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New Analysis: Women of Low Socio-Economic Status Face Unique Challenges Related to Smoking, Smoking Ban Policies

August Issue of the American Journal of Preventive Medicine Examines Unintended Consequences

WASHINGTON, Aug. 3 /PRNewswire-USNewswire/ -- Smoking bans, while a necessary and positive trend for reducing exposure to secondhand smoke, have some unintended consequences--especially for women. The August 2009 issue of the American Journal of Preventive Medicine includes a special supplement, Unintended Consequences of Tobacco Policies, a compilation of nine original, peer-reviewed articles focused on examining these unique challenges related to a smoking stigma, childcare and personal safety.

According to the report, low-income women who live in urban areas may have safety concerns about going outside to smoke when smoking indoors isn't permitted. Moreover, childcare and adequate child supervision may be a concern when they go outside their homes in order to avoid exposing their children to secondhand smoke. The reports go on to find that many women of low socio-economic status feel an increased stigma associated with smoking, more so than their more advantaged counterparts. This stigma often leaves mothers in this category with a label of being "bad mothers" and thus, cause additional unintended consequences including resistance to seeking out help in quitting from healthcare providers.

"Women of low socio-economic status have elevated challenges across-the-board when it comes to smoking and access to quit-smoking resources," said Dr. Pebbles Fagan, Health Scientist, Tobacco Research Branch, Division of Cancer Control and Population Sciences at the National Cancer Institute. "Unfortunately, the articles in this issue find that this group also faces a unique set of consequences related to the evolving policy context of smoking worldwide."

The American Legacy Foundation(R), the National Cancer Institute and the National Cancer Institute's Office of Science Planning and Assessment co-sponsored the supplement.

"Collectively, the papers in this special issue draw attention to the need for lawmakers to consider how the policies they enact may differentially affect less powerful groups in our society. For example, weak provisions for enforcing smoke-free workplaces may result in low SES female bartenders being obliged to breathe secondhand smoke in order to work," said supplement editor Roland Moore, Ph.D., Senior Research Scientist at the Pacific Institute for Research and Evaluation.

Elisa Tong, M.D., Assistant Professor of Medicine at the University of California, Davis, and a lead author of research in this special issue added, "California has had a long-standing history of smoke-free social norms and regulations. We wanted to see how these policies affected Asian-American women by analyzing California's tobacco surveys of Chinese-Americans and Korean-Americans. The surveys were conducted in-language and the largest of their kind."

Tong's study, "Smoke-Free Policies Among Asian-American Women: Comparisons by Education Status" suggests that low socio-economic women in California may need additional help with enforcement of smoke-free policies, compared to their high socio-economic counterparts. The women had similar rates of smoke-free policies at home and indoor work across educational status. However, lower-educated women reported greater smoke exposure at home or indoor work, despite similar high rates of knowledge about the health consequences of secondhand smoke exposure. Besides establishing policies, lower-educated Asian-American women may need to be empowered to assert and enforce their right to smoke-free environments.

This analysis is just one example of several in this supplement outlining similar challenges among women both domestically and abroad.

"We are hopeful that the findings in this special issue bring light to the need for increased sensitivity and strengthened resources for this group of women struggling to quit smoking," said Cheryl G. Healton, Dr. P.H., president and CEO of the American Legacy Foundation. "Tobacco control policies have made a significant contribution toward reducing tobacco use in the U.S. and worldwide. We hope that with greater effort, the groups of women studied will also benefit from the positive effects without the burden of unintended consequences."

Remedies in the supplement's forward are proposed for practitioners to help reduce the unintended burden on the population groups outlined:

  • Ensure that secondhand smoke-related messages target PARENTS, not just mothers, and are delivered in culturally appropriate ways
  • Focus smoking-cessation messages to an individual woman's health, as well as the health of her children and family
  • Build acceptance and trust within the patient-provider relationship to facilitate treatment initiation among women and mothers who smoke
  • Underscore the need for smoke-free policy initiatives to be coupled with increased access to smoking cessation programs
  • Develop strategies for women who work in bars and restaurants where smoking is still allowed and/or where smoke-free laws are not enforced.

"We still know remarkably little about if and how tobacco policies affect men and women differently. We do have growing evidence to suggest that there are differences based on both sex and gender, which then interact with economic and cultural factors. Smoke-free policies are a good example. They affect women, especially disadvantaged and low-SES women at all levels- in relationships, at home, in public and at work-sometimes in deleterious ways. Women's gendered responsibilities for child care, unequal power in relationships and lower earning power are among the factors that affect women's exposure to secondhand smoke and their ability to control exposures. Much more investigation, and special programming, needs to be developed to deal with these issues," added Lorraine Greaves, British Columbia Centre of Excellence for Women's Health and President, International Network of Women Against Tobacco.

The American Legacy Foundation offers a free quit smoking program called EX(R). The innovative program is web-based and free and helps smokers identify the triggers that make them want to smoke. The foundation recommends a comprehensive plan to help smokers quit that involves seeking medical advice from a health care practitioner, nicotine replacement therapies, social support from family and friends and setting a firm quit date. Smokers who want to quit can visit and join a forum of fellow quitters.

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The American Legacy Foundation(R) is dedicated to building a world where young people reject tobacco and anyone can quit. Located in Washington, D.C., the foundation develops programs that address the health effects of tobacco use, especially among vulnerable populations disproportionately affected by the toll of tobacco, through grants, technical assistance and training, partnerships, youth activism, and counter-marketing and grassroots marketing campaigns. The foundation's programs include truth(R), a national youth smoking prevention campaign that has been cited as contributing to significant declines in youth smoking; EX(R), an innovative public health program designed to speak to smokers in their own language and change the way they approach quitting; research initiatives exploring the causes, consequences and approaches to reducing tobacco use; and a nationally-renowned program of outreach to priority populations. The American Legacy Foundation was created as a result of the November 1998 Master Settlement Agreement (MSA) reached between attorneys general from 46 states, five U.S. territories and the tobacco industry. Visit

The American Legacy Foundation(R) is equipped with a VideoLink ReadyCam(TM) television studio system, providing you with faster, easier access to the nation's leading tobacco prevention and cessation experts. From this in-house broadcast studio, Legacy can offer immediate access to its experts to comment on breaking news, new research publications, or any news related to youth smoking prevention, adult quit smoking programs, or any issue related to smoking. The studio is connected directly to the Vyvx fiber network and is always available for live or pre-taped interviews.

NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

SOURCE American Legacy Foundation
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