Kristina N. Piorkowski and Alok K. Bohara
The cigarette-smoking epidemic is shifting from high-income to low- and middle-income countries (LMICs): 80 percent of smokers worldwide currently reside in LMICs (WHO n.d.). Globally, the number of women smokers has increased since smoking began to be marketed as a means of women’s liberation, the cigarette being called a “torch of freedom.” Smoking is a feminist issue because smoking poses unique consequences for women’s health, well-being, and agency.
Kristina N. Piorkowski and Alok K. Bohara expand the dialogue on women’s smoking to bring it to the forefront of women’s health issues. They do so by empirically estimating women’s smoking behaviors in Nepal, which has the highest rate of women smokers in South Asia. They contribute to the literature by using large datasets, which allow for exclusively concentrating on women’s smoking behaviors, including the number of cigarettes smoked, while incorporating vital contextualizing factors into the analysis.
Methodology. Piorkowski and Bohara’s analyses utilize three waves of data from the Nepal Demographic and Health Survey – from 2001, 2006, and 2011. The analytical sample size for each data wave was 8,434, 8,596, and 9,773 women, respectively, who are between the ages of 15 and 49. Piorkowski and Bohara explore the roles that formal education, exposure to public health information, geography and culture, and income have on women’s smoking behaviors. Specifically, they study two smoking behaviors: current smoking status and the number of cigarettes smoked. The former is estimated using a logit regression and the latter is estimated using both a negative binomial and a zero-inflated negative binomial model.
Main findings. Piorkowski and Bohara find that formal education and visiting a health center mitigates smoking behaviors, whereas being employed and living in certain geographic regions promotes smoking behaviors. Women with a secondary or higher education are 70 percent less likely to be smokers and to smoke fewer cigarettes than women without a formal education. Visiting a health facility was correlated with a decrease in smoking participation of around 20 percent, with a 30 percent reduction in the quantity smoked. Women employed in agriculture or other professions were 1.45 times and 2.21 times more likely to be smokers than unemployed women, respectively. Separate regression analyses find that both unpaid and paid employment increases the odds of being a smoker. However, only paid employment is associated with a significant increase in the number of cigarettes smoked.
Policy implications. Recently passed anti-tobacco legislation in Nepal, in part, establishes a committee charged with creating policies to control and regulate tobacco products. Informed by their empirical findings, Piorkowski and Bohara recommend that this committee take a multi-level approach to tobacco control. The committee should endorse policies that dramatically increase tobacco taxes, create anti-tobacco campaigns that actively engage the community, and introduce culturally sensitive individual-level anti-tobacco programs. These policies can improve well-being by promoting women to be tobacco-free and increase women’s agency in choosing to be tobacco-free.
Piorkowski and Bohara encourage rigorous studies that increase the scope of women’s tobacco use beyond cigarettes in LMICs. By obtaining a comprehensive understanding of women’s smoking behaviors, gender-conscious policies can be established to improve women’s health worldwide.
World Health Organization. n.d. “WHO: Tobacco Facts.” Accessed October 2014. http://www.who.int/mediacentre/factsheets/fs339/en/.