Men's business, women's work: gender influences and fathers' smoking

Barriers to physical activity for father's living in marginalising conditions

Physical activity can be a conduit for improving men's social connectedness as well as physical gains for well-being. However, marginalised men, and fathers in particular, can be challenged to engage in leisure time physical activity. This qualitative study reports how fathers, who experience complex and significant social and health inequities, conceptualise and experience barriers to physical activity. Drawing from focus groups with 17 fathers, and semi-structured interviews with seven service providers about their perspectives on men's physical activity in Vancouver's Downtown Eastside (DTES), a highly marginalised neighbourhood. A masculinities framework was used to describe and contextualise physical activity in fathers' lives. Three themes were inductively derived through the analyses: (1) 'they're busy surviving' a finding referencing the work and limits invoked by poverty wherein survival was triaged ahead of leisure time physical activity; (2) 'there is no activity centre' chronicling the lack of physical activity spaces, programmes and resources available to fathers; and (3) 'lifestyle affects our capability to exercise' a theme detailing how social isolation amplified by factors including housing and opioid crises, and being a father in a resource poor setting imposed significant barriers to physical activity. The findings support reconceptualising physical activity programmes with men who are living in marginalising conditions to address behavioural and structural health inequities in tailoring father-centred programmes and resources.

Smoking Cessation Experience in Indonesia: Does the Non-smoking Wife Play a Role?

Objective

More than 63% of Indonesian men are smokers, and smoking has long been a part of Indonesian culture and the concept of masculinity in Indonesian culture. Given the pro-smoking environment, we were interested in examining why smokers would willingly quit and whether their wives played a role in their quitting process as social factors are mentioned second most frequent as a reason for quitting smoking.

Design

In-depth interviews.

Method

We interviewed 11 couples (N = 22)—ex-smoking husbands and non-smoking wives—in Yogyakarta, Indonesia. The data were analysed by using the thematic analysis approach.

Results

Four themes were discussed: (1) reasons for stopping smoking, (2) the process of quitting smoking, (3) the wives’ attitudes toward smoking, and (4) the families’ attempts to make the (ex-)smokers quit. The most commonly cited reasons for quitting were family and personal motivation. The (ex-)smokers preferred to quit without assistance and in private. The wives’ attitude toward smoking ranged from dislike to tolerance, and most did not know when their husbands were trying to quit. Both husbands and wives reported that the wives did not influence the smoking cessation process.

Conclusion

Indonesian ex-smokers often had multiple reasons for quitting smoking. The process was typically difficult and kept private. While wives had little influence on the cessation process, they provided support and could institute a smoking ban in the house.

Smoking-Related Social Control in Indonesian Single-Smoker Couples

Background

The majority of Indonesian smokers are men and those who are married nearly always have a non-smoking wife (i.e. single-smoker couples). Previous studies have suggested that Indonesian women dislike smoking. However, contesting their husbands’ smoking could be seen as disrespectful. In this study, we examine whether, and if so how, wives employ social control tactics to change their husbands’ smoking and how the smokers perceive the tactics.

Method

In-depth interviews (N = 12) with five single-smoker couples (N = 10 individual interviews) and two non-smoking wives of smokers (N = 2) were conducted in Jogjakarta, Indonesia. We used a social control framework and thematic analysis approach to analyse the transcribed interviews.

Results

Three themes emerged from smokers and their wives: (1) although the wives know that smoking is bad, they have to tolerate it, (2) wives and their husbands find it important to maintain harmony and (3) their family’s needs serve as common ground. All the wives interviewed exerted social control to some degree, especially when they were pregnant or had children. Smokers reacted positively to social control and agreed to child-related house rules, but not to requests to give up smoking.

Conclusion

Wives do exert social control and smokers are willing to accommodate and adapt their smoking. However, wives’ influence on smoking may be limited in Indonesia, and focusing on managing their husbands’ smoking at home rather than overall smoking might be more fruitful.

Electronic supplementary material

The online version of this article (10.1007/s12529-020-09935-z) contains supplementary material, which is available to authorized users.

A scoping review of men, masculinities, and smoking behavior: The importance of settings

Background: In many countries, smoking rates are higher among men than women, highlighting the importance of focusing on factors that influence smoking prevalence among men. Expressed masculinities occur within settings that can influence men’s perspectives and behaviours towards smoking.

