The surprising truth about women smokers in China

September 20, 2011
Chinese woman smoking (Photo by Jorge Fernández Garcés)

Photo by Jorge Fernández Garcés

In the United States, more than one out of six women still smoke. And as in most Western countries, cigarette usage is concentrated among the young—those women aged 25 to 44. But according to a recent report by Albert Hermalin and Deborah Lowry of the Institute for Social Research (ISR), that pattern is reversed in China. Only one out of 25 Chinese women smoke, recent data show, and smoking is more common among older women than younger. The reason, the researchers say, has everything to do with the particular culture and gender attitudes of the region.

The smoking project arose from some of Hermalin’s earlier research in Taiwan, during which he discovered that older women who emigrated from Mainland China in the mid-20th Century were much heavier smokers than older Taiwanese women. Hermalin, an ISR Population Studies Center (PSC) research professor emeritus, wanted to see if older women in China were also smoking at a substantial rate, and he became intrigued by the unusual age pattern he discovered.

Hermalin found the perfect collaborator in Lowry, a sociologist who came to PSC in 2008 as a postdoctoral fellow. Hermalin brought deep demographic expertise and decades of research in Taiwan to the partnership. Lowry had done her dissertation research in China, was fluent in Mandarin, and, like Hermalin, was studying aging in China.

Watch: Hermalin and Lowry talk about their research and collaboration

According to Hermalin and Lowry, the adoption of smoking in a country generally follows a predictable pattern. Young men start first, and smoking gradually becomes more common and accepted throughout the male population, but particularly among successive groups of young men in their late teens and early 20s. Adoption by women follows, and, as with men, is concentrated at first among younger women. As a result, as a country’s experience with cigarettes matures, smoking rates for both genders tend to be highest among the young.

To study the Chinese age patterns of smoking in depth, the researchers analyzed data from the 2002 Chinese Longitudinal Healthy Longevity Survey, a study managed by Peking University. It allowed them to track the smoking habits of 11,045 men and women born between 1908 and 1937, who as part of the study were asked if they had ever smoked; smokers were further asked when they began, and if and when they quit.

Because cigarettes were introduced into China before 1900, Hermalin and Lowry found that for men, each five-year group they studied had reached a similar high peak of smoking prevalence, ranging from 65 percent to 75 percent. But for women, the results were strikingly different. The oldest group—those born between 1908 and 1912—reached a peak of more than 25 percent, while smoking rates peaked at only about 12 percent for those born between 1933 and 1937. “You start out with these fairly high rates,” Lowry says, “and then you see a gradual but quite marked decrease throughout the century.” It’s a pattern, the researchers say, found almost no place else, except for nearby Asian countries such as Japan and Korea.

Albert Hermalin in Taiwan (Photo courtesy of Albert Hermalin)

Albert Hermalin (left) in the streets of Taiwan. Click image for higher resolution. (Photo courtesy of Albert Hermalin)

To understand this anomaly, Lowry and Hermalin eventually looked at the interplay between historic and cultural forces and smoking. In the US and Europe, women’s smoking rates early on increased in step with advances in gender equality—a link exemplified by the Virginia Slims marketing slogan, “You’ve come a long way, baby.” (Although a growing awareness of health risks has led to a steady decline in smoking among both women and men since the 1960s.)

Emerging women’s roles were also important in China. In fact, because pipe smoking was already a well established tradition among Chinese men and women in the 1800s, the initial adoption of cigarette smoking by Chinese women may have been smoother and more enthusiastic than in the West as women early in the 20th Century started to work in offices, shops, and factories and adopted more modern dress and behaviors.

But it didn’t take long for countervailing forces to develop. Public acceptance of smoking by women was dampened not only by traditional Confucian roles of subservience and decorous behavior, but also by the influence of foreign temperance movements promoted by the many foreign missionaries of the time combined with calls by contemporary intellectuals for China’s “new woman” to be serious, public-minded, and disinterested in fashionable trends.

Deborah Lowry in China (Photo courtesy of Deborah Lowry)

Deborah Lowry in China. Click image for higher resolution. (Photo courtesy of Deborah Lowry)

Indeed, women’s smoking came to be seen as a backward practice that could foster national or even genetic “degeneration,” and women who smoked were regarded as “modern girls”—self-absorbed women who were immoral, superficial, and unpatriotic. These beliefs, Hermalin and Lowry wrote, “…led to the development of norms that gave free rein to the use of cigarettes by men—even making it an integral part of many social occasions—but sharply curtailing its acceptable use by women.” Even Mao’s Cultural Revolution of the late 1960s and 1970s, which promoted a more equal role for women, didn’t change these norms, demonstrating that there can be change in many gender-related spheres but persistence in other dimensions.

The upshot: A bulge of women smokers early in the century was followed by decades during which far fewer women adopted the habit. As a result, by the late 1900s, the majority of women smokers in China were the now elderly members of that group of early adopters. Similar smoking patterns in Japan and Korea—countries with like cultural influences—bolster the argument that a similarity in historical forces and cultural beliefs lies at the heart of these behaviors, the researchers say.

According to Hermalin, the smoking project was unusual in that the researchers’ conclusions relied to a large extent on “circumstantial” evidence. Rather than using statistics to answer a question, they started with the statistical observation and then had to turn to history, politics, and culture to devise an explanation for what the data showed. “That’s not usually an area that demographers tread, so it’s been very exciting,” Hermalin says.

The collaboration itself also has been a pleasure, both researchers say. Hermalin relished the opportunity to dig into history books, and learn from Lowry’s cultural expertise. Lowry, who has accepted a tenure-track position teaching sociology at the University of Montevallo near Birmingham, Alabama, appreciated Hermalin’s demographic experience, and the hand-drawn tables he sometimes brought to the office to work through ideas. Both say the similarities have outnumbered the differences. “I definitely look to Al as a mentor,” Lowry says. “He’s been a great colleague, as well.” Adds Hermalin: “We’ve both gained a lot.”