Tobacco

Sex and Gender-based Analysis of this topic

Definition
Overall smoking rates are decreasing in Canada but rates are not decreasing as fast among women as among men [1]. According to data from the 2007 Canadian Tobacco Use Monitoring Survey, 16.5% of women and 20.8% of men (aged 15 and older) were current smokers. In 2010, 13% of Canadian women (12 years and older) reported being daily smokers [2]. Historically, men have usually smoked more than women; however a higher proportion of young women aged 18-19 smoke compared to young men (24.4% versus 22.2%, respectively). In Canada, girls are also starting to smoke at a younger age compared to boys [3]. It is important to note that most smoking statistics only focus on cigarettes, often ignoring other forms of tobacco use, such as chewing tobacco, water pipes, bidis, chutta, betel nut, and snus or snuff, all of which have unique patterns of use by women around the world.
 
 
Sex Issues
Evidence suggests that due to biological differences, girls and women may be more affected by smoking and smoke exposure than boys and men and therefore be at a greater risk of developing diseases such as chronic obstructive pulmonary disease (COPD), lung cancer, and breast cancer [4]. As well, smoking may have detrimental effects on women’s reproductive function including decreased fertility and early menopause [5] and researchers have found links between smoking and both cervical cancer and breast cancer [6].
 
 
Gender Issues
Gendered patterns of tobacco use influence when and how women smoke or are exposed to tobacco smoke. Females start smoking at an earlier age than males and are thus exposed to tobacco for longer periods of time [2]. Adolescent girls often report that they started smoking because of curiosity or to deal with stress. Girls may be more influenced by the tobacco use of their friends and family compared to boys, likely due to the nature of close adolescent female friendships [7]. Many women report smoking in order to reduce stress, which explains why some women experience more withdrawal symptoms and are less successful when trying to quit. Fear of weight gain is also a barrier for many women to stop smoking [7], as women encounter tobacco marketing which brand cigarettes as a means to achieve cultural ideals of thinness [8].
 
 
Diversity
Current Canadian smokers often occupy a marginalized social position in relation to age, socioeconomic status, Aboriginal status, sexual orientation, and/or experiences such as trauma, mental illness, and use of other substances [1, 6]. In all of these situations, attention to specific women’s issues is warranted. For example, smoking rates among 20-24 year old women are 20%; 13% of whom are daily smokers. On average, female daily smokers (25 years and older) consume 13.1 cigarettes per day [9]. Younger girls (15-17 years old) smoke on average fewer cigarettes per day (11.2 cigarettes). Among women, females aged 45-54 years smoke the most cigarettes (14.7 cigarettes) [10]. Despite the cost, smoking in Canada is often associated with low income and low levels of education and unemployment. Low-income women report that smoking is an escape from the stressful realities of their lives, such as childcare, household, and work responsibilities [7].  

Tobacco use rates for the Aboriginal population over 20yrs are more than double the Canadian average [11]. Smoking among Aboriginal girls in BC, for example, is higher than Aboriginal boys [12] and the age of smoking initiation is youngest for Aboriginal girls (age 10) [7]. According to results from the First Nation Regional Health Survey (RHS), smoking rates among First Nations girls (age 15-17 years) were significantly higher (33%) [13] compared to 9% among other Canadian female teens (aged 15-17 years) [9]. Regional differences in smoking rates have also been documented. The highest rates daily female smoking is found in the three territories: Nunavut (56%), the Northwest Territories (30%), and Yukon (20%). Four provinces have daily smoking rates lower than 15%, including British Columbia, Ontario, Albertam and Manitoba [14]. 

 
Equity
Smoking rates among Canadian women vary significantly with socioeconomic status, age, and Aboriginal status. Smoking rates in higher socioeconomic groups are decreasing more rapidly than in any other group [15] but young women, women living on low income, Aboriginal girls and women, and young pregnant women/lone mothers are more likely to smoke than other women. Smoking rates are also higher among women with a history of mental illness and/or trauma and among women who use other substances [1, 6, 16]. One reason for higher smoking rates among disadvantaged and marginalised women could be that they often experience higher levels of stress, which is associated with smoking. For example, Statistics Canada reports that smoking rates were as high as 26% among women aged 25 to 44 years who reported the highest level of stress but 14% among women who reported that most of their days were “not at all stressful” [17]. Smoking cessation programs, however, often fail to address underlying conditions related to smoking [18]. Smoking is also seen a one of the main contributors to health inequities and disadvantaged groups may experience additional barriers in accessing smoking cessation services [19].
 
 
Critique
While overall female smoking rates in Canada are decreasing there are subgroups of women that are more likely to smoke, including women with low income, lone mothers, and Aboriginal girls and women [12]. There are no detailed, large-scale surveys or surveillance initiatives focusing specifically on Canadian women’s tobacco patterns and more research is needed to accurately understand why women start and continue to smoke, in light of evidence of the harmful health effects. Most studies on tobacco use also rely on self-reporting, which may be subject to social desirability bias due to the increasing stigma attached to smoking.
 
 
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health determinants > substance use > tobacco