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

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.

Mass media exposure, social stratification, and tobacco consumption among Nigerian adults

“…In Ghana, smoking prevalence was higher in households that owned a television or radio, compared with those that owned a telephone or car [12]. In South Africa, exposure to cigarette advertising, mainly through radio advertisements and ''giveaways'' of tobacco paraphernalia, was associated with more favorable tobacco attitudes among adult women [13]. Favorable attitudes towards tobacco were associated with smoking among school-age youth in India and mediated the relationship between increased exposure to Western media and smoking among Egyptian adolescents [14,15].…”

“…The few reports on tobacco use in Nigeria document prevalence that is significantly higher for men than for their female counterparts [22]. The few studies on gender norms and smoking show that in South Africa and Egypt smoking tobacco is regarded as a cultural taboo for women and qualitative data suggest that women smokers are thought to be ''disrespectful'' and ''manly'' [13,14]. The few female tobacco users are more likely to use the more discrete smokeless tobacco [23].…”

Targeted Marketing and Public Health

“…These gaps in coverage have become increasingly problematic, given that most advertising budgets have shifted to nontraditional channels (15,65); thus, a large proportion of targeted marketing is essentially unregulated even in countries that have extensive protections in place for the traditional channels and especially in developing countries where there may be major regulatory gaps overall. Also, industry observers note that tobacco companies are using social influence efforts such as "underground" parties in South Africa to target youth and circumvent the country's regulations on tobacco marketing (130).…”

Cigarette Smoking Trends and Social Disparities Among South African Adults, 2003–2011

“…The new sociopolitical dispensation in postapartheid South Africa continues to advocate for women emancipation and this new social climate has been characterized by increased movement of females to cities for job opportunities, reduced influence of tradition and customs, and overall greater corporate opportunities. 21 As a result, an increasing proportion of women in managerial/executive positions has been observed, with corresponding higher disposable income. During 2001-2011, the proportion of South African women in elementary (lowest) occupations declined from 29.5% to 24.4%, whereas the proportion in the management, professional, and technical group increased from 23.5% to 30.7%, and was higher than the proportion of males in such high paying positions during 2011 (24.6%).…”

“…Although the average retail price (per 20-cigarette pack) of cigarettes in the most popular price category in South Africa, rose nationally from 18.99 R ($2.59) in 2008; to 21.99 R ($3.00) in 2010, and reached 30.90 R ($3.77) in 2012, 8 the real price changes for the respective years were −1.5%, +6.7% and −0.6%. 7 However, during the study period (i.e., [2003][2004][2005][2006][2007][2008][2009][2010][2011], marked increases were noted in the economy and earnings, with South Africa's gross national income status (as classified by the World Bank) rising from a "lower-middle" status during the 2003 calendar year, to an "upper-middle" status during 2011.…”