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New Report Highlights Need For Global Action To Break Link Between Increasing Empowerment And The Growing Female Tobacco Epidemic

July 30, 2017

A new research study from the University of Waterloo, Canada, published in the international public health journal, the Bulletin of the World Health Organization (WHO), has identified a correlation between increased female political and economic empowerment and prevalence of smoking among women. As a consequence, the authors of the report are calling on governments around the globe to take concerted action to implement tobacco control policies in order to help prevent potential increases in smoking rates, particularly among recently emancipated women in developing nations.

"A World Bank report estimated that smoking rates among men are five times higher than among women, while WHO studies show that the ratio of female-to-male smoking varies dramatically across countries, with the greatest difference found in low to middle income countries. Our analysis of smoking rates across 74 countries shows that this difference declines as measures of women's status improve. However, this correlation between female empowerment and smoking does not mean that women will automatically start smoking if they become empowered," comments co-author Dr. Geoffrey T. Fong from the International Tobacco Control Policy Evaluation Project at the University of Waterloo in Ontario, Canada. "Our study makes a strong case for implementing gender-specific tobacco control activities in addition to the policies already identified in the WHO's Framework Convention on Tobacco Control (FCTC), such as more higher tobacco taxes, more prominent graphic health warnings, smoke-free laws, and advertising and promotion bans," said Fong, who is also Senior Investigator at the Ontario Institute for Cancer Research.

The report notes that historical investigations of the tobacco epidemic show that younger and more highly educated women are among the first to take up smoking when there is a breakdown of the traditional norms that discourage women from using tobacco. However, it also notes that the course of the tobacco epidemic may not evolve in exactly the same way across countries. Therefore, the authors also called for greater monitoring of the uptake of smoking among women in developing nations and more evaluation of the tobacco control strategies and policies that are most effective in preventing that uptake.

"Women's empowerment must and will continue. As demonstrated in the 2010 United Nations Development Programme Report on Human Development, empowerment is linked with positive outcomes in health, education, and other dimensions of human development. Moreover, it is not inevitable that the bad has to follow the good," says the study's lead author, Sara C. Hitchman. "We must pay more attention to the ways in which the tobacco industry is capitalizing on societal changes to target women, such as marketing cigarettes to women as a symbol of emancipation. In this respect, bans on advertising, promotion and sponsorship could be a key strategy in deterring women from taking up smoking. However, we also need to understand more about the other factors that determine whether or not a women starts to smoke, such as educational level or female employment rate. Further research into patterns of uptake could help governments take more effective action and reduce adoption rates for smoking among women in the future." As an example, Hitchman and Fong argue there is a need to monitor and evaluate how price and tax measures affect the uptake of smoking among girls and women in countries where the tobacco epidemic is currently in its early stage.

"This study highlights the need to act quickly to curb smoking among women, particularly in developing countries where current female smoking rates are quite low," says Dr Douglas Bettcher, Director of the Tobacco Free Initiative at WHO. "The tobacco epidemic is still in its early stages in many countries but is expected to worsen. More strategies such as bans on tobacco advertising are needed to prevent the tobacco industry from targeting women."

The Tobacco Free Initiative at WHO encourages countries to prevent the spread of the tobacco epidemic by implementing policies outlined in the WHO Framework Convention on Tobacco Control. These include public awareness campaigns, packaging and promotion regulations and tax measures to reduce demand for tobacco products.


About The Bulletin of the World Health Organization

The Bulletin of the World Health Organization is one of the world's leading public health journals. It is the flagship periodical of WHO, with a special focus on developing countries. Articles are peer-reviewed and are independent of WHO guidelines. Abstracts are available in the six official languages of the United Nations. The March issue table of contents can be found here.

About the ITC Project

The International Tobacco Control Policy Evaluation Project (the ITC Project) is an international research collaboration involving 80 tobacco control researchers and experts from 20 countries (Canada, United States, United Kingdom, Australia, Ireland, Thailand, Malaysia, China, South Korea, New Zealand, Mexico, Uruguay, France, Germany, The Netherlands, Brazil, Mauritius, Bangladesh, Bhutan, and India) who have come together to conduct research to evaluate the impact of tobacco control policies of the WHO Framework Convention on Tobacco Control (FCTC), the world's first health treaty. These policies include more prominent warning labels (including graphic images), comprehensive smoke-free laws, restrictions or bans on tobacco advertising, promotion, and sponsorship, higher taxes on tobacco products, removal of potentially deceptive labelling (e.g., "light" and "mild" and packaging design that lead consumers to the misperception that certain brands may be less harmful), promotion of cessation, education of public on the harms of tobacco, reduction of illicit trade, reduction of youth access, and product regulation. The ITC team in each country conducts longitudinal cohort surveys and capitalizes on natural experiments to evaluate the impact of these policies over time. ITC Surveys contain over 150 measures of tobacco policy impact and have been conducted in countries inhabited by over 50% of the world's population, 60% of the world's smokers, and 70% of the world's tobacco users.

University of Waterloo