National Cancer Institute
Behavioral Research - Cancer Control and Population Sciences

TReND: Low SES Women and Girls Project: Examining the Effects and Potential Unintended Consequences of Tobacco Control Policies on Low SES Women and Girls


Visit TReND’s web portal www.tobaccodisparities.org exit disclaimer to learn more about research, programs, policies, and resources relevant to tobacco and health disparities.

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About the Project

Rationale: Despite significant progress in reducing rates of cigarette smoking, the epidemic of tobacco-related disease continues to threaten the lives of women in the United States. Lung cancer remains the number one cancer killer among U.S. women and although lung cancer incidence and death rates steadily decline among men, we have not seen similar rates of decline among women. Women from lower socioeconomic status backgrounds are significantly more likely to smoke compared to their more advantaged counterparts, and thus, are at greater risk of tobacco-related death and disease. Furthermore, the increased burden of tobacco among lower socioeconomic status women is not limited to the United States. While global rates of tobacco use among men are slowly declining, use of tobacco is increasing among women, particularly in low- and middle-income countries.

The World Health Organization’s Framework Convention on Tobacco Control (FCTC) exit disclaimer acknowledges the growing epidemic of tobacco-related disease among women stating that the parties to the Convention are "alarmed by the increase in smoking and other forms of tobacco consumption by women and young girls worldwide and [is] keeping in mind the need for full participation of women at all levels of policy-making and implementation and the need for gender-specific tobacco control policy." Tobacco control policies, such as increases in cigarette excise taxes, worksite smoking bans, and youth-focused media campaigns show promise in reducing smoking at the population level. However, few studies have examined the effects of policies in reducing smoking prevalence and secondhand smoke exposure among disadvantaged women and girls. The Low SES Women & Girls Project was initiated in 2004 to strategically examine the effects of multiple tobacco control policies on diverse populations of low SES women and girls.

Purpose: The overall purpose of this project is to stimulate new research, review existing research, and, as a result of its findings, inform the development and implementation of policies and programs that may reduce tobacco use among low SES women and girls. This project also seeks to challenge the traditional assumptions of a “one-size fits all” approach to evidence-based policies and programs by critically examining both their intended effects and unintended consequences. Unintended consequences may be harmful or helpful to the lives and livelihoods of low socioeconomic status women and girls (e.g., impact on worksite conditions, home life, social networks, etc).

Impact: There is no question that strong, effective tobacco control policies are needed to curb the global epidemic. The Low SES Women and Girls Project challenges researchers and policymakers to examine the effects of such policies from a socio-gender-sensitive lens and to consider the full ramifications of tobacco control policies. Results from this research effort will help to initiate dialogue and generate the research-based evidence necessary for developing and implementing effective tobacco control policies and programs that not only decrease tobacco consumption behaviors among low SES women and girls, but also promote their overall well-being within the broader context of their families and other inter-personal relationships, communities, and socioeconomic structures.

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Research Team

Laura Beebe, PhD, MPH
University of Oklahoma Health Sciences Center

Michele Bloch, MD, PhD
National Cancer Institute

Richard Clayton, PhD
University of Kentucky

Sherry Emery, MBA, PhD
University of Illinois at Chicago

Pebbles Fagan, PhD, MPH
National Cancer Institute

Anita Fernander, PhD
University of Kentucky

Jean Forster, PhD
University of Minnesota

Lorraine Greaves PhD (Lead guest editor, 2006 JECH special issue)
British Columbia Centre for Excellence for Women’s Health, Canada

Nancy Kaufman, RN, MS (Low SES Women and Girls Meeting Co-Chair)
Aurora Health Care

Gary King, PhD
Pennsylvania State University

Deirdre Lawrence, PhD, MPH
National Cancer Institute

Anna T. Levy, MS
National Cancer Institute

Deborah McLellan, MHS (Low SES Women and Girls Meeting Co-Chair; Guest editor, 2009 AJPM
special issue)
Brandeis University

Roland Moore, PhD (Lead guest editor, 2009 AJPM special issue)
Pacific Institute for Research and Evaluation

Allison Rose, MHS
SAIC-Frederick, Inc.

Melissa JH Segress, MS
University of Kentucky

Vickie Shavers, PhD
National Cancer Institute

John A. Tauras, PhD (Guest editor, 2009 AJPM special issue)
University of Illinois at Chicago

Donna Vallone, PhD, MPH (Guest editor, 2006 JECH special issue)
American Legacy Foundation

Wayne Velicer, PhD (Guest editor, 2006 JECH special issue)
University of Rhode Island

K. Vish. Viswanath, PhD
Harvard School of Public Health
Dana-Farber Cancer Institute

Barbara Wingrove, MPH (retired)
National Cancer Institute

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Contact Us

For questions and comments regarding the Low SES Women & Girls Project, please contact:
Pebbles Fagan, PhD, MPH
Health Scientist
Tobacco Control Research Branch
Behavioral Research Program
Division of Cancer Control and Population Sciences
National Cancer Institute
faganp@mail.nih.gov

Deborah McLellan, MHS
Brandeis University
deborah_mclellan@comcast.net

To request a copy of the Meeting Report, Executive Summary, or Special Issues, please contact:
Allison Rose, MHS
Clinical Project Manager I
National Cancer Institute/SAIC-Frederick Contractor
Tobacco Control Research Branch
Behavioral Research Program
Division of Cancer Control and Population Sciences
National Cancer Institute
rosea@mail.nih.gov

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Project Activities and Findings

Meeting and Meeting Reports

Research planning meeting, Tobacco Control Policies: Do They Make a Difference for Low SES Women and Girls? (September 22–23, 2005, in Bethesda, Maryland).

