco industry and weak regulatory frameworks.

“One of the key challenges of tobacco control is that the tobacco industry continuously finds ways to circumvent regulations, and lobbies against public health measures aimed at reducing tobacco use.”

It is no coincidence that there is an alarming amount of smoking seen in movies and TV series these days. Because the tobacco industry is no longer allowed to advertise its products, one of its tactics is to pay for product placements in film and TV productions, or to compensate social media influencers to promote their products.

Young people are particularly susceptible to marketing, especially to vaping and heated tobacco products, and hookah use, with attractive packaging and retail outlets luring them in. The industry goes a step further by persuading them that these and other tobacco products – like Snus, a smokeless tobacco pouch taken orally – are safe and designed for harm reduction, which is simply not true, Prof Ayo-Yusuf says.

“Survey data collected by ATIM over a 15-year period showed that the number of 16- to 34-year-olds smoking cigarettes and vaping is continuing to escalate,” he says.

Smoking prevalence in this age group increased from 15.3% in 2010 to 27.3% in 2024, while vaping or the use of e-cigarettes increased from 0.3% to 11.1% during the same period. This evidence suggests that the “natural experiment” of so-called tobacco harm reduction that the industry has subjected South Africans to over the past 15 years has failed, as the use of these new products, especially e-cigarettes, has been associated with an increase in tobacco smoking rather than a reduction.

In March this year, Kenya published legislation stating that some of the graphic warnings on cigarette packs must be included on e-cigarette or e-liquid packaging.

“We need to do the same in South Africa; e-cigarettes need to be regulated similarly to cigarettes,” Prof Ayo-Yusuf says.

In 1998, secret documents came to light during the class action brought against the tobacco industry across 50 states in the US, revealing the industry’s deliberate tactics to escalate different forms of tobacco use and maximise profits.

“We now have decades of peer-reviewed research about the devastating effects of tobacco use on people’s health and the public health system at large,” Prof Ayo-Yusuf says. “We believe in research for impact, and have been vigorously presenting the research to appeal for stronger government policies to regulate the tobacco industry.”

He explained there is not enough oversight of the massive illicit (tax-not-paid) cigarette market in South Africa.

“SARS tried to introduce CCTV in tobacco factories to address the possible under-declaring of production, but the tobacco industry blocked this in court,” Prof Ayo-Yusuf says. “Under-declaring fuels the large illicit cigarette market. You can buy a pack for as little as R10, produced by the same manufacturers but sold for a third of the price, because they haven’t had to pay the R21 excise tax on the packet. This makes it affordable for many more people to smoke.

“South Africa needs a track-and-trace system linked in real time to each cigarette-manufacturing machine in the factories all the way to sales,” he adds. “The tender for this was issued by the government in 2019 but then cancelled, which is strange. We also urgently need funding for structured interventions to help adults and youth quit all forms of tobacco use, with programmes led by trained health workers.”

Moreover, he says, the appealing packaging of tobacco products also needs to be addressed.

“A study we conducted among South Africans showed that when selecting cigarette brands, their response is strongly based on what the pack looks like. This corroborates with the results of experiments conducted elsewhere by the tobacco industry, where it found that cigarettes in a white pack were seen as ‘light’, whereas the very same cigarettes in a red pack were perceived as being ‘strong’. Similarly, recent e-cigarette research in the UK showed that if the product came in a bland, standardised pack, young people would be less interested.”

Prof Ayo-Yusuf adds that his research team also put together 10 mock packs with graphic images warning about diseases and conditions that may be caused by smoking, including lung cancer, gum disease, leg gangrene, male impotence, oral health disease, even death. People were most put off and motivated to quit by the packs displaying images of lung cancer, leg gangrene, male impotence and oral health disease.

Deceptive marketing tactics extend to newer products too, like heated tobacco products (HTPs) such as the IQOS Heets and Terea sticks range, which comes in colour-coded packaging to get around the current ban on the use of descriptors like “mild” or “light”.

“Consumers have come to think that they represent strength profiles (light/mild or bold/regular) and flavour (menthol or non-menthol), giving them the impression that they’re opting for less harmful products by choosing colours that depict mild/light variants (Turquoise, Amber and Yellow) which our study shows are the dominant brands sold over the past six years after their introduction,” Prof Ayo-Yusuf says. “However, a recent study of these products in six countries, including South Africa, showed that there are no differences in the amount of cancer-causing chemicals they contain, irrespective of whether they’re colour-coded as mild or bold. Furthermore, South African HTP brands contained higher levels of cancer-causing agents compared to similar brands from countries like Japan.”

Prof Ayo-Yusuf recommends that South Africa ramp up the WHO’s MPOWER approach: to monitor (M) the use of tobacco with proper polices in place to regulate the industry; protect (P) the public from second-hand smoke; offer (O) structured, free programmes to help people quit; warn (W) about the dangers of tobacco use; enforce (E) bans on any form of tobacco advertising; and raise (R) taxes on tobacco.

“Hopefully there will be urgent action to regulate tobacco and nicotine products and related industry practices, especially as the Tobacco Products and Electronic Delivery Systems Control Bill is currently under consideration by the Parliamentary Portfolio Committee on Health,” he says.

Prof Lekan Ayo-Yusuf of UP.