Tobacco and Public Health - TCSC Indonesia

332
TOBACCO AND WOMEN
urban dwellers, and therefore may not represent the national picture. Smoking rates
vary, but overall it is estimated that about 10% of African women smoke. This ranges
from less than 2% in Nigeria, Ivory Coast, and Zimbabwe to 11% in South Africa.
Studies from the few countries where more than one survey has been undertaken show
a rising trend, especially in urban areas (Elegbeleye and Femi-Pearse 1976). Smoking
patterns and trends may also differ considerably by ethnic group. For example, in
South Africa 59% of coloured women smoked in 1995 compared to 10% of black
women and 7% of Indians (WHO 1997). Rates of smoking have declined among white
South African women but are increasing among black women.
Americas. Rates of smoking in women vary considerably between the 36 countries.
In the USA and Canada rates among women peaked at over 30% and are now declining.
In contrast, low rates of female smoking are reported in Caribbean countries.
Prevalence in women varies from 6% in Paraguay to 39% in Venezuela (Mackay and
Eriksen 2002). Rates of female smoking can vary considerably by ethnic group. While
in the USA smoking rates among white women have been consistently higher than
those among Black women, a study in Trinidad and Tobago found that there was a
higher prevalence among women of European origin (14%) than among women of
African (7%) or Indian origin (8%).
South East Asia. The prevalence of cigarette smoking is generally very low among
women. Only 3% of women smoke manufactured cigarettes but in several countries
other forms of tobacco use by women have been integrated into cultural practices for
several decades. In several areas of India, for example, 50–60% of women chew tobacco,
and rural women smoke the kretek, dhumti, khi yo, ya muan, chilum, and water pipe,
and ‘reverse smoke’ bidis and chutta, with the lighted end inside the mouth (Aghi et al.
1988). Very high rates of tobacco smoking are found in women in Nepal.
Western Pacific.Although the overall smoking rate across these 31 countries is estimated
to be less than 10%, there are wide variations. For example, in some parts of
Papua New Guinea 80% of women smoke, and rates are also high among women in
the Pacific Islands (Tuomilehto et al. 1986). Only 4% of women in China smoke
(Chinese Academy of Preventive Medicine 1999) and 3% in Hong Kong (Hong Kong
CSD 1998), Malaysia, and Thailand. Tobacco chewing is uncommon. China deserves
special mention because of its size. The prevalence of smoking remains high among
older women in cities such as Beijing and Tianjin. Although a substantial minority of
women born before 1940 became smokers by age 25, only about 2% of those born
since 1950 have done so. In two large nationwide surveys, the prevalence of smoking
among women aged 15–24 was 0.5% both in 1984 and in 1996 (Chinese Academy of
Preventive Medicine 1999). However, it is still possible that the number of young
women becoming smokers will increase. Surveys have reported 10% of young women
smoking in selected small areas in China (Liu et al. 1998).
Eastern Mediterranean. Smoking in women is often considered vulgar, improper,
even immoral. Only 2% of Egyptian women smoke compared with 35% of men