Objectives: To provide an overview of key aspects of how masculinities underpin men’s behaviours regarding tobacco smoking.

Methods: The Health, Illness, Men and Masculinities framework was used to develop a synthesis of masculinities captured in published articles about men’s smoking behaviours. Five databases (PubMed, Medline Ovid, Embase, CINAHL and PsychINFO Ovid) and Google Scholar (up to April 2016) were searched using keywords derived from three concepts: men, smoking and health. In total, 351 articles that focused on smoking and used/implied masculinity concepts were identified. These underwent a two-stage screening process applying inclusion/exclusion criteria, first titles/abstracts and then full-text. Data from 45 selected articles were extracted and charted.

Results: Regions with high prevalence of smoking among men, such as South East Asia and the Western Pacific, had a disproportionate number of studies on masculinity and smoking, with less exploration of masculinity as a protective factor, especially for young people, and men-specific settings to support non-smoking behaviour.

Conclusions: Incorporating masculinity in future settings-based approaches to smoking-related health promotion programmes has the potential to reduce smoking prevalence among men.

Suffering in Silence: Impact of Tobacco Use on Communication Dynamics Within Vietnamese and Chinese Immigrant Families

The goal of this project was to explore family communication dynamics and their implications for smoking cessation. We conducted 39 in-depth dyadic and individual qualitative interviews with 13 immigrant smoker-family member pairs of Vietnamese ( n = 9 dyads, 18 individuals) and Chinese ( n = 4 dyads, 8 individuals) descent, including seven current and six former smokers and 13 family members. All 13 dyadic and 26 individual interviews were analyzed using a collaborative crystallization process as well as grounded theory methods. We identified three interrelated pathways by which tobacco use in immigrant Vietnamese and Chinese families impacts family processes and communication dynamics. Using a two-dimensional model, we illustrate how the shared consequences of these pathways can contribute to a dynamic of avoidance and noncommunication, resulting in individual family members "suffering in silence" and ultimately smoking being reinforced. We discuss the implications of these findings for development of smoking cessation interventions.

Masculinity and Fatherhood: New Fathers' Perceptions of Their Female Partners' Efforts to Assist Them to Reduce or Quit Smoking

Health promotion initiatives to reduce smoking among parents have focused almost exclusively on women to support their cessation during pregnancy and postpartum, while overlooking the importance of fathers' smoking cessation. This study was a secondary analysis of in-depth interviews with 20 new and expectant fathers to identify how they perceived their female partners' efforts to assist them to reduce or quit smoking. Social constructionist gender frameworks were used to theorize and develop the findings. Three key themes were identified: support and autonomy in men's smoking cessation, perception of challenging men's freedom to smoke, and contempt for men's continued smoking. The findings suggest that shifts in masculinities as men take up fathering should be considered in designing smoking cessation interventions for fathers.

A qualitative study of Chinese Canadian fathers' smoking behaviors: intersecting cultures and masculinities

BACKGROUND

China is home to the largest number of smokers in the world; more than half of the male population smoke. Given the high rates of Chinese immigration to Canada and the USA, researchers have explored the effect of immigration on Chinese smokers. Reduced tobacco use among Chinese immigrants has been reported in the United States; however, little is known about the social factors underlying men's smoking practices in settings where tobacco control measures have denormalized smoking, and in the context of fatherhood. The purpose of this Canada-based study was to explore the smoking-related experiences of immigrant Chinese fathers.

METHODS

In this qualitative study, semi-structured telephone interviews were conducted with 22 Chinese Canadian fathers who smoked or had recently quit smoking, and had at least one child under the age of five years old.

RESULTS

The Chinese fathers had dramatically changed their smoking patterns due to concern for their children's health and social norms and restrictions related to smoking in Canada. The facilitators and barriers for men's smoking were intertwined with idealized masculine provider and protector roles, and diverse Canadian Chinese cultural norms related to tobacco use.

CONCLUSIONS

The findings have implications for the development of future smoking cessation interventions targeting Chinese Canadian immigrant smokers as well as smokers in China.

