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“Coming to Town”: The Impact of Urbanicity, Cigarette Advertising, and Network Norms on the Smoking Attitudes of Black Women in Cape Town, South Africa

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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

  1. 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.

  2. Prior to 1994, apartheid laws required black South Africans to reside in specific and mostly rural areas designated as tribal “homelands”.

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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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