Gender, Social Change, and Global Patterns of Cigarette Use

高收入、较发达国家（MDC）卷烟使用量的下降与中低收入、欠发达国家（LDCs）卷烟使用量的增长形成对比。这一对比还涉及性别差异：虽然在中等发展中国家，女性和男性吸烟人数趋于一致，但在最不发达国家，女性吸烟人数仍然低于男性。公共卫生官员谴责最不发达国家男性吸烟人数的增加，但也担心女性吸烟率低意味着她们未来有可能大幅增加。沿着公共卫生问题，这些全球性的男女吸烟模式提出了关于社会分化和健康行为的本质的理论问题。本研究提出了以下研究问题：什么是潜在的来源，收敛的性别差异吸烟在MDC？这些潜在来源对最不发达国家吸烟的性别差异是否有同样的影响？它们是否解释了最不发达国家与中等发达国家相比存在更大的性别差异？一个常见的论点回答了这些问题，假设走向性别平等的运动产生了MDCs中男性和女性吸烟率的趋同。报告还进一步指出，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的原因，也是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。与此相反，扩散的论点表明，男性和女性之间的差距的变化吸烟是一个副产品的女性滞后的一般过程中的香烟的采用，传播，并减少，并与妇女地位的改善。还有一些解释表明，需要考虑经济增长、预期寿命、贸易自由化、贸易依赖和公共卫生政策等影响。很少有研究用MDCs和LDCs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区域和收入水平的各国在烟草使用方面的性别差异，改进了现有工作。它将收集22个中等发展中国家和87个最不发达国家的男女吸烟情况、性别平等、香烟传播以及其他经济和公共政策对香烟使用的影响的综合数据。MDCs的数据允许对处于性别平等和卷烟传播运动中后期的国家进行长期研究，而MDCs和LDCs的数据允许对跨越性别平等和卷烟传播运动早期和晚期的国家之间的横截面差异进行研究。有了这些数据，统计模型将检验从理论论点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社会和发展中社会一个主要公共卫生问题的潜在来源-吸烟的好处。虽然许多研究调查了吸烟的原因，但它们往往侧重于个人风险因素，而忽视了构成个人风险基础的基本社会力量。这里对社会变革的宏观力量的关注突出了理解这些基本社会力量、烟草在美国以外的传播以及最不发达国家在这一流行病早期阶段的经验的重要性。此外，拟议项目对妇女的关注也给社会带来了好处，因为妇女在医学研究中的代表性往往不足，值得就吸烟问题进行特别研究。

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.