Tobacco and Public Health - TCSC Indonesia

AMANDA AMOS AND JUDITH MACKAY 339
Thus, despite their overall positive effects, policies to increase tobacco taxation can
be seen as regressive, penalising female smokers within the very poorest group of society
which is least able to find a way out of addiction. Therefore, nonprice measures in
conjunction with price measures may be more effective in helping women to quit
(Jacobs 2001). In addition, interventions and public policies relevant to smoking
should take account of the needs of the poorest female smokers. For example, a proportion
of tobacco tax revenues could be hypothecated to address both the dimensions
of disadvantage that bind women to smoking as well as providing specifically targeted
smoking interventions (Marsh 1997; Graham 1998; Gaunt-Richardson et al. 1999;
INWAT Europe 2000).
Smoking cessation
Our understanding of smoking cessation among women is mainly drawn from
research carried out in countries with the longest history of smoking, in particular the
US and UK. In these countries the decline in cigarette smoking has been faster in men
than women. This may in part be due to some men changing from smoking cigarettes
to cigar and/or pipes. However, several studies have suggested that women may indeed
find it more difficult to quit smoking than men, and that as well as similarities, there
may be important differences between men and women as to the reasons why they
smoke which have implications for policy and practice.
The reasons why women seem to find it more difficult to quit than men are not well
understood (Hunter 2001). It is likely to be due to a combination of biological, psychological,
and social factors. There is increasing evidence that while most smokers are
addicted to nicotine, factors other than nicotine may be more important in reinforcing
smoking among women than men. For example, cessation studies with nicotine
replacement therapy (NRT) have consistently reported lower quit rates in women
compared to men (Perkins et al. 1999). Similarly, studies of self-quitters have found
that women were less likely to quit initially or to remain abstinent at follow up. British
data show that, despite a similar desire to quit, women feel more dependent on their
smoking than men (Bridgwood et al. 2000). Women are more likely to say that they
would find it very hard to go without smoking for a whole day than men who smoke
the same amount.
Social and environmental factors are believed to be a more important influence
on the smoking behaviour of women than men. For example, British and Canadian
qualitative sociological research has shown how the social circumstances of disadvantage
play an important part in reinforcing smoking among women (Graham 1993;
Greaves 1996). This research illustrates how smoking is one mechanism which women
use to cope with living and caring in disadvantaged circumstances. That is, smoking
may constitute an important source of pleasure and satisfaction for women in caring
roles by helping them to deal with frustration, stress, boredom, and material insecurity.