The meanings of smoking to women and their implications for cessation

Smoking cigarettes is a gendered activity with sex- and gender-specific uptake trends and cessation patterns. While global male smoking rates have peaked, female rates are set to escalate in the 21st century, especially in low and middle income countries. Hence, smoking cessation for women will be an ongoing issue and requires refreshed attention. Public health and health promotion messages are being challenged to be increasingly tailored, taking gender into account. Women-centred approaches that include harm-reduction, motivational interviewing and trauma-informed elements are the new frontiers in interventions to encourage smoking cessation for women. Such approaches are linked to the meanings of smoking to women, the adaptive function of, and the overall role of smoking cigarettes in the context of women’s lives. These approaches respect gender and sex-related factors that affect smoking and smoking cessation and respond to these issues, not by reinforcing destructive or negative gender norms, but with insight. This article discusses a women-centred approach to smoking cessation that could underpin initiatives in clinical, community or public health settings and could inform campaigns and messaging.

Picture Me Smokefree: a qualitative study using social media and digital photography to engage young adults in tobacco reduction and cessation

Background

Young adults have high rates of tobacco use compared to other subpopulations, yet there are relatively few tobacco interventions specifically targeted to this group. Picture Me Smokefree is an online tobacco reduction and cessation intervention for young adults that uses digital photography and social networking.

Objective

The main goal of the project was to determine the feasibility of engaging young adults in participating in user-driven, online forums intended to provide peer support and motivate critical reflection about tobacco use and cessation among this high-use, hard-to-reach population. A related aim was to explore the influence of gender-related factors on participation, in order to determine the need for online interventions to be tailored to the specific gender preferences reflecting young men and women’s participation styles.

Methods

A total of 60 young adults ages 19-24 years who self-identified as current cigarette smokers or who had quit within the last year were recruited from across British Columbia, Canada, and participated in an online photo group on Facebook over a period of 12 consecutive weeks. A variety of data collection methods were used including tracking online activity, a brief online follow-up survey, and qualitative interviews with study participants. Data analysis involved descriptive statistics on recruitment, retention, and participation and qualitative (eg, narrative analysis, synthesis of feedback) feedback about participant engagement.

Results

Findings from this study suggest good potential for Facebook as an accessible, low-cost platform for engaging young adults to reflect on the reasons for their tobacco use, the benefits of quitting or reducing, and the best strategies for tobacco reduction. Young adults’ frequent use of mobile phones and other mobile devices to access social networking permitted ease of access and facilitated real-time peer-to-peer support across a diverse group of participants. However, our experience of conducting the study suggests that working with young tobacco users can be accompanied by considerable recruitment, participation, and retention challenges. Our findings also pointed to differences in how young women and men engaged the photo-group intervention that should be considered, bearing in mind that in follow-up interviews participants indicated their preference for a mixed gender and “gender neutral” group format.

Conclusions

Tobacco interventions for youth and young adults should be embedded within the existing social networking platforms they access most frequently, rather than designing a stand-alone online prevention or intervention resource. This subpopulation would likely benefit from tobacco reduction interventions that are gender-sensitive rather than gender-specific.

Gender, smoking and tobacco reduction and cessation: a scoping review

Considerations of how gender-related factors influence smoking first appeared over 20 years ago in the work of critical and feminist scholars. This scholarship highlighted the need to consider the social and cultural context of women's tobacco use and the relationships between smoking and gender inequity. Parallel research on men's smoking and masculinities has only recently emerged with some attention being given to gender influences on men's tobacco use. Since that time, a multidisciplinary literature addressing women and men's tobacco use has spanned the social, psychological and medical sciences. To incorporate these gender-related factors into tobacco reduction and cessation interventions, our research team identified the need to clarify the current theoretical and methodological interpretations of gender within the context of tobacco research. To address this need a scoping review of the published literature was conducted focussing on tobacco reduction and cessation from the perspective of three aspects of gender: gender roles, gender identities, and gender relations. Findings of the review indicate that there is a need for greater clarity on how researchers define and conceptualize gender and its significance for tobacco control. Patterns and anomalies in the literature are described to guide the future development of interventions that are gender-sensitive and gender-specific. Three principles for including gender-related factors in tobacco reduction and cessation interventions were identified: a) the need to build upon solid conceptualizations of gender, b) the importance of including components that comprehensively address gender-related influences, and c) the importance of promoting gender equity and healthy gender norms, roles and relations.

