Tobacco control and gender in south-east Asia. Part II: Singapore and Vietnam

Abstract

In the World Health Organization's Western Pacific Region, being born male is the single greatest risk marker for tobacco use. While the literature demonstrates that risks associated with tobacco use may vary according to sex, gender refers to the socially determined roles and responsibilities of men and women, who initiate, continue and quit using tobacco for complex and often different reasons. Cigarette advertising frequently appeals to gender roles. Yet tobacco control policy tends to be gender-blind. Using a broad, gender-sensitivity framework, this contradiction is explored in four Western Pacific countries. Part I of the study presented the rationale, methodology and design of the study, discussed issues surrounding gender and tobacco, and analysed developments in Malaysia and the Philippines (see the previous issue of this journal). Part II deals with Singapore and Vietnam. In all four countries gender was salient for the initiation and maintenance of smoking. Yet, with a few exceptions, gender was largely unrecognized in control policy. Suggestions for overcoming this weakness in order to enhance tobacco control are made.

Gender Differences in Smoking Behaviors in an Asian Population

“…13,19 The overall prevalence of smoking was nine times higher among men than women, but the gap is closing rapidly because of the dramatic increase in smoking rate among younger women. The smoking rates for men were 19.2, 12.6, 9, 8, and 3.8 times higher than for women at Ն 55 years, 45-55, 35-44, 25-34, and 18-24 year old, respectively (Table 1).…”

“…13,14,20 In addition, earlier studies have shown that the tobacco industry intentionally targeted women by focusing on female-identified needs, preferences, and positive images of smoking, [21][22][23] although there are no conclusive studies of how the tobacco industry targets women and teenage consumers in Taiwan. More work should be done to monitor and decrease the impact of the trade liberalization and cigarette marketing on smoking in these minority groups.…”

“…8,10,11,13,14,20 Traditional values and normative gender expectations may be becoming less of a protective factor against smoking in women in Asia. Therefore, it is crucial to gain a deeper understanding of the normative gender roles and social values of modern Asian women and identify the effects of sociocultural influences on cigarette diffusion and behaviors.…”

“…8,10,11 Almost no research has been done on smoking in women in Asia, where although relatively low, the prevalence is increasing at an alarming rate. [12][13][14][15] In many smoking studies of Asian populations, findings were not sex-disaggregated because the prevalence is so low among women that their statistics overcomplicate general tobacco research. Research interest in female smoking is nascent in Asia, and tobacco control advocates are less likely to recognize the determinants of female smoking, and policymakers are less likely to have developed gender-sensitive tobacco control policies.…”

Global tobacco inequalities: a new frontier

“…In East and South Asia, North Africa and the Middle East, men smoke much more than women [1], and it is possible that more traditional gender expectations and cultural norms about women may delay the uptake of tobacco use among women [11][12][13]. In these regions, men are clearly in stage II of the epidemic whereas women remain in stage I although use of smokeless tobacco is quite common in South Asia and more prevalent among persons of lower SEP.…”