Printer-friendly versionby Lorraine Greaves, PhD and Victoria J. Barr, M.H.Sc.
A collaboration of the British Columbia Centre of Excellence
for Women's Health, Women and Tobacco Working Group,
Women's Health Bureau (Health Canada)
Table of Contents in pdf format (1.4 MB)
Filtered Policy in pdf format (313k)
The facts, as we enter the 21st century...
- Smoking-related disease continues to be the number one killer of Canadian women.
- In Canada, tobacco use is the number one preventable cause of death and disease.
- At least half of all women who smoke will die as a result of the effects of tobacco.
- Lung cancer, a key smoking-related disease, has surpassed breast cancer as the leading cause of cancer death in women.
- Smoking doubles the risk of cardiovascular disease, the leading cause of death in women.
Women are equally, if not more, affected by tobacco than men. We don't yet fully understand the effect of smoking on females due to gaps in biomedical research.
There are troubling trends for the future regarding women and tobacco.
In what seems to be a continuing trend, teen girls are smoking at higher rates than teen boys.
Clearly, there is cause for concern, if not alarm, over girls, women and tobacco use in Canada.
We need a new approach. Tobacco policy can have a huge impact on tobacco use. Filtered Policy reveals the need for consistent gender analysis of tobacco policy and the need for women-centred policy. Filtered Policy makes recommendations for changing how tobacco policies are developed and how they work.
The Old Way
Tobacco Control and Regulation
The primary aim of the traditional tobacco control approach has been the reduction or elimination of smoking across the entire population. Its broad and blunt policy aims have been generic, or gender neutral. Its focus is on taxation, regulation, health pro-motion, prevention and cessation. These efforts benefit women by reducing the use of tobacco overall, and reducing exposure to smoking. However, a gender analysis highlights other considerations for women.
There are key factors, such as child care responsibilities, income adequacy and the nature of women's work that cause women to experience the effects of broad tobacco policies differently.
For example, health warnings on cigarette packages are used to transmit health information to smokers about the effects of smoking. "Tobacco smoke can harm your children" and "Smoking during pregnancy can harm your baby", while informative, carry additional emotional messages for women.
Mothers, not fathers, spend the most time at home with children. Pregnant women must work through the most conflict regarding the effects of smoking on the fetus.
These messages present smoking cessation as something to be done for its benefit to others instead of for the woman herself. Women are reduced to caregivers or vessels. These messages invite a guilt response, which may increase stress.
Instead, warnings should consider a more holistic, supportive and non-blaming approach. Women-centred package warnings would address the meanings of smoking for women, and the social determinants that influence smoking.
Messages that aim to reduce children's exposure to environmental tobacco smoke (ETS) have a primary impact on women. ETS exposure among children under 12 is greatest in disadvantaged homes, many of which are lone-parent households headed by women.
Traditional health promotion strategies urging smokers with children to quit often ignore the class and gender factors that help perpetuate the problem. Parents, especially mothers, are blamed, which will work against the goal of reducing tobacco use. In some situations, women's smoking around children has been framed as a custody, neglect and abuse issue.
Taxation to increase cigarette prices can be seen as either progressive or regressive. From a broad, population perspective, increased prices reduce tobacco consumption. A closer look at sub-groups, such as low-income women indicate that higher cigarette prices cause economic hardship, sometimes manifesting as spending less money on food.
How does this affect the nutritional health of women and children?
These examples illustrate how tobacco control without gender sensitivity overlooks the differential causes and consequences of smoking in women.
The New Way
An Integrated Comprehensive Policy Approach
The primary aim of this approach is a reduction of inequities in health. In turn, this will help to reduce tobacco use. This approach focuses on integrating tobacco policy with social and economic policy that benefits women's overall health and socioeconomic position, rather than focusing only on reducing tobacco use and related illness.
For a women-centred policy to emerge, women would be included as experts on their lives. Policy making would involve women. Women-centred policy would take into account the social context of women's smoking and all the various barriers to good health. It would account for the unintended consequences of tobacco control measures.
Tobacco policy would be integrated with policy concerning unemployment, low income, single parenthood, housing, low levels of education, family violence, etc. Only then will policies reflect the systemic changes needed to affect women's tobacco use and cessation and have the desired effect on women's and girls' tobacco use.
For disadvantaged women to take control of their lives through smoking cessation, it is necessary to adopt comprehensive strategies that address not only smoking, but the range of circumstances that contribute to tobacco use. Filtered Policy points out that given the increasing rates of young women's smoking, and the demographics of low-income, Francophone and Aboriginal women smoking more than the general female population, the need for more re-search into the role of smoking in women's lives is acute.
Filtered Policy contains a clear call for more sex- and gender-sensitive biomedical re-search on the effects of tobacco use on girls and women. Women experience specific and differential effects of nicotine that contribute to a range of illnesses and often, early death.
Such research will inform the new approach to a comprehensive tobacco policy. The traditional approach and the comprehensive approach must be mined for their best elements, and the best of each utilized in creating new policy for girls and women. Perhaps higher taxation should be married with free cessation aids and programs? Perhaps cigarette tax in Canada should be earmarked for programs that reduce the inequities in health for women and low-income people?
It is not acceptable, nor effective, to simply ask women smokers to quit if an appropriate social exchange and support is not offered. Sharing responsibility for tobacco use is sharing responsibility for health.
A generic, one-size-fits-all tobacco policy is no longer adequate. In particular, girls and women, Aboriginal people and low-income people are not responding to it. Filtered Policy makes key recommendations for a new approach to tobacco policy, an approach whose time, given the stark facts about women and tobacco use in Canada, has clearly come.
Filtered Policy reveals the need for consistent gender analysis of tobacco policy and the need for women-centred policy.
Traditional health promotion strategies urging smokers with children to quit often ignore the class and gender factors that help perpetuate the problem.
Women-centred policy would take into account the social context of women's smoking and all the various barriers to good health.
Sharing responsibility for tobacco use is sharing responsibility for health.
Web Resources
Bridging the Visions
Women and Tobacco Working Group
Resources for Women
Tobacco Reduction - Health Canada
Second-Hand Smoke and Pregnancy
National Clearinghouse on Tobacco and Health
Exercise Helps Women Quit Smoking
Canadian Association for the Advancement of Women and Sport and Physical Activity
Evening the Odds : Adolescent Women, Tobacco and Physical Activity
Canadian Association for the Advancement of Women and Sports and Physical Activity
Young Women and Smoking
Canadian Association for the Advancement of Women and Sports and Physical Activity
Helping Young Women Choose A Tobacco-Free Lifestyle
Canadian Association for the Advancement of Women and Sports and Physical Activity