Aim: This study examined the influence of the social context in which people live on self-ratings of their oral health. Method: This study involved a representative sample of 2,907 South African adults (≥16 years) who participated in the 2007 South African Social Attitude Survey (SASAS). We used the 2005 General Household Survey (n = 107,987 persons from 28,129 households) to obtain living environment characteristics of SASAS participants, including sources of water and energy, and household cell-phone ownership (a proxy measure for the social network available to them). Information obtained from SASAS included socio-demographic data, respondents’ level of trust in people, oral health behaviors and self-rated oral health. Results: Of the respondents, 76.3% self-rated their oral health as good. Social context influenced women’s self-rated oral health differently from that of men. Good self-rated oral health was significantly higher among non-smokers, employed respondents and women living in areas with higher household cell-phone ownership. Furthermore, trust and higher social position were associated with good self-rated oral health among men and women respectively. Overall, 55.1% and 18.3% of the variance in self-rated oral health were explained by factors operating at the individual and community levels respectively. Conclusion: The findings highlight the potential role of social capital in improving the population’s oral health.

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BackgroundThe prevalence of smoking and consumption of cigarettes have decreased in South Africa over the last 20 years. This decrease is a result of comprehensive tobacco control legislation, particularly large cigarette tax increases. However, little attention has been given to the potential use of ‘roll-your-own’ cigarettes as cheaper alternatives, especially among the socio-economically disadvantaged population. This study therefore sought to determine socio-demographic correlates of ‘roll-your-own’ cigarette use among South African adults (2007–2010).MethodsThis secondary data analysis used a merged dataset from two nationally representative samples of 2 907 and 3 112 South African adults (aged ≥16 years) who participated in the 2007 and 2010 annual South African Social Attitude Surveys respectively. The surveys used a face-to-face interviewer-administered questionnaire. The overall response rates were 83.1% for 2007 and 88.9% for 2010. Data elicited included socio-demographic data, current smoking status, type of tobacco products used, past quit attempts and self-efficacy in quitting. Data analysis included chi-square statistics and multi-variable adjusted logistic regression analysis.ResultsOf the 1 296 current smokers in this study, 24.1% (n = 306) reported using roll-your-own cigarettes. Some of whom also smoked factory-made cigarettes. Roll-your-own cigarette smoking was most common among black Africans and was more common among male smokers than among female smokers (27% vs 15.8%; p < 0.01). Compared to smokers who exclusively used factory-made cigarettes, roll-your-own cigarette smokers were less confident that they could quit, more likely to be less educated, and more likely to reside in rural areas. The odds of use of roll-your-own cigarette were significantly higher in 2010 than in 2007 (OR = 1.24; 95% CI: 1.07-1.44).ConclusionsDespite an aggregate decline in smoking prevalence, roll-your-own cigarette smoking has increased and is particularly common among smokers in the lower socio-economic group. The findings also suggest the need for a more intensive treatment intervention to increase self-efficacy to quit among roll-your-own cigarette smokers.

Based on these findings, it can be concluded that the combined lifetime use of both snuff and cigarettes may increase the odds of developing osteoporosis among women who are 40 years and older.

This study sought to determine the contributions of socio-economic position and health insurance enrollment in explaining racial disparities in preventive dental visits (PDVs) among South Africans. Data on the dentate adult population participating in the last South African Demographic and Health Survey conducted during 2003–2004 (n = 6,312) was used. Main outcome measure: Reporting making routine yearly PDVs as a preventive measure. Education, material wealth index and nutritional status indicated socio-economic position. Multi-level logistic regression analysis was conducted to determine the predictors of PDVs. A variant of Blinder-Oaxaca decomposition analysis was also conducted. Health insurance coverage was most common among Whites (70%) and least common among black Africans (10.1%) in South Africa. Similarly, a yearly PDV was most frequently reported by Whites (27.8%) and least frequently reported among black Africans (3.1%). Lower education and lower material wealth were associated with lower odds of making PDVs. There was significant interaction between location (urban/rural) and education (p = 0.010). The racial and socio-economic differences in PDVs observed in urban areas were not observed in rural areas. In the general dentate population, having health insurance significantly increased the odds of making PDVs (OR = 4.32; 3.04–6.14) and accounted for 40.3% of the White/non-White gap in the probability of making PDVs. Overall, socio-economic position and health insurance enrollments together accounted for 55.9% (95% CI = 44.9–67.8) of the White/non-White gap in PDVs. Interventions directed at improving both socio-economic position and insurance coverage of non-White South Africans are likely to significantly reduce racial disparities in PDVs.