NCI Meeting Report and Research Recommendations, Executive Summary, Tobacco Control Policies: Do They Make a Difference for Low SES Women and Girls?

NCI Meeting Report and Research Recommendations, Summary Report, Tobacco Control Policies: Do They Make a Difference for Low SES Women and Girls?

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Special Journal Issues

Greaves L, Vallone D, Velicer W, eds. (2006) Tobacco Control Policy and Low Socioeconomic Status Women and Girls, Journal of Epidemiology and Community Health exit disclaimer; Vol 60 (Suppl II).

Moore R, McLellan D, Tauras J, eds. (2009). Tobacco Policy and It’s Unintended Consequences among Low Socioeconomic Status Women and Girls, American Journal of Preventive Medicine; Vol 37 (2 Suppl II).

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Manuscripts

Rose A, Fagan P, Lawrence D, Hart A Jr., Shavers V, & Gibson T. (in-press). The role of worksite and home smoking bans in smoking cessation among U.S. employed adult female smokers. American Journal of Health Promotion, 26(1):26-36.

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Presentations

Fagan P (November 2009). Reducing tobacco use among low socioeconomic status women: Opportunities and challenges. DHHS Office on Women’s Health Collaborative, Washington, D.C.

Fagan P (May 2008). What do we know about low SES women and girls? Centers for Disease Control and Prevention, Office of Smoking and Health, Media Network, Bethesda, MD.

Fagan P (December 2007). What do we know about low SES women and girls? Tobacco and young low SES women: Federal collaboration to make a difference. Bethesda, MD.

Fagan P, McLellan D, Moore RS, Chen MS, Campbell R, & Lew R (November 2009). Tobacco Control Policy: The need to prepare for unintended consequences. Panel presentation at the 137th American Public Health Association Annual Meeting and Expo, Philadelphia, PA exit disclaimer.

McLellan D, Fagan P, Levy A, Kaufman N & Jones W (November 2006). Tobacco control policies: Do they make a difference for low SES women and girls? Panel session at the 134th American Public Health Association Annual Meeting & Exposition, Boston, MA exit disclaimer.

Rose A, Fagan P, Hart A & Lawrence D (March 2009). Worksite and home bans among employed adult female smokers in the United States: A promising approach for women and girls worldwide. 14th World Conference on Tobacco or Health, Mumbai, India.

Rose A, Fagan P, Lawrence D, Hart A & Gibson T (March 2009). Increased risk of smoking among low socioeconomic status women in the United States: Informing research and practice worldwide. Poster presentation (Best Poster, Blue-Ribbon Award), 14th World Conference on Tobacco or Health, Mumbai, India.

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Other

Fact Sheets on Low Socioeconomic Status Women and Smoking (under development)

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Other Resources and Publications

Web Resources

For Women Who Want to Quit: Visit women.smokefree.gov

World Health Organization, Tobacco-Free Initiative exit disclaimer

World Health Organization, Framework Convention on Tobacco Control (FCTC) exit disclaimer. In the preamble to the FCTC, the parties to the convention note that they are “Alarmed by the increase in smoking and other forms of tobacco consumption by women and young girls worldwide and keeping in mind the need for full participation of women at all levels of policy-making and implementation and the need for gender-specific tobacco control strategies." For more information, download a copy of the Framework Convention on Tobacco Control exit disclaimer.

World Health Organization’s World No Tobacco Day (May 31, 2010): Gender and tobacco with an emphasis on marketing to women exit disclaimer

International Network of Women Against Tobacco (INWAT) exit disclaimer is a global network of tobacco control specialists dedicated to achieve improved health and greater equality among women and girls in the world by eliminating tobacco use and exposure.

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Select Scientific Publications and Articles

World Health Organization (2007). Gender and Tobacco: A Policy Brief. exit disclaimer WHO Press, World Health Organization, Geneva, Switzerland. Highlights the differential problem of tobacco use among men and women worldwide and calls for the need to incorporate a "gender-responsive infrastructure for tobacco control."

Samet JM & Yoon S, eds. (2001). Women and Tobacco: Challenges for the 21st Century, WHO Monograph. World Health Organization, Geneva, Switzerland exit disclaimer. This report was developed based on the 1999 WHO International Conference on Women and Tobacco, held in Kobe, Japan, and to support the Kobe Declaration which urged the World Health Organization to fully integrate gender equality into the Framework Convention on Tobacco Control (FCTC). This report highlights the growing problem of tobacco among women and recommends strategies for circumventing this global epidemic.

National Cancer Institute (2005). Eliminating Tobacco-Related Health Disparities Summary Report. A scientific effort to review the current research, identify gaps, and develop a comprehensive research agenda to eliminate tobacco-related disparities.

National Cancer Institute (2004). Women, Tobacco, and Cancer: An Agenda for the 21st Century. This report builds on the 2001 Surgeon General's report on women and smoking by articulating a set of strategies to stimulate research and to prevent smoking related cancers in women. These strategies span the areas of discovery, development, delivery, partnerships, evaluation, and surveillance.

U.S. Department of Health and Human Services (2001). Women and Smoking: A Report of the Surgeon General. This report summarizes smoking patterns among women and girls, the health consequences of tobacco use among women, and factors influencing tobacco use among women.

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The National Cancer Institute (NCI) and American Legacy Foundation are proud to fund the Tobacco Research Network on Disparities (TReND). Previous support has also been provided by the Department of Health and Human Services (DHHS) Office on Women’s Health, NCI Office of Women’s Health, and the NCI Center to Reduce Cancer Health Disparities.

National Cancer Institute    Legacy - American Legacy Foundation
Last Updated: August 8, 2012

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