D ISCUSSION

Building on our finding that the increase in female smoking largely pre-dated the transition period, in this section, we examine the more general phenomenon of pronounced gender differences in smoking, and in the Russian context, particularly the reasons for the (relative) persistence of the habit among men into older age as well as the potential reasons for rising smoking rates among women from the 1980s.

In the previous chapter we introduced the Lopez model that describes the differential adoption of smoking by gender and socioeconomic characteristics, and the subsequent smoking-related mortality. In 2010, a revised version of the model was proposed, among others by the main author of the original model, out of the recognition that the 2-3 decade lag with which the model predicts female smoking to increase compared to men is too restrictive and not applicable to many low and middle-income countries where we see high prevalence rates as well as high smoking-attributable mortality among men, but still low levels of both indicators among women (Thun et al., 2012). Rather than defining the four stages in terms of comparative levels of smoking prevalence and smoking-

attributable mortality in men and women, they suggest in their revised model to describe the stages separately by gender since it is difficult to predict when female smoking will rise. That is, a country could be in the final stage for male smoking, but still in the second stage with regard to female smoking. The low prevalence and lagging behind of female smoking is typically driven by social taboos that label smoking as an unfeminine behaviour. Increases in female smoking are thus associated with the breaking away from such cultural traditions, often facilitated by social, economic and political transformations associated with globalisation.

One potential explanation for the strongly gendered nature of smoking in Russia comes from the sociological literature which has focused on the normative influences of negative health-related behaviours within the context of the long-term deterioration/stagnation of health outcomes in Russia. Cockerham (1999, 2009) argues that negative health lifestyles such as excessive alcohol consumption, smoking, a high fat diet and lack of exercise are shaped both by cultural traditions and material circumstances and differ along the three key dimensions of gender, age and class (Cockerham, 2009, 1999). In his view the entrenched pattern of negative health lifestyles among men originates in peasant and working class culture which put a certain set of normative demands on male behaviour, for example, drinking as long as one is able to. Cockerham sees the working-class tradition of heavy episodic drinking as a structural constraint on individual choice in that norms and group dynamics ‘force’ men to drink if they want to belong to a certain group. While such norms might not be as strong for smoking, the strong association between drinking and smoking links tobacco consumption to the social norms of male behaviour described above. The working-class lifestyle explanation also accommodates the lower consumption of alcohol and cigarettes among females and argues that, while considered the social norm for men, drinking and smoking were not considered an acceptable behaviour for women (Cockerham, 2009).

A qualitative study by Abbott et al. (2006) based on interviews, focus groups and essays conducted within the 2001 Living Conditions, Lifestyles and Health (LLH) project sheds further light on the gender norms in health behaviours in Russia. According to the study, respondents regarded smoking as a normal behaviour for men and rarely referred to smoking as being bad for health (Abbott et al., 2006). Drinking and smoking were seen as habitual and natural elements of daily life and a way to cope with stress, which was also reflected in the fact that the majority of male respondents both drank and smoked.

Female respondents by contrast reported drinking, but relatively few of them reported smoking. There are, however, sources that report increases in negative health behaviours among females already in the Soviet period, see for example (White, 1996).

Further evidence on the normative influences on smoking behaviour in both Soviet and post-Soviet Russia comes from data collected for an oral history project. The data, based on interviews with people born between the 1910s and 1980s living in four major Russian cities and two rural sites, suggest that developing a relationship with smoking (whether positive or negative) was a near-universal childhood experience in Russia from the late 19th century onwards (Kelly, 2009). Despite the long time period spanned, the individual accounts are remarkably consistent across time and point to a starting age of smoking between fourteen and eighteen years. The interviews also give interesting insights into the attitudes and social acceptance of smoking in 20th century Russia. For example, while adults disapproved of children’s smoking, they at the same time considered it inevitable that they would one day become smokers. This resulted in a kind of “normative doublethink” where smoking was regarded both as socially “normal” and medically “harmful to health” (ibid.). In general, attitudes to smoking were shaped by the fact that tobacco was cheap and widely available and that there were few social or moral prohibitions on its use in most public places. However, smoking decisions were strongly influenced by gender roles. Whereas smoking was a sign of manliness for boys and thus socially encouraged, female smokers were considered to be unfeminine, and public smoking by women was thus rarely observed.

Several authors suggest that the increases in alcohol and tobacco consumption among women may be a sign of changing gender norms, where younger cohorts of females engage in traditionally ‘un-feminine’ behaviours as a way to express their individuality and exert personal agency, or to make a statement against the masculine-dominated social order of the Soviet period (Hinote et al., 2009a, 2009b). Among young Russians, Western cigarettes were seen as relatively inexpensive status symbols (Gilmore, 2009), and compared to other consumer products cigarettes were widely and easily available. Thus, while the desire to “Westernize” made cigarettes attractive to men and women alike, smoking might have carried additional symbolic meaning for women in their quest to strip off existing gender roles and lead a modern lifestyle. This is by no means a new explanation since, throughout the history of tobacco in Russia, smoking served as a

marker of gender and status, with tobacco consumption being associated with the modern, forward-thinking, revolutionary, and the young (Romaniello and Starks, 2009, p. 4).

