The 89th Annual Meeting of the American Association of Physical Anthropologists (2020)

Does variation in female reproductive status explain variation in female smoking? Evidence from cross national and longitudinal studies in low- and middle-income countries


1Department of Anthropology, Washington State University, 2Department of Anthropology, University of Washington

April 16, 2020 52, Platinum Ballroom Add to calendar

Variation in female smoking is usually ascribed to variation in women's social and economic power and attendant norms regulating women’s substance use. Nicotine and other constituents of tobacco, however, are potent teratogens. Moreover, nicotine activates virtually all neurophysiological toxin defense mechanisms, such as bitter taste receptors, nuclear receptors, xenobiotic transporter proteins, metabolizing proteins, and conditioned aversions. This raises the possibility that, to protect their fetuses and nursing infants, reproductive-aged women who have an earlier age of first marriage and first birth, shorter interbirth intervals, and extended periods of breastfeeding, avoid regular consumption of teratogenic substances like tobacco. This avoidance should abate post-menopause. Previously, in data aggregated at the nation level, total fertility rate was found to be negatively associated with the prevalence of female tobacco use, controlling for gender inequality, with an increase in the prevalence of female smoking seen post-menopause.

To test the gender inequality vs. fetal protection hypotheses of female smoking using individual-level data, we conducted a cross-sectional study using Demographic and Health Survey data from 34 countries (N=572,958) and a longitudinal study of data from Cebu, Philipines (N=3,327). We found that pregnancy, breastfeeding, and having young children were negatively associated with female smoking, and postmenopausal status positively associated, even after controlling for indices of women’s social, economic, and educational status. Furthermore, the indices of women's status were negatively associated with smoking, contrary to the gender inequality hypothesis. These results suggest that fetal protection helps explain female smoking decisions.

This investigation was supported in part by funds provided to EHH for medical and biological research by the State of Washington Initiative Measure No. 171