Tobacco and alcohol use in the context of adolescent pregnancy and postpartum: a scoping review of the literature

Adolescent girls are more likely than women of other ages to smoke tobacco or drink alcohol during pregnancy. The health impacts of smoking and drinking for girls and the interconnections between alcohol and tobacco use with adolescent pregnancy underscore the urgent need for integrated approaches to prevent and reduce alcohol and tobacco use among pregnant girls/young women. This article reports on the results of a scoping review of the literature focused on adolescents' use of tobacco and alcohol during pregnancy and postpartum. A search of CINAHL, Medline, Social Science Index and Web of Science identified 40 articles published in the two decades between 1990 and 2012 that met our inclusion criteria related to this age group, pregnancy/motherhood status, and use of both alcohol and tobacco. The review points to compelling gaps in our knowledge and our responsiveness to adolescents aged 19 and under who use alcohol and tobacco during pregnancy and the postpartum period. Research has been primarily descriptive, with separate, parallel streams of investigation to identify trends and predictors of alcohol and tobacco use, prior to, during and following pregnancy. There is a marked lack of effective interventions described in the literature that are designed to prevent or reduce alcohol and tobacco use during pregnancy among adolescent girls; and there are few examples of gender-informed prevention or treatment programmes for this population. Research is needed on interventions that attend to the context of adolescent girls' substance use as well as their preferences and developmental needs for support that encourage sustained behaviour change throughout pregnancy and the postpartum period and that effectively address the influence of partners and friends on use.

A multilevel analysis of gender, Latino immigrant enclaves, and tobacco use behavior

Research suggests that immigrant enclaves positively influence health behaviors such as tobacco use through supportive social networks and informal social control mechanisms that promote healthy behavioral norms. Yet, the influence of social cohesion and control on tobacco use may depend on smoking-related norms, which can vary by gender. This study examines the influence of neighborhood Latino immigrant enclave status on smoking and cessation among Hispanic men and women. Data from the Los Angeles Family and Neighborhood Survey was combined with census data to assess the relationship between immigrant enclaves, gender, and smoking using multilevel regression. The effect of the Hispanic enclave environment on smoking differed by gender. Living in an enclave had a harmful effect on tobacco use among Hispanic men, marginally increasing the likelihood of smoking and significantly reducing cessation. This effect was independent of neighborhood socioeconomic status, nativity, and other individual demographics. Neighborhood immigrant concentration was not associated with smoking or cessation for Hispanic women. Research, interventions, and policies aimed at reducing smoking among Hispanics may need to be gender responsive to ensure effectiveness as well as health and gender equity.

Heterosexual gender relations and masculinity in fathers who smoke

The purpose of this research was to explore the role of masculinity and heterosexual gender relations in new and expectant fathers’ explanations of their continued smoking. We conducted a secondary analysis of in-depth interviews with 20 fathers. Two themes were identified: (1) reconciling with partners to maintain a smoke-free family home; and (2) smoking to self-regulate emotions and maintain relationships. Fathers’ decisions to smoke and changes in smoking behavior were shaped by ideals of masculinity and by partner relationships and family and social contexts, including division of domestic duties and childcare. Recognizing the influence of both masculinity and gender relations could provide new directions for supporting men’s smoking cessation efforts during early parenthood. © 2014 The Authors. Research in Nursing & Health Published by Wiley Periodicals, Inc.

Protecting children from smoking in the home: an ethics of care perspective

Community nurses are uniquely placed to help protect child health by facilitating the creation of smoke-free homes. However, there are a number of perceived barriers that may concern community nurses in their role of supporting parents in the creation of smoke-free homes, particularly those faced by disadvantaged parents. Arguments against intervening within the private domain of the home focus on concerns about protecting parents' autonomy to smoke within their own home and the potential for stigmatising parents who smoke, particularly mothers. Drawing on an ethics of care perspective, the authors propose an alternative perspective to the intervention in private settings. An ethics of care perspective may help to justify and encourage parents and community nurses to work in partnership to create a healthy environment for children and decrease the likelihood of children becoming smokers in the future.

Children's resistance to parents' smoking in the home and car: a qualitative study

BACKGROUND AND AIMS

Reducing second-hand smoke exposure in the home is a key tobacco control goal, yet few studies have explored children's views and experiences of this. This study aimed to explore children's accounts of family members' smoking in the home and car and the impact of their socio-economic circumstances.

DESIGN

Individual and friendship group interviews using topic guides and visual stimulus methods.

SETTING

Two communities in Edinburgh, Scotland, one socio-economically advantaged, one socio-economically disadvantaged.

