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The Decline of Smoking Among Female Birth Cohorts in China in the 20th Century: A Case of Arrested Diffusion?

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Abstract

The smoking prevalence by age of women in China is distinct from most other countries in showing more frequent smoking among older women than younger. Using newly developed birth cohort histories of smoking, the authors demonstrate that although over one quarter of women born 1908–1912 smoked, levels of smoking declined across successive cohorts. This occurred despite high rates of smoking by men and the wide availability of cigarettes. The analysis shows how this pattern is counter to that predicted by the leading theoretical perspectives on the diffusion of smoking and suggests that it arose out of a mix of Confucian traditions relating to gender and the socio-economic and political events early in the twentieth century which placed emerging women’s identities in conflict with national identities. That a similar pattern of smoking is evident in Japan and Korea, two countries with strong cultural affinities to China, is used to buttress the argument.

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Notes

  1. A recent exception is Benedict (2011).

  2. Pampel’s (2001) analysis argues that this was more due to ongoing diffusion trends than to emerging gender equity. His measure of diffusion, however, is the number of decades since cigarette consumption reached its peak in each country, and is designed to capture the stage of smoking prevalence of men and women. As such it is a descriptive measure of typical trends rather than a reflection of any set of individual or societal actions, which several critics of diffusion analysis believe is necessary, as discussed further below.

  3. Data on smoking prevalence in China can also be found in a national survey conducted in 1984. However, the 1984 data are over-representative of the urban population (Weng and Niu 1998).

  4. Kenkel et al. (2009) use data from the Chinese Health and Nutrition Survey (CHNS) which covers the provinces of Guangxi, Guizhou, Heilongjiang, Henan, Hubei, Hunan, Jiangsu, Liaoning, and Shandong.

  5. The missing provinces represent about 15 % of the population (Yi et al. 2009).

  6. A total of 152 cases were dropped due to conflicting responses to these three questions or to missing information about birth place.

  7. There are reports of tobacco being cultivated in Fujian province by 1590 and being distributed to other provinces (Laufer 1924; Brook 2004).

  8. An intriguing question suggested by the events of 1900–1940 is whether women born earlier than 1908 (the first cohort we can observe) might have smoked at an even higher rate than the 1908–1912 cohorts. Although no data exist for these women, we speculate that the smoking prevalence of women born approximately from 1890 to 1907 may have exceeded the (rural) 27 % peak prevalence rate we observe for the 1908–1912 cohorts. These earlier cohorts grew up when pipe smoking was still widespread among women and children, and came of age between 1910 and 1930, when cigarette consumption was growing rapidly and when public opinion about the proper role and behavior of women was still evolving and cigarette smoking was often viewed as fashionable and appropriate for the ‘new’ Chinese woman (Benedict 2011, pp. 200–206). The 1908–1912 cohorts by contrast came of age as the Nanjing Decade was well underway and critiques against female smoking were gaining ground and becoming solidified. As such, their level of smoking may already reflect a downturn from the previous high.

  9. The cohort data presented in Fig. 3a and b do not suggest a significant uptake in smoking prevalence by those coming of age during the Maoist period on the part of the two youngest cohorts in comparison with the older cohorts, nor an upsurge by the older cohorts. It is possible that the amount of smoking per user increased during this period given the efforts of the government to boost consumption (Kohrman 2007, p. 101). For women, the low peak prevalence obtained by the two youngest cohorts—who largely came of age during this period—confirms the anti-smoking climate for women, possibly reinforced by the lower availability of cigarettes for them in the way tobacco vouchers were allocated to families (Kohrman 2007, pp. 101–102).

  10. In Korea, after 1885 a number of missionary schools were established which provided some Korean women with a Western-style education (Yoo 2008) and the Korean branch of the WWCTU was founded in 1923 which conducted anti-smoking campaigns (KWCTU 2008). After the Meiji restoration, Japan closely followed developments in the West and was sensitive to attitudes and opinions expressed about it. The charge that widespread smoking by women and children was a sign of backwardness and national degeneracy enabled anti-smoking activists within the country, working with foreign WWCTU missionaries, to pass an anti-juvenile smoking bill in 1900, according to Benedict (2011, p. 216).

