Similar approaches are relevant to practice and programme design particularly those that engage gender and diversity considerations in assessing better practices or developing clinical or public health guidelines (eg, the WHO report Gender Analysis in Health: A Review of Selected Tools 43).Gender and diversityIn addition, relatively few studies of women smokers have explored the ways in which gender intersects with other dimensions of diversity including age calabipartners.com, disadvantage, religion Replica Belts, SES, occupation and race/ethnicity to create conditions and complexities that increase the risk of tobacco use and/or SHS exposure.44 45 Some research in HICs has used quantitative and qualitative methods to undertake nuanced and sophisticated analyses which explore tobacco use and exposure in the context of the diversity of girls’ and women’s lives, circumstances and experiences.44 46 48 These approaches have shown how women’s risks of becoming and remaining smokers relate to gendered and disadvantaged life trajectories and biographies that often include early pregnancy, lone motherhood, deprivation and violence.44 49 In addition, women with the least success in quitting often live in environments where smoking is normative and there is little support for quitting.47Smoking initiation studies have found that the meanings that young people attach to smoking are gendered and smoking may act as a marker of gender and identity.50 52 Gender differences have been found in HICs with regard to the perceived value of smoking in relation to, among other factors Replica Belts, affect control, creating and maintaining social relationships, body image, weight control, enhancing social identity and status (social capital), and as self medication.44 46 48 53 54 Some studies have also found that women have greater difficulty quitting compared to men.55 Although the mechanisms are not well understood Replica Belts, they are probably related to biological and psychosocial aspects of addiction and dependence.56 57 Several studies have found that nicotine replacement therapy is less effective in women than men.58 60 Non nicotine cues to smoke appear to be more important for women than for men, and smoking has a perceived functional value in the lives of low income single mothers, who use smoking to cope and provide care in disadvantaged circumstances, making cessation more difficult.48 61A narrow focus on HICsMost studies have been carried out in HICs where the patterns and trajectories of girls’ and women’s tobacco use and SHS exposure differ from those in LMICs. Few studies have explored the interaction between gender and smoking uptake and/or cessation in LMICs. While studies conducted in the Philippines and Indonesia found similar reasons for female smoking uptake and continuation as in HICs,62 63 few studies have explored protective factors within specific cultural contexts that promote resiliency in women and girls and serve to inhibit smoking.64 Studies in HICs have shown how unequal power relationships and restricted living circumstances can limit women’s ability to reduce exposure to SHS for themselves and their children, arising from smoking by others (usually men) in the home and workplace.65 70 In LMICs, where women’s social Replica Hermes Belts, political and economic power is often limited, women have even less ability to protect themselves and their children from exposure to SHS from male smokers.71 72Marketing of tobacco to girls and womenThe limited response of the tobacco control community in applying gender and diversity based analyses to tobacco control contrasts starkly with the comprehensive gendered approach of the tobacco industry.
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