PARTICIPANTS

Thirty-eight children aged 10-15 years who had a close family member who smoked.

MEASUREMENTS

Focus group and interview topic guides.

FINDINGS

Participants in both communities expressed a strong dislike of family members' smoking and concern about the potential impact on the smoker's health. Participants described overt and covert acts of resistance, including challenging relatives about their smoking, expressing disgust and concern, hiding or destroying cigarettes. Some acts were carried out in collusion with a non-smoking parent and/or sibling. Resistant acts were constrained by expectations of negative responses, which appeared to increase with age, wider social norms around smoking and whether or not the young person smoked.

CONCLUSIONS

Some children and young people in the United Kingdom, irrespective of socio-economic status, may actively oppose parents' smoking in the home and car, although their influence may be limited by their position in the family and social norms.

Can tobacco control be transformative? Reducing gender inequity and tobacco use among vulnerable populations

Tobacco use and exposure is unequally distributed across populations and countries and among women and men. These trends and patterns reflect and cause gender and economic inequities along with negative health impacts. Despite a commitment to gender analysis in the preamble to Framework Convention on Tobacco Control there is much yet to be done to fully understand how gender operates in tobacco control. Policies, program and research in tobacco control need to not only integrate gender, but rather operationalize gender with the goal of transforming gender and social inequities in the course of tobacco control initiatives. Gender transformative tobacco control goes beyond gender sensitive efforts and challenges policy and program developers to apply gender theory in designing their initiatives, with the goal of changing negative gender and social norms and improving social, economic, health and social indicators along with tobacco reduction. This paper outlines what is needed to progress tobacco control in enhancing the status of gendered and vulnerable groups, with a view to reducing gender and social inequities due to tobacco use and exposure.

The experiences of women who quit smoking during pregnancy and how they dealt with their spouses' continued smoking

OBJECTIVE

to explore how pregnant women in Taiwan dealt with their spouses who continued to smoke and with passive smoking during their own process of quitting and abstaining.

DESIGN

a qualitative study using an oral history approach. Data were collected via tape-recorded open-ended interviews. All interviews were transcribed verbatim. Data were analysed using narrative analysis.

SETTING

the homes of the participant women living in the district of a regional hospital of eastern Taiwan.

PARTICIPANTS

a purposive sample of 10 Taiwanese women who had quit smoking while pregnant was recruited at 1-3 months following the birth of their infants.

FINDINGS

five major themes emerged: (1) the women coping with tobacco addiction on their own, (2) creating a non-smoking section or environment at home, (3) dealing with passive smoking, (4) conflict over the wife's sensitivity to her spouse's residual tobacco smell, and (5) allowing the husband to continue smoking to avoid conflicts.

KEY CONCLUSIONS

the pregnant women were expected by their spouses to quit smoking, yet the husbands continued to smoke. Women had to struggle to quit smoking on their own. The findings from this study support the need to listen to pregnant women's stories, as this is paramount to understanding their experiences of tobacco-use reduction and cessation, and for developing gender appropriate interventions to support their efforts.

IMPLICATIONS FOR PRACTICE

health care providers should encourage and help pregnant women who are willing to quit smoking. This help could be more family-centred instead of focusing on the pregnant women alone, and therefore involve educating the spouse to support his wife.

Heterosexual gender relations in and around childhood risk and safety

Injuries are a leading cause of child death, and safety interventions frequently target mothers. Fathers are largely ignored despite their increasing childcare involvement. In our qualitative study with 18 Canadian heterosexual couples parenting children 2 to 7 years old, we examined dyadic decision making and negotiations related to child safety and risk engagement in recreational activities. Parents viewed recreation as an important component of men's childcare, but women remained burdened with mundane tasks. Most couples perceived men as being more comfortable with risk than women, and three negotiation patterns emerged: fathers as risk experts; mothers countering fathers' risk; and fathers acknowledging mothers' safety concerns but persisting in risk activities. Our findings suggest that contemporary involved fathering practices privilege men in the outdoors and can erode women's control for protecting children from unintentional injury. We recommend promoting involved fathering that empowers both parents and developing injury-prevention strategies incorporating both fathers' and mothers' perspectives.