This study sought to evaluate the in utero exposure to aluminum and status of selected trace elements in South African women at delivery since aluminum is known to be toxic in all developmental stages even at low concentrations. Serum aluminum was negatively correlated with aluminum in urine, both uncorrected and corrected for creatinine, which suggests the retention of aluminum in body stores. Serum copper and zinc levels were found to be high in this study population. Serum copper levels were negatively correlated with aluminum in serum (β = −0.095; p = 0.05). There was a marginal negative correlation between aluminum levels in serum and manganese levels in whole blood (β = −0.087; p = 0.08). Copper levels in maternal serum were negatively correlated with birth weight and the length of neonates. There were a number of positive correlations between maternal characteristics and birth outcomes. Mothers who consumed root vegetables frequently appeared to be protected from aluminum retention and increased body burden since their serum aluminum levels were found to be significantly lower. The findings of the current study can be used as a baseline for further research on aluminum exposure and its associated interactions and outcomes in vulnerable populations.

Background: Temperature and air pollution are often treated as separate risk factors and very few studies have investigated effect modification by temperature on air pollution, and the impact of this interaction on human health in Africa. This study therefore investigated the modifying effects of temperature on the association between air pollution and Respiratory disease (RD) hospital admission in South Africa.  Methods: RD admission data (ICD10 J00-J99) were obtained from two hospitals located in Secunda, South Africa beween 1 January 2011 to 31 October 2016. NO2, SO2, PM10, PM2.5, temperature and relative humidity data were obtained from the South African Weather Services. A case-crossover epidemiological study design was applied and lag0-1 was used. Models were adjusted for public holidays and  Apparent Temperature (Tapp). Tapp was classified as warm (Tapp>75th percentile), cold (Tapp<25th percentile) and normal (Tapp  25th-75th  percentile). Results: Of the 14 568 RD admissions, approximately equal number of females and males were admitted. The average daily NO2, SO2, PM2.5 and PM10 levels were 12.4 μm/m3, 8.5 μm/m3, 32.3 μm/m3 and 68.6 μm/m3, respectively. Overall, a 10 μm/m3 increase in SO2 on warm days was associated with an increase in RD hospital admissions among the patients by 8.5% (95% Conf. Int: 0.4%, 17.2%) and 8.4% (95% Conf. Int: 0.3%, 17.1%) after adjustment for PM2.5 and PM10 respectively. However, increasing PM2.5 or PM10 by 10 μm/m3 was associated with an increase in RD hospital admissions when the temperature was normal after adjusting for SO2.  On cold days there were significant associations between the SO2 and RD admissions among the 0-14 year age group after adjusting for either PM2.5 (6.5%; 95% Conf.Int: 0.9%, 12.4%) or PM10 (5.5%; 95% Conf.Int: 0.3%, 11.1%). Conclusions: SO2 was affected by extremes of temperature while the particulate matters had effect on RD admission during normal temperature in Secunda.

Early life exposure to inorganic arsenic (iAs) has been shown to interfere with foetal and early childhood development, and is associated with morbidity and mortality in adulthood. The purpose of this study was to evaluate exposure to As in utero, to determine the association between maternal and cord blood of As and birth outcomes in South African populations. Total arsenic was measured in maternal blood of a total cohort (n=650) and in paired cord blood and urine of a subset cohort (n=317). Overall, the geometric mean (GM) of As in maternal blood was 0.62μg/L (n=650; 95% CI, 0.58-0.66). In the subset cohort, the GM of maternal blood As was 0.96μg/L (n=350; 95% CI, 0.91-1.02); in paired cord blood, the GM was 0.78μg/L (n=317; 95% CI, 0.74-0.83); and in urine (creatinine-corrected), the GM was 14.26μg/g creatinine (n=317; 95% CI, 12.64-16.09). A linear correlation was found between log maternal blood As and log cord blood As (rho=0.80, p<0.001). Birth outcomes showed geographical differences. in gestational age (p<0.001), birth length (p=0.019), head circumference (p<0.001), Apgar score at 5min (p<0.001) and parity (p<0.002). In a multivariate analysis, no association between maternal blood (AsB) levels and birth outcomes were found. However, the lower the gestational age, the higher the levels of maternal AsB (β=-0.054; 95% CI-0.087 to -0.020) and mothers who had had at least one child were less likely to have higher AsB if compared to those who had never had any child (β=-0.177; 95CI-0.322 to 0.031). In both univariate and multivariate analyses, being single, and drinking water from communal outdoor taps, boreholes and rivers was associated with higher As levels. The findings suggest that more research is needed to evaluate the impact of low level As exposure on postnatal development.