Another factor that might have contributed to the rise in female smoking towards the end of the 1970s is the arrival of a new product – machine-rolled cigarettes, and specifically Bulgarian cigarettes exported into the USSR by Bulgarian state monopolist Bulgartabac. Bulgartabac produced cigarettes with American Technology from Philip Morris and based on American blends which, while more addictive and carcinogen-laden, were milder in taste compared to Russian cigarettes, and surely compared to the traditional Russian papyrosi (Neuburger, 2009). While the traditional papyrosi without filter might have been too rough in taste, the aesthetic turn to filtered cigarettes, and particularly the milder Bulgarian cigarettes might have ‘made’ cigarettes a product for women.

3.6 C

ONCLUSION

In conclusion, it seems that rather than simply ‘inducing’ higher smoking rates, from the traditional low base, the transition environment with its new forms of marketing of cigarettes and decline in real prices provided impetus to a pre-existing trend of increasing popularity of smoking among women. While we do not doubt that the marketing strategies specifically targeted at women did have an impact on female smoking, we maintain that it should be seen as an ‘accelerator” that unlocked existing behavioural patterns within the cohorts of women at vulnerable ages for taking up the habit: On the one hand by making smoking a socially acceptable and desirable behaviour for modern women, and on the other hand by increasing the availability and affordability of cigarettes. Already, prior to transition, smoking was seen as a sign of a Western lifestyle that attracted young men and women, so that the marketing efforts by TTCs fell on fertile ground which in combination with falling real prices in the struggle for market share created favourable conditions for increasing demand. This does not reduce the significance of the aggressive marketing mechanisms to recruit female smokers in Russia. By contrast, a better understanding of the ways in which tobacco companies exploited existing cultural changes to propagate a positive image of cigarettes and create contexts that encourage smoking initiation might also help design interventions to reduce their attractiveness and promote cessation.

C

HAPTER

3A

PPENDICES

3-A Sample composition for the replenished and life-course samples

Individuals aged 15 and above (1) (2) (3) (4)

Replenished 2001-2010 sample Life-course sample based on replenished 2001-2010 sample Represen- tative 2001-2010 sample Life-course sample based on representative 2001-2010 sample Gender Female 55.63 58.26 56.14 58.77 Male 44.37 41.74 43.86 41.23 Age 15-24 years 19.07 8.80 18.79 8.42 25-34 years 20.26 13.59 17.63 11.51 35-44 years 15.42 13.91 15.04 13.26 45-54 years 15.46 17.60 16.18 17.95 55-64 years 12.74 17.31 13.66 18.08 65 plus years 16.70 28.78 18.35 30.77 Region

Moscow & St. Petersburg 14.42 15.01 11.94 14.19

Northern & North Western 6.83 6.37 6.17 6.28

Central & Central Black Earth 17.36 17.90 18.00 18.34 Volga-Vyatski & Volga Basin 15.29 15.69 16.54 15.07

North Caucasian 13.32 13.04 14.78 13.80

Ural 13.39 13.13 13.90 13.24

Western Siberian 9.25 9.10 9.48 9.35

Eastern Siberian & Far Eastern 10.15 9.77 9.19 9.72 Education

University 20.82 20.76 20.75 20.62

Technical, medical, pedagogical and

art colleges 20.12 21.19 20.43 21.49

Complete secondary + vocational

training 13.01 11.82 12.27 11.19

Incomplete secondary + vocational

training 5.54 6.13 5.38 5.97

Complete secondary (11 years) 20.37 17.35 20.89 17.59 Incomplete secondary (8 years) 18.95 21.75 19.13 22.20

3-B Life-course smoking based on representative sample (males)

3-D Smoking prevalence over time based on representative sample

(males)

3-E Smoking prevalence over time based on representative sample

(females)

4 RLMS evidence on smoking patterns

between 2001 and 2010

4.1 I

NTRODUCTION

In the previous chapter we explored patterns of smoking across the life-course and over time based on retrospective reports of smoking status from round 17 (2008) of the RLMS. Among other things, the analysis has highlighted the strongly gendered nature of smoking in Russia, with female rates having increased from cohort to cohort, and more strongly so from the 1980s onwards. Taking this finding as our departure, we now draw a more fine- grained picture of smoking patterns in the first decade of the century (2001-2010). We start by analysing the association of smoking with key socioeconomic characteristics such as age, region, settlement type and education, separately for men and women. Changes in bivariate associations of smoking status can be clouded by compositional changes of the sample (e.g. if a larger share of respondents has university education in 2010 than in 2001, this might lead one to mistakenly conclude that smoking has increased among people with higher education). Therefore, we also explore the associations for constant 2001 population shares. While for men, decreases in smoking between 2001 and 2010 are confirmed across all the associations, a different pattern emerges for women, where we see both increases and decreases, with the differences in prevalence rates according to age, region, and settlement size decreasing, and the educational gradient becoming steeper. Building on these associations, section 4 presents the socioeconomic profile of a smoker by comparing the characteristics of smokers to their non-smoking counterparts. The profiles confirm the gender differences, with male smokers being on average older than non-smokers, married or divorced, having a lower income and living in a medium- sized city in the Ural or Siberian regions, whereas female smokers are considerably younger than non-smoking women, are more likely to be single, have a higher income and live in Moscow and St. Petersburg.

In document The economics of smoking in Russia: evidence from the Russia Longitudinal Monitoring Survey (RLMS-HSE) (Page 87-95)