Space and power: young mothers' management of smoking in extended families in China

Multigenerational co-residence is a widespread phenomenon in China but there is little knowledge about the impact of power dynamics on smoking behaviors among extended family residents. Using a gender lens, this ethnographic study explored how young mothers in extended families in mainland China managed the smoking of their husbands and other family members. Analysis of data resulted in a model of 'two units-three domains' to reflect gendered relationships between young mothers and other family members, and young mothers' participation in family management. Exploration of the mothers' efforts to deal with household smoking using the model provided an explanation for why the young mothers had limited control over household space and could only impose partial restrictions on home smoking in the extended family.

'I'm not doing this for me': mothers' accounts of creating smoke-free homes

This article explores mothers' narratives of changing home smoking behaviours after participating in an intervention (Reducing Families' Exposure to Smoking in the Home [REFRESH]) aimed at reducing families' exposure to secondhand smoke (SHS) in homes in Scotland. An analysis of qualitative findings illuminates quantitative changes in levels of SHS exposure. Prospective quantitative and qualitative data were drawn from 21 smoking mothers with at least one child under 6 years. Quantitative change was measured by home air quality, i.e. fine particulate matter <2.5μg (PM(2.5)). These measurements guided the organization of mothers into categories of change (smoke-free home at baseline [SFB], smoke-free home at final, some change and no change [NC]). Qualitative data from 17 mothers with non-SFB were analysed thematically within and across these categories. Three comparative case studies illustrate the varying changes made, barriers to change and how mothers valued such changes. The outcomes varied post-intervention, with homes smoke-free, partially smoke-free or making NC. The changes in home smoking behaviour were incremental, yet beneficial to reducing SHS exposure, and related to the nature of the restrictions and personal circumstances in the home pre-intervention. Across all change categories, mothers valued the changes they had made and expressed an intention to increase the changes.

Caught in a dilemma: why do non-smoking women in China support the smoking behaviors of men in their families?

Intimate relationships influence family members' health practices. Although cigarette smoking in China is predominantly a male behavior, (non-smoking) women's roles should be taken into account for the development of home-smoking interventions. Drawing on ethnographic interviews with 22 families in a rural area of China, this article explores non-smoking women's attitudes towards male smoking. The findings suggest that women's ability to influence male behavior is largely determined by culturally defined gender roles, underpinned by ideologies of familism and collectivism. Despite concerns about the adverse results of smoking to their family members and households, non-smoking women ultimately maintain the (male) smokers' argument that smoking plays an important role in construction and maintenance of intra- and extra-family relationships. By accepting male smoking and men's engagement in the social practice of smoking and cigarette exchanges, women maintain their identities as supportive wives, filial daughters/in-law and responsible family members who pursue family collective interests at the expense of their own personal beliefs. Future smoking control initiatives that target non-smoking women to influence male smoking should take into account the women's overarching need to maintain the status and harmony of their families.

Women on men's sexual health and sexually transmitted infection testing: a gender relations analysis

Sexual health and sexually transmitted infection (STI) testing is typically portrayed as a women's issue amid men's estrangement from healthcare services. While the underreporting of men's STIs has been linked to masculinities, little is known about how women interpret and respond to heterosexual men's sexual health practices. The findings drawn from this qualitative study of 34 young women reveal how femininities can be complicit in sustaining, as well as being critical of and disrupting masculine discourses that affirm sexual pleasure and resistance to health help-seeking as men's patriarchal privileges. Our analysis revealed three patterns: looking after the man's libido refers to women's emphasised femininity whereby the man's preference for unprotected sex and reticence to be tested for STIs was accommodated. Negotiating the stronger sex refers to ambivalent femininities, in which participants strategically resist, cooperate and comply with men's sexual health practices. Rejecting the patriarchal double standard that celebrates men as 'studs' and subordinates women as 'sluts' for embodying similar sexual practices reflects protest femininities. Overall, the findings reveal that conventional heterosexual gender relations, in which hegemonic masculinity is accommodated by women who align to emphasised femininity, continues to direct many participants' expectations around men's sexual health and STI testing.

Gender influences in tobacco use and cessation interventions

Smoking rates among and between men and women are in large part a reflection of the influence of gender and its intersections with other social factors including ethnicity, age, and social class that influence tobacco use and, ultimately, tobacco reduction and cessation. In this article, opportunities for developing and delivering gender-sensitive (programs addressing gender) and gender-specific (programs designed for men or women) interventions in the context of tobacco dependence treatment are discussed.