Abstract
This study was conducted to examine the effect of urban living on smoking attitudes among black African women in South Africa. We examine how urbanicity affects attitudes toward smoking and how it moderates the relationship between both advertising exposure and network norms on black women’s smoking attitudes. Respondents were 975 black women currently living in Cape Town townships, some of which were raised in rural villages or small towns. Respondents completed a cross-sectional survey, which included data on smoking attitudes, norms, and exposure to cigarette advertising. Multiple linear regression analysis was performed with smoking attitudes as the response variable, and urbanicity, cigarette advertising exposure, and network smoking norms as primary explanatory variables. Interactions were tested to determine whether urbanicity modified the effect of advertising exposure and network norms on smoking attitudes. Independent effects of urbanicity, exposure to cigarette advertising, and greater smoking prevalence within women’s networks were associated with more favorable smoking attitudes. In addition, urbanicity moderated the relationship between network smoking norms and smoking attitudes, but not cigarette advertising exposure and smoking attitudes. Urbanicity, cigarette advertising, and networks play important roles in women’s attitudes toward smoking, and potentially, smoking behavior. Overall, our results suggest that strong and creative anti-smoking efforts are needed to combat the potential for a smoking epidemic among an increasingly urbanized population of black women in South Africa and similar emerging markets. Additional research is warranted.
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Notes
During the apartheid years, the Population Registration Act of 1950 classified all South Africans into “racial groups”. These groups included “black” (people of black African descent), “colored” (people of mixed descent), “white” (people of European descent) or “Asian” (people of Indian and Pakistani descent). Information is still collected along these “racial” divisions in public health to address disparities based on the classification. The use of these variables in this research is not intended to convey that the authors subscribe to this classification.
Prior to 1994, apartheid laws required black South Africans to reside in specific and mostly rural areas designated as tribal “homelands”.
References
Rodu B, Cole P. Declining mortality from smoking in the United States. Nicotine Tob Res. 2007;9(7):781–784.
Centers for Disease Control and Prevention. 2001 Surgeon General's Report—Women and Smoking. Atlanta, GA: CDC; 2001.
Mucha L. Meta-analysis of disease risk associated with smoking, by gender and intensity of smoking. Gend Med. 2006;3(4):279–291.
Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet. 2003;362(9387):847–852.
Steyn K, de Wet T, Saloojee Y, Nel H, Yach D. The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth to Ten Study. Paediatr Perinat Epidemiol. 2006;20(2):90–99.
Landers SJ. Lung cancer deadlier than breast cancer for women. American Medical News: the Newspaper for American Physicians. http://www.ama-assn.org/amednews/2003/12/01/hlsc1201.htm. Accessed January 8, 2007
Murray C, Lopez AD. The Global Burden of Disease. Boston, Massachusetts: World Health Organisation; 1996.
Yach D, Saloojee Y, McIntyre D. South Africa: Health and Economic Impact. Cape Town: MedTech; 1992.
Saloojee Y. Tobacco control in South Africa. In: Steyn K, Fourie J, Temple N, eds. Chronic Diseases of Lifestyle in South Africa 1995–2005. Athabasca, Canada: Athabasca University; 2006.
Marks AS, Steyn K, Ratheb E. Tobacco use by black women in Cape Town. Med Res Coun Policy Brief. Capetown, South Africa; 2001;3:1–4.
Central Statistical Services/Republic of South Africa. Mid-Year Population Estimates, 2007. Pretoria: Statistics South Africa; 2007.
Peto R, Lopez AD, Boreham J, Thun M, Heath CJ. Mortality from Smoking in Developing Countries 1950–2000. Oxford: Oxford University Press; 2006.
Robinson RG, Barry M, Bloch M, Glantz S, Jordan J, Murray KB. Report of the tobacco policy research group on marketing and promotions targeted at African Americans, Latinos and women. Tob Control. 1992;1(Suppl):S24–S30.
Sacks D, Abratt R. The moral minefield: legal and social issues of tobacco and liquor marketing. In: Abratt R, ed. Marketing Management: S.A. Cases and Readings, 2nd edn. Durban: Butterworth; 1989:44–63.
Wallach L, Montgomery K. Advertising for all by the year 2000: public health implications for less developed countries. J Public Health Policy. 1992;13(2):204–223.
Reddy P, Meyer-Weitz A, Yach D. Smoking status, knowledge of health effects and attitudes towards tobacco control in South Africa. S Afr Med J. 1996;86(11):1389–1393.
Steyn K, Bourne LT, Jooste PL, Fourie JM, Lombard CJ, Yach D. Smoking in the black community of the Cape Peninsula, South Africa. East Afr Med J. 1994;71(12):784–789.
Steyn K, Kazenellenbogen JM, Lombard CJ, Bourne LT. Urbanization and the risk for chronic diseases of lifestyle in the black population of the Cape Peninsula, South Africa. J Cardiovasc Risk. 1997;4(2):135–142.
Van Walbeek C. Recent trends in smoking prevalence in South Africa—some evidence from AMPS data. S Afr Med J. 2002;92(6):468–472.
Marks AS, Hooper V. Beliefs, Attitudes and values influencing smoking behaviour in black women in Cape Town area townships: an exploratory social marketing analysis. Paper presented at the 9th World Conference on Tobacco and Health. Paris; 1994:10–14 October. New York: Plenum Press; 1995.
