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Gender equality and smoking: a theory-driven approach to smoking gender differences in Spain
  1. Usama Bilal1,2,
  2. Paula Beltrán2,3,
  3. Esteve Fernández4,5,6,
  4. Ana Navas-Acien1,7,
  5. Francisco Bolumar2,8,9,
  6. Manuel Franco1,2,10
  1. 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
  3. 3Department of Preventive Medicine, Hospital Universitario La Paz, Madrid, Spain
  4. 4Tobacco Control Unit, Cancer Prevention Program. Institut Català d'Oncologia (ICO). l'Hospitalet de Llobregat, Spain
  5. 5Cancer Control and Prevention Area, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
  6. 6Department of Clinical Sciences, Medical School (Bellvitge), Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
  7. 7Department of Environmental Health Sciences, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  8. 8CIBER Epidemiología y Salud Pública (CIBERESP), Spain
  9. 9Hunter School of Public Health, City University of New York
  10. 10Department of Epidemiology, Atherothrombosis and Cardiovascular Imaging Centro Nacional de Investigaciones Cardiovasculares Madrid, Spain
  1. Correspondence to Dr Manuel Franco, Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid 28871, Spain; mfranco{at}uah.es

Abstract

Background The intersection between gender and class can aid in understanding gender differences in smoking.

Aim To analyse how changes in gender inequality relate to differences in smoking prevalence by gender, education and birth cohort in Spain over the past five decades (1960–2010).

Methods The Gender Inequality Index (GII) was calculated in 5-year intervals from 1960 to 2010. GII ranges from 0 to 1 (1=highest inequality) and encompasses three dimensions: reproductive health, empowerment and labour market. Estimates of female and male smoking prevalence were reconstructed from representative National Health Surveys and stratified by birth cohort and level of education. We calculated female-to-male smoking ratios from 1960 to 2010 stratified by education and birth cohort.

Results Gender inequality in Spain decreased from 0.65 to 0.09 over the past 50 years. This rapid decline was inversely correlated (r=−0.99) to a rising female-to-male smoking ratio. The youngest birth cohort of the study (born 1980–1990) and women with high education levels had similar smoking prevalences compared with men. Women with high levels of education were also the first to show a reduction in smoking prevalence, compared with less educated women.

Conclusions Gender inequality fell significantly in Spain over the past 50 years. This process was accompanied by converging trends in smoking prevalence for men and women. Smoking prevalence patterns varied greatly by birth cohort and education levels. Countries in earlier stages of the tobacco epidemic should consider gender-sensitive tobacco control measures and policies.

  • Socioeconomic status
  • Disparities
  • Prevention
  • Priority/special populations

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