‘Gender’- socially determined roles for each sex - provides the social explanation for sex-linked patterns of tobacco use. Popular interest in ‘gender and health’ is synonymous with ‘women and health’. As a result connections between masculinity and risk behaviours are overlooked (1).

In most of the world, being born male is the greatest predictor for tobacco use, with overall prevalence about four times higher among men than women globally (48% versus 12%) (2). Recent findings of the Global Youth Tobacco Survey, however, show that young girls are smoking almost as much as young boys and that girls and boys are using non-cigarette tobacco products such as spit tobacco, bidis, and water pipes at similar rates. Nearly 24% of all young smokers started by the age of ten, when they are far too young to understand the risks of tobacco use and addiction or to resist social expectations (3,4).

• The tobacco industry targets women: Using seductive mages of vitality, slimness, emancipation, sophistication, and sexual allure, the industry targets women. Liberation, autonomy, and even female friendship feature in developed countries advertising, and, increasingly, where female roles have begun to change and women aspire to reach autonomy (7).
• The tobacco industry continues also to target men: Smoking is portrayed as a manly habit linked to happiness, fitness, wealth, power and sexual success (nevertheless in reality it brings premature death and sexual problems (5)).

The preamble to the WHO Framework Convention on Tobacco Control (WHO FCTC) states:

‘The Parties to this Convention, ……..Alarmed by the increase in smoking and other forms of tobacco consumption by women and young girls worldwide and keeping in mind the need for full participation of women at all levels of policy-making and implementation and the need for gender-specific tobacco control strategies’.

Applying a gender perspective to each component could enhance the WHO FCTC’s implementation. This will require sound multi-disciplinary research to produce appropriate recommendations within countries. For example:

• Differential impacts on men and women of different ages should be considered when deciding upon tobacco pricing, health warnings, access and advertising and promotion bans (6); Women may benefit more from messages destroying the myth of the ‘slim’ cigarette, while men may be concerned by tobacco’s threats to virility (7).
  
• Too often, the sole group singled out by sex is pregnant women, primarily driven by foetal health concerns.
  
• Community interventions are important to supplement the macro impacts of legislation. Media and community-based campaigns and workplace activities should ensure messages and actions work successfully with both sexes.

References

(1) Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Social Science & Medicine, 2000, 50: 1385-1401.
(2) Corrao MA, Guindon GE, Cokkinides V, Sharma N. Building the evidence base for global tobacco control. Bulletin of the World Health Organization, 2000a, 78 (7): 884-890.
(3) The Global Youth Tobacco Survey Collaborative Group (US Centers for Disease Control and Prevention; the World Health Organization, the Canadian Public Health Association, and the U.S. National Cancer Institute). Tobacco use among youth: a cross country comparison. Tobacco Control 2002, 11: 252-270.
(4) The Global Youth Tobacco Survey Collaborative Group Differences in worldwide tobacco use by gender: Findings from the Global Youth Tobacco Survey. Journal of School Health, August 2003, Vol. 73, No. 6 : 207-215.
(5) Mackay J and Eriksen M. The Tobacco Atlas. World Health Organization 2002.
(6) Jacobs R. Economic policies, taxation and fiscal measures. In, eds J Samet, Soon-Young Yoon, Women and the tobacco Epidemic: Challenges for the 21st Century, 2001. World Health Organization, Geneva: 177-200.
(7) Samet J , Yoon SY. Women and the Tobacco Epidemic. Challenges for the 21st Century WHO Monograph WHO/NMH/TFI/01.1

Related links

• Women and the Tobacco epidemic
  pdf, 2.79Mb
• Factsheet: Gender, health and tobacco
  pdf, 601kb

Reports

• Special report: The GYTS Collaborating Group. Differences in worldwide tobacco use by gender: findings from the GYTS.
  Journal of School Health. August 2003, Vol.73, No.6, 207-215
• Smoking & reproductive life The impact of smoking on sexual, reproductive & child health
  Board of Science and Education February 2004