Smoking is one of the major public health issues that has been productively addressed by feminist social science research. Understanding smoking as a gendered practice has provided an important corrective to the dominant approach to smoking as an individual behaviour explicable primarily through a medical model of addiction.
The role and meaning of smoking in women’s lives remained unexplored until feminist writers and researchers began to examine the issue in the 1980s. As they argued, smoking research tended to assume that men’s and women’s smoking had the same causes and meanings. Women’s particular struggles with smoking cessation were ignored. When differences were considered, male patterns and practices were viewed as the norm; female patterns as deviations from the norm resulting from presumed sex differences in biology and psychology. In contrast, the tobacco industry paid careful attention to women’s desires and ambitions, employing themes of sophistication, liberation and autonomy to market cigarettes to women. One notable exception to the gender blindness of tobacco research and control was the focus on women’s reproductive role which constituted the female smoker primarily as a threat to infant and child health.
Understanding the relationship between health-related practices and gender has demanded both conceptual and methodological innovation. Traditionally medical and health-related social science research has focused on ‘sex’ as a binary variable, with gender treated simply as an effect of this universal biological dichotomy. In this approach sex and gender are understood as attributes of individuals. Feminist health research has challenged these assumptions by demonstrating the entanglement of sex, gender and other forms of difference, by refiguring gender as a set of social relations, and by investigating lived experiences of health and illness within specific social locations.
Patterns of smoking are gendered, both historically and in the present. Gender differences are seen in patterns of uptake, in prevalence rates and in levels of consumption. In Western countries, women adopted the use of cigarettes later than men, and their use generally peaked at lower rates. However, the gender gap in smoking in these countries has narrowed as smoking declined over the 20th century, while class differences have widened. In the 1980s young girls in several industrialised countries took up smoking at higher rates than their male peers.
These gendered patterns are highlighted in the influential cigarette epidemic model proposed by epidemiologists in the 1990s. The model suggests four successive stages of tobacco use as the practice develops within a population: 1) low rates for men and women but men increasing cigarette use; 2) sharp increase in smoking among men while women gradually increase use; 3) men’s smoking rates peak and begin to decline, women’s smoking begins to decrease but at a slower rate; 4) decline in both men and women’s smoking continues and smoking rates become almost equal.
Globally, low and middle income countries are experiencing rising tobacco use. While women’s use of cigarettes remains low in countries such as India and China and regions such as Africa, the tobacco industry is targeting these markets. Global female smoking rates are predicted to escalate steeply during the twenty-first century. The WHO estimates that 20 per cent of the world’s women will be smokers by 2025. While the four stage model is often used to forecast global smoking trends, on the assumption that all countries will follow the pattern of Western Europe, North America and Australia, it is not clear that this assumption is warranted given the multiple factors that influence smoking patterns.
Despite these clear gender differences in smoking and evidence of the impact of the practice on women’s health, women’s smoking has been considered secondary to men’s smoking and has remained under-researched. While prevalence data on women’s smoking is collected in many countries, the information available globally is inconsistent and difficult to compare. Negative attitudes towards women and girls smoking can be an obstacle to data collection.
In what follows I briefly outline key contributions of the feminist sociological and cultural research into women’s smoking, highlighting the insights that have been produced through the adoption of a gender lens. I conclude by discussing the impact of this research on smoking research in general.
Smoking and gendered oppression
The Ladykillers: Why smoking is a feminist issue published by Bobbie Jacobson in 1981 was the first text to explicitly explore women’s smoking from a feminist perspective. Jacobson was a journalist and former deputy director of the UK organisation Action on Smoking and Health who carried out interviews with women smokers to answer the question ‘why do women smoke?’. She argued that nicotine addiction and psychological factors could not explain the reasons why female smokers continued despite awareness of the health risks. Instead she suggested that experts should listen to women who consistently spoke of their emotional attachment to smoking and their use of smoking to suppress expressions of anger, hostility and frustration as they dealt with the stress of multiple roles and the requirement to be ‘nice’. The smokers interviewed by Jacobson feared that giving up smoking would result in a loss of control over their socially unacceptable emotions (as well as their control over their weight and sexual desirability). Jacobson thus presented women’s dependence on cigarettes as a reflection of their social and economic subordination. Women were exploited by both tobacco companies and patriarchal society which worked together to keep them smoking.
