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In urban informal areas of South Africa, obesity and hunger represent two sides of food insecurity. Despite this, public health and clinical obesity interventions focus on nutrition education, implying dietary choice and thereby overlooking food insecurity. The objective of this paper is to explore peri-urban residents' perspectives of changing food environments, framed by the Food Aid Organization (FAO) definition of food security and demonstrating the interconnectedness of dimensions of food security. We conducted three-part in-depth interviews with 21 participants and nine focus group discussions with a total of 57 participants, consisting primarily of women aged 20-84, in a peri-urban township and informal settlement outside of Cape Town, South Africa. Participants' encounters in clinical settings framed choice as a driver of diet-related non-communicable disease (NCD). Yet participants lacked economic access to food, particularly at the end of the month. Diets consisted of fewer green leafy vegetables relative to their diets in rural areas, despite affirming a preference for these foods. They described consuming more meat, which was also perceived as unhealthy. Based on self-report, residents within this peri-urban area of South Africa were food insecure: they lacked access to food at specific times of the month, they were unable to consume foods they preferred, and they felt that their diets were neither nutritious nor enabled an active and healthy life. When viewed in terms of multiple facets of food security, participants' concurrent experiences of hunger and obesity were unsurprising. Health interventions related to diet should incorporate an understanding of food security as shaped by the interactions of access, availability, utilization and stability. [ABSTRACT FROM AUTHOR]

This paper explores how housing modifies the temperature–mortality relationship in the Eastern and Western Cape provinces of South Africa. We estimate dose–response relationships for residents living in each of the five common types of South African housing by combining linear-threshold models for Cape Town with concurrent data on the city's housing composition and expert estimates of how well different types of housing protect against heat and cold. We then apply temperature data to determine provincial-level dose–response relationships, relative risks, attributable fractions and mortality burdens for heat and cold under seven housing scenarios – three past, three future and a scenario of maximum protection. We find that future mortality burdens would be lower under a policy scenario that prioritizes the replacement of informal housing compared to one that prioritizes the replacement of traditional dwellings. In a maximum protection scenario, where everyone lived in houses characteristic of the wealthy, temperature-related mortality could be reduced by over 50% (approximately 5000 deaths annually) in the two provinces combined. These results have relevance to current housing policy but also reinforce the importance of the built environment in mitigating adverse effects of future climate change. [Copyright &y& Elsevier]

Background. This paper examines the effect of pro- and antisocial opinions about communities on cigarette use by Black, Colored, and White 8th- and 11th-grade students in Cape Town, South Africa.Methods. This analysis consists of 1,328 students who completed a questionnaire in 1997 on sociodemographic characteristics, substance abuse, adolescent behaviors, and opinions about their communities. Structural equation modeling (SEM) was used to assess hypotheses related to the social development model positing direct and indirect associations between community constructs and smoking within the previous 31 days.Results. White students had the highest proportion (36.3%, P < 0.01) of past-31-days smokers compared to Colored (29.7%) and Black (9.7%) students. SEM analysis showed that among all groups the strongest association (β = 0.29, Whites, P < 0.01; β = .14, Coloreds, P < 0.01; β = 0.05, Blacks, P < 0.05) with recent cigarette smoking was the personal knowledge of adults who engaged in antisocial behavior.Conclusions. Youth smoking behavior may be affected by antisocial adult behavior, subjective adult norms, and community affirmation. Thus, in addition to other factors, social norms and community influence should be considered in preventing adolescent smoking. [Copyright &y& Elsevier]