Gender, Social Change, and Global Patterns of Cigarette Use

高收入、较发达国家(MDC)香烟使用量的下降与中低收入、欠发达国家(LDC)香烟使用量的增长形成对比。这种对比还涉及性别差异：尽管在最不发达国家，女性和男性吸烟已趋于一致，但与男性吸烟相比，女性吸烟率仍然较低。公共卫生官员谴责最不发达国家男性香烟使用率的上升，但也担心女性吸烟率低意味着她们未来有可能大幅增加。除了对公共健康的担忧，这些男性和女性吸烟的全球模式引发了关于社会分化和健康行为本质的理论问题。这项研究提出了以下研究问题：发展中国家吸烟性别差异趋同的潜在来源是什么？这些潜在来源对最不发达国家吸烟的性别差异有同样的影响吗？它们是否解释了最不发达国家与发展中国家相比存在更大的性别差异？一种常见的论点回答了这些问题，认为性别平等运动导致了发展中国家男性和女性吸烟率的趋同。报告还指出，性别不平等和对女性行为的限制是最不发达国家女性吸烟率低以及最不发达国家和最不发达国家吸烟性别差距大小不一的原因。相反，一种扩散的论点表明，男性和女性吸烟差距的变化是女性在吸烟、传播和减少吸烟的一般过程中滞后的副产品，与女性地位的改善没有什么关系。还有其他解释表明，需要考虑经济增长、预期寿命、贸易自由化、贸易依存度和公共卫生政策等影响。很少有研究使用发展中国家和最不发达国家的跨国数据来评估这些理论论点。该项目通过审查代表世界所有地区和收入水平的国家的烟草使用的性别差异，改进了现有的工作。它将收集22个发展中国家和多达87个最不发达国家的男女吸烟、性别平等、香烟扩散以及其他经济和公共政策对香烟使用的影响的汇总数据。发展中国家的数据可以对处于实现性别平等和香烟扩散运动的中后期阶段的国家进行长期研究，而发展中国家和最不发达国家的数据可以研究在实现性别平等和扩散香烟运动的早期和后期阶段的国家之间的横向差异。有了这样的数据，统计模型将检验从理论论证得出的非线性和非加性假设。这项研究的更广泛影响涉及了解现代和发展中社会重大公共卫生问题的根本根源--香烟的使用--的好处。尽管许多研究探讨了吸烟的原因，但它们往往侧重于个人风险因素，而忽视了个人风险背后的基本社会力量。这里对社会变革的宏观力量的关注突出了了解这些基本社会力量、烟草在美国境外的传播以及最不发达国家在该流行病早期阶段的经验的重要性。此外，对社会的好处来自于拟议的项目对妇女的关注，这是一个在医学研究中往往代表不足的群体，值得在香烟使用方面进行特别研究。

ABSTRACTThe decline of cigarette use in high-income, more developed countries (MDCs) contrasts with the growth of cigarette use in middle and low-income, less developed countries (LDCs). The contrast also involves gender differences: Although female and male smoking have converged in MDCs, female smoking remains low compared to male smoking in LDCs. Public health officials decry the rising use of cigarettes among men in LDCs, but also worry that the low rates of smoking among women means they have the potential for large future increases. Along with public health concerns, these global patterns of male and female smoking raise theoretical questions about the nature of social differentiation and health behavior. This study poses the following research questions: What are the underlying sources of converging gender differences in smoking in MDCs? Do these underlying sources have the same influence on gender differences in smoking in LDCs? And do they explain the larger gender differences in LDCs compared to MDCs? A common argument answers these questions by positing that movement toward gender equality produces converging male and female rates of smoking in MDCs. It further suggests that gender inequality and restrictions on female behavior account for low rates of female smoking in LDCs, and the varied size of the gender gap in smoking in MDCs and LDCs. In contrast, a diffusion argument suggests that variation in the gap between male and female smoking is the byproduct of a female lag in the general process of cigarette adoption, spread, and abatement, and has little to do with improvements in women's status. Still other explanations suggest the need to consider influences such as economic growth, life expectancy, trade liberalization, trade dependency, and public health policies. Few if any studies have evaluated these theoretical arguments with cross-national data for both MDCs and LDCs. This project improves on existing work by examining gender differences in tobacco use across nations that represent all regions and income levels of the world. It will gather aggregate data on cigarette smoking of men and women, gender equality, cigarette diffusion, and other economic and public policy influences on cigarette use for 22 MDCs and up to 87 LDCs. The data for the MDCs allow the over-time study of nations at middle to late stages of the movement toward gender equality and cigarette diffusion, while data for both the MDCs and LDCs allow the study of cross-sectional differences among nations that span both early and late stages of the movement toward gender equality and cigarette diffusion. With such data, the statistical models will test non-linear and non-additive hypotheses that follow from the theoretical arguments. The broader impacts of this research relate to the benefits of understanding the underlying sources of a major public health problem in both modern and developing societies - the use of cigarettes. Although many studies examine the causes of cigarette use, they tend to focus on individual risk factors and neglect the fundamental social forces that underlie the individual risks. The attention here to macro-level forces of social change highlights the importance of understanding these fundamental social forces, the spread of tobacco outside the United States, and the experiences of LDCs at the early stages of the epidemic. In addition, benefits to society come from the attention given by the proposed project to women, a group often under-represented in medical research, and deserving of special study in relation to cigarette use.