Abstract P187: Gender Equality and female-to-male Smoking Ratio: Trends in Spain Over the Last 50 Years (1960-2010)

Abstract

INTRODUCTION Gender empowerment has been associated with higher gender smoking ratio (GSR) and proved to be a strong predictor of the GSR. Our aim is to study how changes in gender equality may be associated with female-to-male smoking ratio trends in Spain over the last 50 years. HYPOTHESIS We hypothesize that greater gender equality will increase female-to-male gender smoking ratio. METHODS Values of the United Nations Development Programme’s Gender Inequality Index (GII) were calculated in 5-year intervals from 1960-2010, using data from the National Institute of Statistics. The GII ranges from 0-1 (1 meaning highest inequality) and contemplates 3 dimensions: reproductive health (measured by maternal mortality ratio and adolescent fertility rate), empowerment (share of parliamentary seats and % of each gender with at least secondary education), and female and male labor force participation rates. Female and male smoking prevalence and female-to-male smoking ratio were measured by retrospective reconstruction of National Health Surveys conducted in 2001, 2003, 2006, 2009 (n=20.426, n=21.358, n=29.478, n=22.188), attending to smoking initiation and cessation dates and birth cohorts. In order to test the association between the GII and GSR over the 5 decades we performed Pearson’s correlation. FINDINGS The GII decreased from 0.65 to 0.09 in Spain in the last 50 years. Higher women’s empowerment (parliamentary representation: from 0% to 36%; attainment of secondary education: from 5% to 63%), higher women’s participation in the labor force (from 19% to 68%), and lower maternal mortality ratio (from 45.36 to 4.11 deaths/100.000 live births), can account for most of the reduction in the GII. The smoking prevalence reconstruction reproduced the model of the epidemic in developed countries. Women born after 1951 had a smoking prevalence pattern similar to men’s, as opposed to women born prior to this date. GSR increased from 0.05 to 0.66, indicating that smoking prevalence of both genders converged in time. A gradient of the GSR by level of education was observed and women with higher education had equal smoking prevalence compared to men since 1990. The relation between the GII and GSR over time resulted inversely proportional (r=-0.99) with decreases in gender inequality relating to higher female-to-male smoking ratio. CONCLUSIONS We found a strong negative correlation between gender inequality and female-to-male smoking ratio. Gender equality has significantly improved in Spain over the last 50 years and this process has been accompanied of differential smoking prevalence patterns by genders, which eventually result in analogous female and male smoking prevalence. Gender sensitive tobacco control measures specifically targeted to women are necessary to prevent female smoking prevalence from rising, especially in the context of social transitions involving women’s development.