Using country-level data, Hitchman and Fong found that higher gross national income and gender empowerment were independently associated with higher female-to-male smoking prevalence ratios [ 12 ]. Subsequently, in many countries, smoking rates among men are on the decline, signifying a late-stage epidemic, but rates among women are still rising, indicating an early-stage epidemic [ 9 , 10 ]. To consolidate information about smoking among Chinese women, we conducted a systematic review on correlates reported in peer-reviewed and gray literature. The methodological quality of each study was independently assessed by two investigators DD and KG using a quality checklist adapted from previous reviews of observational studies [ 24 , 25 ]. Therefore, a plausible and worrisome projection is that with the increasing spending power and weakening cultural and social constraints of women in emerging economies, such as China, there may be an expanding epidemic of smoking among women with subsequent impacts on overall mortality, morbidity, and economic systems [ 9 ]. Exclusion criteria were as follows: Methods Literature Search We conducted a systematic literature review on correlates of smoking among Chinese women. Papers written in either English or Chinese were eligible.
Only full-text papers were considered for review. The characteristics of studies and correlates of smoking were synthesized separately for youth and adults. Subsequently, in many countries, smoking rates among men are on the decline, signifying a late-stage epidemic, but rates among women are still rising, indicating an early-stage epidemic [ 9 , 10 ]. Successful public health and behavioral medicine interventions should be based on in-depth knowledge about smoking susceptibility among young Chinese women and girls and particularly about the population distribution and correlates of smoking. Abstract Background Despite the historically low smoking prevalence among Chinese women, there is a trend of future increase. Methods Literature Search We conducted a systematic literature review on correlates of smoking among Chinese women. Quality Assessment and Data Extraction Information on the study population, measurement, and analyses both adjusted and unadjusted was extracted for each paper. It has been estimated that if the current smoking prevalence continues, one in three Chinese men will eventually die from tobacco-related diseases [ 4 ]. There is evidence of an increase in smoking rates among women in Japan and Korea as a result of westernization and promotional campaigns of the tobacco industry targeting women and girls [ 17 — 19 ]. Although the smoking epidemic among Chinese women is still at an early stage, proactive actions are necessary in order to prevent further growth of the epidemic. Purpose We systematically reviewed the correlates of smoking among Chinese girls and women. Exclusion criteria were as follows: Conclusion Overall, the evidence base for smoking among Chinese women is limited. Papers written in either English or Chinese were eligible. The currently low smoking prevalence among Chinese women is largely due to traditional gender roles and social expectations [ 13 ]. Although further research is needed, findings from the current study provide a roadmap for research and policy on prevention of smoking among Chinese girls and women. Knowledge of harms and negative attitudes towards smoking were found to be negatively associated with smoking. Results from the China National Tobacco Survey have shown a slight increase in smoking prevalence among women, particularly young women, from to [ 2 ]. Initial screening was conducted by two independent investigators DD and KG for English literature and DD and XZ for Chinese literature scanning the titles and abstracts of identified papers. With a huge population and a historically low smoking rate among women, China is an almost limitless potential market for the tobacco industry [ 21 , 22 ]. Based on these studies, peer smoking was the most consistent correlate of smoking among Chinese girls. In the situation of multiple papers from the same study [ 26 , 27 ] reporting the same association e. The methodological quality of each study was independently assessed by two investigators DD and KG using a quality checklist adapted from previous reviews of observational studies [ 24 , 25 ]. China is an important case study for the diffusion of smoking among women in low- to middle-income countries. Among Chinese women, partner smoking, job-related stress, and exposure to cigarettes made for women were consistent correlates of smoking. Although smoking among Chinese women is still at an early stage, it is becoming more prevalent among specific population subgroups, such as rural-to-urban migrant workers.
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