Gender equality and smoking: a theory-driven approach to smoking gender differences in Spain

Tob Control. 2016 May;25(3):295-300. doi: 10.1136/tobaccocontrol-2014-051892. Epub 2015 Feb 20.


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.

Keywords: Disparities; Prevention; Priority/special populations; Socioeconomic status.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Educational Status
  • Employment / trends
  • Female
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Power, Psychological
  • Prevalence
  • Reproductive Health / trends
  • Sex Distribution
  • Sex Factors
  • Smoking / adverse effects
  • Smoking / epidemiology*
  • Smoking / mortality
  • Smoking / trends*
  • Socioeconomic Factors*
  • Spain / epidemiology
  • Time Factors
  • Young Adult