More recent sociological research has produced a more nuanced and empirically supported analysis which understands women’s smoking both as a disciplinary practice of femininity and as an important route to self-definition within gendered relations of power. In her book Smoke screen: women's smoking and social control Canadian sociologist Lorraine Greaves is explicitly critical of the constitution of women as passive victims, either duped by advertising or driven to smoke as a direct result of their treatment in the world. The women interviewed in her study spoke of the value of cigarettes, their role in social life, the comfort and routine they provide and even the protection they can offer in violent situations (one woman found her abusive husband would not hit her if she had a cigarette in her hand). Greaves argues that a theory of women’s smoking must also consider smoking as an active and adaptive response to the world, albeit a self-destructive one.
Intersections of gender and class
UK sociologist Hilary Graham’s research has built productively on the idea that smoking has uses for women, and furthered this insight by placing social inequality at the centre of the picture. Her qualitative study of low-income mothers with pre-school children was ground-breaking in its analysis of smoking as part of a gendered division of labour and a daily pattern of caring in the context of poverty. Graham found that the women’s work days (and nights) were long and focused on their children’s and partner’s needs and demands. Smoking provided a way of structuring time and containing domestic responsibilities, allowing short moments of self-directed adult activity that were both materially and symbolically significant. In contrast to other forms of leisure and escape, cigarettes were instantly accessible and (at the time) relatively affordable. Graham concludes that for these women smoking was a resource essential to their ability to cope with the grind of everyday life, matter of survival in spite of its link with disease and premature death.
In more recent work Graham has developed a detailed structural analysis of inequality and smoking in Britain, drawing on a survey of women caring for young children in manual households. By combining this data with government household income and composition data her study found that being a smoker was linked to the experience of greater disadvantage within social hierarchies of gender and class. Moreover this link had strengthened during a time of increasing income inequality. It was among women in unskilled households that smoking prevalence and tobacco consumption had declined least since the 1970s. Heavier caring responsibilities were also associated with higher smoking prevalence; lone mothers and women with children with behavioural and emotional problems showed particularly high rates.
As well as illuminating the intersections of smoking, gender and class, this work has enabled Graham to question the dominant health promotion approach to smoking. In her article ‘Smoking, Stigma and Social Class’ she argues that:
- Tobacco control policies should engage directly with social inequalities rather than focusing on smoking behaviour.
- Tobacco control policies should be assessed for their impact on inequity, including the exacerbation of stigma which takes highly gendered and classed forms.
In addition, she highlights a changing cultural landscape of class in which embodied differences such as body shape and health behaviours become key indicators of both economic status and moral worth.
- Smoking, Reproduction and the Female Body
In the 1970s the pregnant smoker became a highly visible target of health campaigns. A 1973 image from a UK campaign showed a naked pregnant woman smoking with the caption ‘Is it fair to force your baby to smoke cigarettes?’ Given the general lack of attention to women’s smoking it seemed that women’s health practices were of social concern only when their actions were viewed as harmful to others.
Feminist analyses have highlighted the way the pregnant smoker as problem subject was shaped by the rise of the new public health which produced health as an individual responsibility and project of self-improvement. The management of risk became an obligatory aspect of healthy citizenship and pregnant women’s behaviour came under intense surveillance as a source of risk to foetal health. Thus public health became focused on regulating pregnant women and mothers, reproducing traditional discourses about selflessness, purity and sacrifice as essential elements of virtuous motherhood. Moreover, the depiction of foetuses as vulnerable yet autonomous subjects in anti-smoking campaigns was consistent with anti-abortion discourse and presented women as adversaries of their babies-to-be whose choices should be constrained (and punished) in the name of health.
More broadly, the feminist research on the pregnant body as target of disciplinary power, both medical and legal, highlights the importance of a critical understanding of ideals of health. This suggests that the recognition of women’s smoking as a profound threat to wellbeing should not obscure attention to the politics and ethics of health promotion.
