BACKGROUND: Despite meaningful progress in global tobacco control, significant gender differences in cigarette smoking persist globally. International survey data on cigarette smoking is routinely collected, but there is a notable gap in understanding how cigarette smoking intensity (SI) – the average number of cigarettes smoked per day among current smokers – differs between men and women.
METHODS: We systematically collected nationally representative survey data from 2000–2022 covering over 97% of the global population. Gender differences in smoking intensity were compared across countries and regions using a ratio of SI among men to SI among women. Ordinary least squares regression models were employed to assess the association between SI ratio and factors such as GDP per capita, religion, and gender inequity, as well as 24 sensitivity analyses and robustness checks to validate the results.
RESULTS: Globally, men smoked 58% more cigarettes than women, equivalent to an SI ratio of 1.58, with wide regional and country-level variations. The largest SI ratio was observed in South Asia (SI ratio = 2.78), while the smallest differences were found in North America (SI ratio = 1.14) and Latin America & the Caribbean (SI ratio = 1.18). Gendered differences in SI were significantly associated with regional and cultural factors, as proxied by religion, but not with economic prosperity or gender inequity measures.
CONCLUSIONS: Our findings reveal substantial variation in gender differences in smoking intensity across 172 countries, primarily associated by regional and cultural factors rather than gender equity or economic wellbeing. Countries and regions with the largest gender differences require context-specific tobacco control policies that are sensitive to the unique social and cultural drivers of smoking behaviour for men and women.