Women, Environments and Chronic Disease: Shifting the Gaze from Individual Level to Structural Factors

Introduction: Chronic heart and respiratory diseases are two of the leading causes of morbidity and mortality affecting women. Patterns of and disparities in chronic diseases between sub-populations of women suggest that there are social as well as individual level factors which enhance or impede the prevention or development of chronic respiratory and cardio- vascular diseases. By examining the sex, gender and diversity based dimensions of women’s lung and heart health and how these overlap with environmental factors we extend analysis of preventive health beyond the individual level. We demon- strate how biological, environmental and social factors interact and operate in women’s lives, structuring their opportunities for health and abilities to prevent or manage chronic cardiovascular and respiratory diseases.Methods: This commentary is based on the findings from two evidence reviews, one conducted on women’s heart health, and another on women’s lung health. Additional literature was also reviewed which assessed the relationship between environmental factors and chronic heart and lung diseases. This paper explores how obesogenic environments, exposure to tobacco smoke, and the experience of living in deprived areas can affect women’s heart and respiratory health. We discuss the barriers which impede women’s ability to engage in physical activity, consume healthy foods, or avoid smoking, tobacco smoke, and other airborne contaminants.Results: Sex, gender and diversity clearly interact with environmental factors and shape women’s promotion of health and prevention of chronic respiratory and cardiovascular diseases. The environments women live in structure their opportunities for health, and women navigate these environments in unique ways based on gender, socioeconomic status, race/ethnicity and other social factors.Discussion: Future research, policy and programs relating to the prevention of chronic disease need to move beyond linear individually-oriented models and address these complexities by developing frameworks and interventions which improve environmental conditions for all groups of women. Indeed, in order to improve women’s health, broad social and economic policies and initiatives are required to eliminate negative environmental impacts on women’s opportunities for health

Reshuffling and Relocating: The Gendered and Income-Related Differential Effects of Restricting Smoking Locations

This study investigates secondhand smoke (SHS) exposure and management in the context of smoking location restrictions, for nonsmokers, former, and current smokers. A purposive sample of 47 low income and non-low-income men and women of varied smoking statuses was recruited to participate in a telephone interview or a focus group. Amidst general approval of increased restrictions there were gendered patterns of SHS exposure and management, and effects of SHS policies that reflect power, control, and social roles that need to be considered as policies are developed, implemented and monitored. The experience of smoking restrictions and the management of SHS is influenced by the social context (relationship with a partner, family member, or stranger), the space of exposure (public or private, worksite), the social location of individuals involved (gender, income), and differential tolerance to SHS. This confluence of factors creates differing unintended and unexpected consequences to the social and physical situations of male and female smokers, nonsmokers, and former smokers. These factors deserve further study, in the interests of informing the development of future interventions and policies restricting SHS

Gender Identity, Ethnic Identity, and Smoking among First Nations Adolescents

Smoking rates among Aboriginal adolescents are the highest of any population group in British Columbia, Canada. Recent studies suggest that substance use is affected by gender and ethnic identity among youth. The purpose of our study was to explore the association of gender and ethnic identity with smoking behaviour among First Nations adolescents. This study is based on a convenience sample (i.e., an on-hand, readily available sample) of 124 youth (123 First Nations and 1 Métis) recruited at youth drop-in centres, health fairs, and cultural activities. We obtained information on demographics, smoking history, Bem Sex Role Inventory (BSRI), composite measure of gender and gender identification (GID), and Moran’s Bicultural Ethnic Identity Questionnaire (Bicultural ID). We examined the associations between gender role identification and cultural identification on current smoking status among First Nations youth by using logistic regression analyses stratified by gender. In stratified multivariate regression analysis among girls, current smoking was significantly associated with lower scores on the aggressive masculinity index of the Gender ID scale and the White/Canadian index of the Bicultural ID scale. Among boys, current smoking was significantly associated with higher scores on the affective femininity index of the Gender ID scale and lower scores on the White/Canadian index of the Bicultural ID scale. Reducing smoking among First Nations groups remains an important priority for tobacco control in Canada. Understanding the gendered and cultural aspects of smoking may be instrumental in improving prevention and cessation efforts among First Nations youth

Smoking on the Margins? Assessing the Effects of a Smoke-free Law in Parks and on Beaches

This study uses a health equity lens to examine the development, adoption and implementation of an outdoor smoke-free bylaw in Vancouver, BC, Canada. The study aims to: Understand the health and health equity effects of a new outdoor smoke-free policy in parks and on beaches; Assess the differential impacts of the policy for diverse groups of women and men, in particular those with a high prevalence and susceptibility to smoking and those who are exposed to secondhand smoke (SHS); Develop recommendations to enhance the effectiveness of future smoke-free policies to reduce any unintended contributions to health inequities arising from their implementation