Morrow M, Ngoc DH, Hoang TT, Trinh TH. Smoking and young women in Vietnam: the influence of normative gender roles. Soc Sci Med. 2002;55(4):681–690.
International Network of Women Against Tobacco (INWAT). INWAT warns of womens smoking crisis. In: 12th World Conference on Tobacco or Health—Global action for a tobacco free future. Helsinki, Finland, 3–8 August 2003. http://www.inwat.org/pdf/daily4.pdf. Accessed February 28, 2007.
Vlahov D, Galea S. Urbanization, urbanicity, and health. J Urban Health. 2002;79(4:Supp 1):S1–S12.
Cooper D, Pick WM, Myers JE, Hoffman MN, Sayed AR, Klopper JML. Urbanisation and women’s health in Khayelitsha. Part II. Health status and use of health services. S Afr Med J. 1991;79:428–432.
Pick W, Cooper D. Urbanisation and women's health in Khayelitsha, Cape Town: An overview. In: University of Cape Town Working Paper Series on Women's Health and Urbanisation. Cape Town: Department of Community Health, University of Cape Town; 1993:1–42.
Amos A, Haglund M. From social taboo to “torch of freedom”: the marketing of cigarettes to women. Tob Control. 2000;9(1):3–8.
Otis GA. You’re going too far, baby: activists cry foul as cigarette makers woo women in the developing world. Village Voice. August 8, 2000.
Hafez NL, Ling PM. How Philip Morris built Marlboro into a global brand for young adults: implications for tobacco control. Tob Control. 2005;14:262–271.
Amos A. Creating a global tobacco culture among women. In: Waller M, Lipponen S, eds. Smokefree Europe: Conference on Tobacco or Health; 1996 2–4 October; Helsinki, Finland: Finnish Centre for Health Promotion. http://www.health.fi/smoke2html/Pages/Smoke2–23.html. Accessed on February 28, 2007.
Marks AS. Submission in Support of the Tobacco Product Control Amendment Bill: the Effects of Advertising and Promotion. Testimony presented to and tabled by the Health Committee, Parliament of South Africa, October 1998. http://www.pmg.org.za/PMG Archive 98–99/Previous Term/Marks. Accessed on March 5, 1999.
Amos A. How women are targeted by the tobacco industry. World Health Forum. 1990;11:416–422.
Warner KE, Butler J, Cummings KM, et al. Report of the Tobacco Policy Research Study Group on tobacco marketing and promotion. Tob Control. 1992;1(Suppl.):S19–S23.
Galea S, Nandi A, Vlahov D. Social epidemiology of substance use. Epidemiol Rev. 2004;26:36–52.
Valente T, Gallaher P, Moutappa M. Using social networks to understand and prevent substance use: a transdisciplinary perspective. Subst Use Misuse. 2004;39(10–12):1685–1712.
Brook JS, Morojele NK, Brook DW, Zhang C, Whiteman M. Personal, interpersonal, and cultural predictors of stages of cigarette smoking among adolescents in Johannesburg, South Africa. Tob Control. 2006;15:48–53.
Swart D, Reddy SP, Panday S, Philip JL, Naidoo N, Ngobeni N. The 2002 Global Youth Tobacco Survey (GYTS): the 2nd GYTS in South Africa (SA)—A comparison between GYTS (SA) 1999 and GYTS (SA) 2002. Cape Town: University of Cape Town; 2004. http://www.mrc.ac.za/healthpromotion/reports.htm. Accessed March 2, 2007
StataCorp. Stata Statistical Software: release 8. College Station, TX: StataCorp LP, 2003.
Ruble DN, Seidman E. Social transitons: windows into social psychological processes. In: Higgins ET, Kruglanski A, eds. Social Psychology: Handbook of Basic Principles New York: Guilford; 1997:830–856.
Assunta M, Chapman S. The world's most hostile environment: how the tobacco industry circumvented Singapore's advertising ban. Tob Control. 2004;13:ii51–ii57.
MacKenzie R, Collin J, Sriwongcharoen K. Thailand—lighting up a dark market: British American tobacco, sports sponsorship and the circumvention of legislation. J Epidemiol Community Health. 2007;61:28–33.
National Council Against Smoking. Illegal advertising of tobacco brand. http://againstsmoking.org/pressreleases/NCAS_illegaladvertising.htm. Accessed on July 15, 2007.
Stone AA, Shiffman S. Capturing momentary, self-report data: a proposal for reporting guidelines. Ann Behav Med. 2002;24(3):236–243.
Acknowledgment
This project was carried out with the aid of a grant by Research for International Tobacco Control (RITC), an international secretariat housed within the International Development Research Centre (IDRC) in Ottawa, Canada. The authors would also like to thank the University of Cape Town and Dr. Krisela Steyn of the Medical Research Council of South Africa for support of the collaboration as well as Eleni Eleftheriou Ratheb and Victor Brobbey for research assistance.
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Williams is with the School of Public Health, University of Illinois at Chicago, Chicago, IL, USA; Grier is with American University, Washington, DC, USA; Marks was with the University of Cape Town, Cape Town, South Africa.
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Williams, C.T., Grier, S.A. & Marks, A.S. “Coming to Town”: The Impact of Urbanicity, Cigarette Advertising, and Network Norms on the Smoking Attitudes of Black Women in Cape Town, South Africa. J Urban Health 85, 472–485 (2008). https://doi.org/10.1007/s11524-008-9286-7
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DOI: https://doi.org/10.1007/s11524-008-9286-7