"Coming to town": The impact of urbanicity, cigarette advertising, and network norms on the smoking attitudes of black women in Cape Town, South Africa
School of Public Health, University of Illinois at Chicago, Chicago, IL, United States; American University, Washington, DC, United States; University of Cape Town, Cape Town, South Africa; Kogod School of Business, American University, 4400 Massachusetts Avenue, NW, Washington, DC 20016-8044, United States
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. © 2008 The New York Academy of Medicine.
adolescent; adult; advertizing; article; attitude to health; cigarette smoking; female; human; major clinical study; prevalence; priority journal; smoking habit; social network; South Africa; urban population; urban rural difference; Adolescent; Adult; Advertising as Topic; African Continental Ancestry Group; Aged; Analysis of Variance; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Linear Models; Middle Aged; Questionnaires; Smoking; South Africa; Urban Population; Women's Health