title: Gender equality and smoking: a theory-driven approach to smoking gender differences in Spain.
abstract: BACKGROUND
  The intersection between gender and class can aid in understanding gender differences in smoking.
  
  
  OBJECTIVE
  To analyse how changes in gender inequality relate to differences in smoking prevalence by gender, education and birth cohort in Spain over the past five decades (1960-2010).
  
  
  METHODS
  The Gender Inequality Index (GII) was calculated in 5-year intervals from 1960 to 2010. GII ranges from 0 to 1 (1=highest inequality) and encompasses three dimensions: reproductive health, empowerment and labour market. Estimates of female and male smoking prevalence were reconstructed from representative National Health Surveys and stratified by birth cohort and level of education. We calculated female-to-male smoking ratios from 1960 to 2010 stratified by education and birth cohort.
  
  
  RESULTS
  Gender inequality in Spain decreased from 0.65 to 0.09 over the past 50 years. This rapid decline was inversely correlated (r=-0.99) to a rising female-to-male smoking ratio. The youngest birth cohort of the study (born 1980-1990) and women with high education levels had similar smoking prevalences compared with men. Women with high levels of education were also the first to show a reduction in smoking prevalence, compared with less educated women.
  
  
  CONCLUSIONS
  Gender inequality fell significantly in Spain over the past 50 years. This process was accompanied by converging trends in smoking prevalence for men and women. Smoking prevalence patterns varied greatly by birth cohort and education levels. Countries in earlier stages of the tobacco epidemic should consider gender-sensitive tobacco control measures and policies.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain.
authors.forename: Usama
authors.initials: U
authors.lastname: Bilal
authors.affiliation: Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain Department of Preventive Medicine, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Beltrán
authors.affiliation: Tobacco Control Unit, Cancer Prevention Program. Institut Català d'Oncologia (ICO). l'Hospitalet de Llobregat, Spain Cancer Control and Prevention Area, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain Department of Clinical Sciences, Medical School (Bellvitge), Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Fernández
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Environmental Health Sciences, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
authors.affiliation: Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Spain Hunter School of Public Health, City University of New York.
authors.forename: Francisco
authors.initials: F
authors.lastname: Bolumar
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain Department of Epidemiology, Atherothrombosis and Cardiovascular Imaging Centro Nacional de Investigaciones Cardiovasculares Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Franco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004522:Educational Status; D004651:Employment / Q000639:trends; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011209:Power, Psychological; D015995:Prevalence; D060728:Reproductive Health / Q000639:trends; D017678:Sex Distribution; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000401:mortality / Q000639:trends*; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: Disparities; Prevention; Priority/special populations; Socioeconomic status