  11. A major difference in the status of women presently and in the past is the decline in the proportion of women marrying and their later age at marriage, leading to more years of independent living. In Korea for example, 40 % of women were single at ages 25–29 in 2000 compared to 14 % in 1980 (Byun 2004, table 6.3) and in China, the proportion never married increased from 5 % in 1982 to 13 % in 2005 (China Data Center 2011).

  12. The video may be viewed at http://www.worldlungfoundation.org/ht/d/sp/i/7217/pid/7217.

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Acknowledgments

Special thanks to Dr. Hong-jun Cho and Dr. Makoto Atoh for their help obtaining data and to Dr. John Casterline for valuable comments on an earlier draft. We are grateful to Jason Kung for assistance with translation and obtaining materials, and to Charles Yoo for translation work. We also thank Yan Fu and Lee J. Ridley for help acquiring materials, and the University of Michigan Population Studies Center for providing support for translation. Support for this project was also provided by the National Institute on Aging (T32 AG000221) to Deborah Lowry. The authors gratefully acknowledge use of the services and facilities of the Population Studies Center at the University of Michigan, funded by NICHD Center Grant R24 HD041028. Data used for this research was provided by the longitudinal study entitled “Chinese Longitudinal Healthy Longevity Survey” (CLHLS) managed by the Center for Healthy Aging and Family Studies, Peking University. CLHLS is supported by funds from Duke University under an award from the U.S. National Institutes on Aging (NIA)(R01 AG23627-01; PI: Zeng Yi), and by China Natural Science Foundation, China Social Science Foundation, UNFPA, and Hong Kong Research Grant Council. This is a substantially revised version of a Population Studies Center Research Report (10-718) : The Age Prevalence of Smoking among Chinese Women : A Case of Arrested Diffusion? (October , 2010).

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  1. University of Michigan, Ann Arbor, MI, USA

    Albert I. Hermalin

  2. University of Montevallo, Montevallo, AL, USA

    Deborah S. Lowry

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Correspondence to Deborah S. Lowry.

Appendix 1: Methodology for Calculating Birth Cohort Histories of Smoking Behavior

Appendix 1: Methodology for Calculating Birth Cohort Histories of Smoking Behavior

The data used are survey reports of smoking status and histories of older respondents, including age of initiation, and age of cessation (if applicable), life table survivorship probabilities appropriate to the population and time period, and estimates of differential mortality of smokers and non-smokers.

For each birth cohort (or 5-year cohort), the report on smoking enables one to identify whether the respondent was smoking at each point in the past and his or her age at that point. But those presently observed are the survivors of the larger cohort of smokers and non-smokers. To adjust for this, one needs to “resurrect” the current respondents back to the earlier age. In addition, one needs to take into account the differential survival probabilities of smokers and non-smokers, since smokers have a higher rate of mortality (Hammond 1966).

As outlined in Harris (1983, p. 474), the prevalence of cigarette smoking at age t (denoted by ptt) is derived through the following equation:

$$ {\text{P}}_{\text{tt}} = \frac{{{\text{P}}_{\text{tu}} / {\text{S}}_{\text{tu}} }}{{{\text{P}}_{\text{tu}} / {\text{S}}_{\text{tu}} + (1 - {\text{P}}_{\text{tu}} ) / {\text{N}}_{\text{tu}} }} $$

where Ptu denotes prevalence of smoking at age t among respondents alive at age u, Stu is the proportion of smokers at age t who survive to age u, and Ntu is the survival probability of non smokers at age t.

We estimated Stu and Ntu from life-tables generated by Banister and Hill (2004), the World Health Organization, and the United Nations for the basic survivorship functions applicable to China. We then use the differential in survival between smokers and non-smokers provided by Hammond (1966), adjusted slightly to fit our understanding of the Chinese case.

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Hermalin, A.I., Lowry, D.S. The Decline of Smoking Among Female Birth Cohorts in China in the 20th Century: A Case of Arrested Diffusion?. Popul Res Policy Rev 31, 545–570 (2012). https://doi.org/10.1007/s11113-012-9239-4

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