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

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