Smoking, modernity and visual culture
Feminist historical research has explored the ‘feminisation’ of smoking that occurred in Western countries between the 1880s and 1980s, linking it to social, political, economic, technological and cultural changes. A focus on visual culture has illuminated the meanings of smoking and their relationship with ideas about femininity, modernity, sexuality and respectability. Research carried out by UK sociologist Penny Tinkler reveals that the history of women’s smoking in the 20th century is a history of the visual construction of feminine identities – not only by the tobacco industry and various forms of media but by women themselves. She highlights three main ways visual themes operate in the history of women’s smoking: 1) shifts in the public visibility of women smoking; 2) smoking practices were used by women as visual statements about status and identity and 3) visual images of women became more prominent (in media, advertising and health campaigns).
This work traces the rise of smoking as a signifier of modern femininity, enmeshed with the broader practices of ‘looking and being looked at’ that women became schooled in during the 20th century. In particular cigarette advertisements (as well as representations in popular culture) linked emancipation with slimness, and promoted smoking as the route to both. However, as well as exploring the role of advertising and media in constituting smoking as a feminine practice, the female smoker is also considered an active agent who employs smoking in her own project of self-presentation. This includes attention to the pleasure women found in smoking, challenging the construction of women as purely victims of external forces.
Another important point raised by feminist researchers is that anti-smoking campaigns have frequently reproduced a similar gendered imperative of heterosexual attractiveness to that deployed in cigarette advertisements. Tobacco control campaigns aimed at young women have emphasised smoking as ‘ugly-making’ and ageing, thereby entrenching the idea that female embodiment is primarily about looking good. Thus despite their opposite aims, cigarette advertising and public health produce a stereotypical and narrow vision of successful femininity.
One of the potentially most important impacts of feminist research in smoking is its capacity to complicate the account of gender empowerment and smoking that is dominant in models of global smoking take-up. Gender empowerment (measured by economic and political participation) and smoking has been shown to be positively correlated at a national level, suggesting that as a country moves towards gender equality, female smoking rates will increase. This has led to headlines such as ‘Female empowerment is great – Except when it comes to smoking’ (Time magazine). Feminist researchers have shown that this account of equality obscures issues of equity revealed through an analysis which looks at the interactions between gender and class (as well as race, ethnicity, sexuality and age). They have pointed out that while the link between smoking uptake and women’s status may be able to explain smoking initiation, the gender equality hypothesis cannot explain smoking patterns once diffusion has occurred (as in high income countries). Moreover, there are multiple factors such as globalisation, urbanisation and income distribution which influence smoking.
Feminist research has also been innovative in its consideration of the cultural and social locations of smoking. The appreciation of smoking as a social practice rather than simply an individual behaviour (or physiological addiction) has been promoted by the qualitative research on the meanings and uses of smoking in women’s lives. This has led to a growing recognition of the need for tobacco control research and practice to understand the social context of smoking, including the key role of power relations in shaping social geographies of smoking. Moreover, feminist research has contributed to a broadening of the concept of the social in tobacco research. For example, the analysis of the visual culture of smoking incorporates an understanding of consumption as a key site of identity formation in modern and late modern consumer societies. This has undermined the simplistic notion of the passive consumer who simply absorbs advertising messages such as those which equate smoking with glamour, fun and romance.
Graham, H. (1993). When life's a drag: Women, smoking and disadvantage. London: HM Stationery Office.
Graham, H. (2012). Smoking, stigma and social class. Journal of Social Policy, 41 (1), 83-99.
Greaves, L. (1996). Smoke screen: Women's smoking and social control. London: Scarlet Press.
Jacobson, B. (1982). The ladykillers: Why smoking is a feminist issue.London: Pluto Press.
Oaks, L. (2000). Smoke-filled wombs and fragile fetuses: The social politics of fetal representation. Signs, 26 (1), 63-108.
Tinkler, P. (2006). Smoke signals: Women, smoking and visual culture in Britain. Oxford: Berg Publishers.