BACKGROUND: Tobacco use is a leading cause of preventable death globally, with gender disparities in smoking prevalence and intensity. While much research has explored these differences, the factors contributing to them remain under studied, particularly in cross-country comparisons. Existing studies often examine single-country contexts, examining the intersection of gender with social determinants like occupation, education, wealth, and marital status, however there is limited synthesis of how these factors intersect and vary across global regions.
METHODS: This scoping review aims to map the factors influencing gendered smoking behaviors across diverse social, economic, and cultural contexts. Comprehensive searches in PubMed and Scopus were conducted to capture a wide range of sources from biomedical, health, social science, and multidisciplinary literature.
RESULTS: Data from 77 countries, representing 44% of World Bank-recognized countries, revealed associations between education, occupation, and wealth with differences in smoking behaviours among men and women. For instance, in regions like Europe and Central Asia, lower education levels were linked to higher smoking prevalence, particularly among men. In contrast, in regions such as the Middle East and North Africa, women with higher education levels had higher smoking prevalence. Higher education typically leads to higher-paying occupations where workplace norms discourage smoking, while lower educational attainment is associated with lower-paying occupations where smoking may be more prevalent. Yet, for women in some contexts, higher education correlates with higher smoking rates, possibly due to social pressures or lifestyle factors in professional settings. Marriage and religion were generally associated with lower smoking prevalence across genders, but country-specific differences suggest that cultural expectations and social roles tied to marital status and religion influence smoking behaviour differently for men and women.
CONCLUSIONS: This review underscores the need for researchers to move beyond analyzing factors in isolation and to instead focus on how they intersect and contribute to these gendered differences.