Abstract
Research on the role of neighbourhood-level deprivation in low- and middle-income countries with respect to tobacco use is relatively nascent. In South Africa, where race and deprivation are closely linked due to the history of apartheid, smoking disparities exist by individual risk factors such as gender, race, and socioeconomic status. However, less is known about how community-level factors affect smoking disparities in the country, or how the relationship between deprivation and smoking differs by race. We used data from the 2008 South African National Income Dynamics Study (NIDS) and Poisson generalised estimating equations to assess the relationship between neighbourhood deprivation and current smoking for individuals nested within neighbourhoods, while controlling for individual-level and household-level covariates. Subgroup analyses for racial categories Black and Coloured were performed. We found that the relationship between neighbourhood deprivation and smoking prevalence was non-linear: the smoking prevalence ratio was highest among those in the middle range for our deprivation index, and lower at extremely high and low levels of deprivation. Both Black and Coloured subsamples exhibited this inverted U-shape, although the relationship was weaker in the latter group. That the relationship between neighbourhood deprivation and smoking is non-linear contrasts with what has been found in high-income countries, where the relationship between neighbourhood deprivation and smoking is linear. Moreover, these findings are relevant to assess the potential differential impact of smoking interventions as a function of socioeconomic and environmental context.
Highlights
South Africa is an upper-middle income country with a population of 55.9 million in 2016 (Statistics South Africa, 2016)
We used data from the 2008 South African National Income Dynamics Study (NIDS) and Poisson generalised estimating equations to assess the relationship between neighbourhood deprivation and current smoking for individuals nested within neighbourhoods, while controlling for individual-level and household-level covariates
We found that the relationship between neighbourhood deprivation and smoking prevalence was non-linear: the smoking prevalence ratio was highest among those in the middle range for our deprivation index, and lower at extremely high and low levels of deprivation
Summary
South Africa is an upper-middle income country with a population of 55.9 million in 2016 (Statistics South Africa, 2016). Most of the population is Black (80.7%), followed by Coloured (8.8%; ethnic classification of persons with mixed ancestry), White (8.1%), and Indian/ Asian (2.5%) (Statistics South Africa, 2016). Coloured and Asian/Indian groups were subject to discriminatory practices that gave preferential treatment to Whites; they were conferred social and economic advantages over Blacks (Erasmus, 2001). These practices produced extreme disparities in education, employment, housing, living conditions, access to healthcare, and health outcomes along racial lines, which continue today (Kon and Lackan, 2008; Moller, 1998). South Africa is ranked as one of the most unequal nations in the world (Central Intelligence Agency (CIA), 2016)
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