ArticleEvolution, medicine, and public health2016
The low prevalence of female smoking in the developing world: gender inequality or maternal adaptations for fetal protection?
Article in Evolution, medicine, and public health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed.
- Do youth e-cigarette users perceive smoking as attractive? The dynamics of demographics and contextual factors.International journal of public health · 2026Article
- Prevalence and correlates of smoked and smokeless tobacco use in Saudi Arabia: evidence from the 2021 national health survey.Scientific reports · 2025Article
- Article
- Contribution of Sex Differences to the Development of Cardiovascular Disease in Metabolic-Associated Steatotic Liver Disease (MASLD).International journal of translational medicine (Basel, Switzerland) · 2024Article
- Gender differences in the relationship between income inequality and health in China: Evidence from the China Health and Nutrition Survey data.SSM - population health · 2024Article
- Geographical, sex, and socioeconomic differences in non-communicable disease indicators: A cross-sectional survey in Eastern Uganda.PLOS global public health · 2024Article
- Article
- A combined healthy lifestyle score in relation to glioma: a case-control study.Nutrition journal · 2022Article
- Prevalence and correlates of cigarette smoking among Dulong adults in China: A cross-sectional survey in 2020.Frontiers in public health · 2022Article
- The impact of information about tobacco-related reproductive vs. general health risks on South Indian women's tobacco use decisions.Evolutionary human sciences · 2021Article
- Smoking Prevalence, Patterns, and Cessation Among Adults in Hebei Province, Central China: Implications From China National Health Survey (CNHS).Frontiers in public health · 2020Article
- Risky Behaviors and Health-Promoting Behaviors in Young Adults: An Epidemiological Study.Iranian journal of psychiatry · 2019Article
- Awareness of patients with multiple sclerosis in Saudi Arabia regarding the relationship between smoking and multiple sclerosis.Neurosciences (Riyadh, Saudi Arabia) · 2019Article
- Exploring biocultural models of chewing tobacco and paan among reproductive-aged women: Self-medication, protection, or gender inequality?American journal of human biology : the official journal of the Human Biology Council · 2019Article
- A Comparison of Gender Differences in Smoking Behaviors, Intention to Quit, and Nicotine Dependence among Thai University Students.Journal of addiction · 2018Article
- Tobacco cessation support among dentists: A cross-sectional survey in Saudi Arabia and Kuwait.Tobacco prevention & cessation · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFemale smoking prevalence is dramatically lower in developing countries (3.1%) than developed countries (17.2%), whereas male smoking is similar (32% vs 30.1%). Low female smoking has been linked to high gender inequality. Alternatively, to protect their offspring from teratogenic substances, pregnant and lactating women appear to have evolved aversions to toxic plant substances like nicotine, which are reinforced by cultural proscriptions. Higher total fertility rates (TFRs) in developing countries could therefore explain their lower prevalence of female smoking.
objectiveTo compare the associations of TFR and gender inequality with national prevalence rates of female and male smoking.
methodsData from a previous study of smoking prevalence vs gender inequality in 74 countries were reanalysed with a regression model that also included TFR. We replicated this analysis with three additional measures of gender equality and 2012 smoking data from 173 countries.
resultsA 1 SD increase in TFR predicted a decrease in female smoking prevalence by factors of 0.58-0.77, adjusting for covariates. TFR had a smaller and unexpected negative association with male smoking prevalence. Increased gender equality was associated with increased female smoking prevalence, and, unexpectedly, with decreased male smoking prevalence. TFR was also associated with an increase in smoking prevalence among postmenopausal women.
conclusionsHigh TFR and gender inequality both predict reduced prevalence of female smoking across nations. In countries with high TFR, adaptations and cultural norms that protect fetuses from plant toxins might suppress smoking among frequently pregnant and lactating women.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.