Equity, Evidence & Ethics: Assessing the Implications of Outdoor Smoke-free Policies for Vulnerable Populations

Smoke-free policies in outdoor settings are becoming increasingly common. Economic and social conditions tend to influence tobacco use patterns as well as exposure to secondhand smoke. Thus, active and passive smoking are both health equity and social justice concerns. Smoking on the Margins is a multi-component,mixed-methods project that applies an ethical framework to outdoor smoke-free policies in order to identify both concerns and opportunities to promote health and health equity. Justification for smoke-free policies Smoke-free spaces are primarily justified on the basis of three goals: 1) Reducing exposure to secondhand smoke; 2) Encouraging people to quit smoking; and 3) Preventing youth smoking initiation. Smoke-free policies in parks and beaches may have a small positive population health impact. Such policies reduce secondhand smoke exposure by eliminating a combination of circumstances that create sufficient concentration of tobacco smoke to pose serious health risk; such bans may also facilitate smoking cessation or reduction for some people. There is little evidence to date,however, that smoke-free policies in parks and on beaches have an impact on the prevention of smoking initiation among youth. As well, the documented positive benefits may be offset by other, unintended and/or inequitable burdens, such as when the stigmatization of smoking makes it harder for some smokers to quit or contributes to greater health inequalities

Equitable Consequences? Issues of Evidence, Equity and Ethics Arising from Outdoor Smoke-free Policies

From introduction: Kass argues that an ethical approach in public health is one that places the fewest burdens on individuals’ health without significantly reducing the potential benefits of intervening. Yet many population health regulations are highly intrusive, compromising individual liberty and imposing penalties for non-compliance. Moreover, the benefits of these regulations and the burdens they impose may not be shared equally. When developing interventions, the state has, therefore, an obligation to consider the benefits and burdens, particularly on those vulnerable to health inequities and other disparities

Smoking on the Margins? Assessing the Effects of a Smoke-free Law in Parks and on Beaches

This study uses a health equity lens to examine the development, adoption and implementation of an outdoor smoke-free bylaw in Vancouver, BC, Canada. The study aims to: Understand the health and health equity effects of a new outdoor smoke-free policy in parks and on beaches; Assess the differential impacts of the policy for diverse groups of women and men, in particular those with a high prevalence and susceptibility to smoking and those who are exposed to secondhand smoke (SHS); Develop recommendations to enhance the effectiveness of future smoke-free policies to reduce any unintended contributions to health inequities arising from their implementation

Smoking on the Margins? Assessing the Health Equity Effects of a Smoke-free Law in Parks and Beaches

Policies which aim to limit secondhand smoke (SHS) exposure by restricting spaces where people can smoke have been shown to improve population health and garner a high level of support from the public, health professionals and policy makers. Following local, national and international examples, Vancouver’s Board of Parks and Recreation approved a smoke-free by-law for the city’s parks, beaches, and facilities effective September 1, 2010. Research suggests that such smoke-free by-laws, when enacted indoors, may affect men and women in different ways, but little research has examined the effects of such outdoor smoking bans on women and men and other segments of the population. Such by-laws may have different effects because some people may not have the means to seek out alternative places to smoke, have access to resources to quit smoking, or have other sites for recreation. Hence the aim of this study is to apply a health and health equity lens to examine Vancouver’s smoke free la

Equitable Consequences? Issues of Evidence, Equity and Ethics Arising from Outdoor Smoke-free Policies

From Introduction: Kass argues that an ethical approach in public health is one that places the fewest burdens on individuals’ health without significantly reducing the potential benefits of intervening. Yet many population health regulations are highly intrusive, compromising individual liberty and imposing penalties for non-compliance. Moreover, the benefits of these regulations and the burdens they impose may not be shared equally. When developing interventions, the state has, therefore, an obligation to consider the benefits and burdens, particularly on those vulnerable to health inequities and other disparities

Preventing Smoking in Young People: A Systematic Review of the Impact of Access Interventions

Aims: To examine existing evidence on the effectiveness of interventions that are designed to prevent the illegal sale of tobacco to young people. The review considers specific sub-questions related to the factors that might influence effectiveness, any differential effects for different sub-populations of youth, and barriers and facilitators to implementation. Methods: A review of studies on the impact of interventions on young people under the age of 18 was conducted. It included interventions that were designed to prevent the illegal sale of tobacco to children and young people. The review was conducted in July 2007, and included 20 papers on access restriction studies. The quality of the papers was assessed and the relevant data was extracted. Results: The evidence obtained from the review indicates that access restriction interventions may produce significant reductions in the rate of illegal tobacco sales to youth. However, lack of enforcement and the ability of youth to acquire cigarettes from social sources may undermine the effectiveness of these interventions. Conclusions: When access interventions are applied in a comprehensive manner, they can affect young people's access to tobacco. However, further research is required to examine the effects of access restriction interventions on young people's smoking behaviour