Background:
Roll-Your-Own (RYO) smoking is considered a cheaper and healthier alternative to smoking. However, only limited information is available on the prevalence and trends in the African region. The study aimed to determine the most current prevalence and trends in RYO smoking.

Methods:
This study involved a secondary analysis of merged data obtained from adults >15 years, who participated in the South African Social Attitude Survey (SASAS) during 2007 (n=2907), 2011 (n=3004) and 2016 (n=3063). Current RYO smoker and current factory-manufactured cigarette (FMC) smokers are those who indicated daily or non-daily use of RYO cigarettes and FMC respectively. Participants were also asked if they had attempted to quit in the last 12 months. All statistical analysis took into account the complex sample design used in the SASAS.

Results:
Current smoking was estimated at 20.8%, 19.4%, 20.1% during 2007, 2011 and 2016 respectively. Among the general population, the prevalence of current RYO smoking was 4.2%, 5.3% and 5.3% during 2007, 2011 and 2016 respectively. The prevalence of use of RYO among factory-manufactured cigarette (FMC) smokers significantly increased from 14% in 2007 to 24.1% in 2016 (p for trend =0.09). Over the study period, RYO smoking was most prevalent among male (8.8%), coloureds (6.7%), rural residents (6.2%) and with < Grade 12 education (6.4%). Among smokers, RYO smoking was associated with a lower odds of reporting a quit attempt in the last 12 months (OR=0.60; 95% CI = 0.40 - 0.91).

Conclusions:
RYO smoking remain most common among those of lower socioeconomic status and concurrent use of RYO with FMC has increased. RYO smoking may be associated with lower odds of quitting smoking, thus the need for targeted interventions.