Masculinity and Smoking

Editor's note: This Wiki was carried over from Men's Health and Masculinity (created 12/07/2019); I made my scope more specific after Drafting. 

Man smoking. Retrieved from Creative Commons, "ian taylor charles frith" by charles.frith.

Overview

Findings from the World Health Organization (WHO) state that the prevalence of tobacco use in men is approximately four times higher than that in women, from a rate of 48% compared to 12%. Many studies have examined the relationships between smoking and masculinity and found that men's smoking behaviour is generally associated with features of hegemonic masculinity. Hegemonic masculinity refers to conceptualizations of masculinity which typically promote men as being powerful, violent, and dominant society, while rejecting traditionally feminine characteristics. Aspects of hegemonic masculinity that are linked to smoking include the desire to reject association with feminine qualities, the drive to appear dominant in social situations over women and other men, being stoic or emotionally invulnerable, and being in control.

Social Determinants of Smoking in Men

"Man Smoking Cigarette, Mt. Lawu Indonesia" by AdamCohn is licensed under CC BY-NC-ND 2.0

Smoking and Culture

The gender disparity of smoking prevalence varies, and can be more extreme in countries such as China, Korea, and Indonesia, where the ratio of men to women smokers is closer to 10:1. Oftentimes in such cultures, beginning smoking is seen as a rite of passage from childhood into manhood. In some countries such as Indonesia, women smokers are culturally derided while smoking is a key presence in social interactions among men. As such, these men smoke as a way to reaffirm their masculinity and reject feminine attributes. Additionally, immigrant men who come from countries with a high smoking prevalence often continue to smoke in their new country as a means to maintain their cultural identity.

Smoking and Gay Men

Cigarette smoking is more prevalent in gay than in heterosexual men, with prevalence estimates ranging from 25-49% for gay men and 14-44% for straight men. One possible explanation for this difference is that gay men take up smoking to assert and emphasize their masculinity. Thus, smoking may provide a way for gay men to reconcile their own masculinity when other facets of their gay identity do not align with stereotypically masculine characteristics. Some research has also proposed that smoking can allow gay men to promote an outward appearance of heterosexuality in order to avoid discrimination or harassment. Finally, smoking can serve as a mechanism for stress-relief for gay men, who may be especially vulnerable to minority stress due to lack of social supports. This aspect is particularly relevant when considering the high smoking rates among young gay men, many of whom have been rejected by their families for not conforming to traditional definitions of masculinity.

Smoking and Fatherhood

Hegemonic masculinities commonly promote the notion that a man should remain stoic and emotionally unaffected, even in the face of great stressors. Additionally, such masculinities suggest that men be self-reliant and not seek help or comfort from others when faced with stress. As a result of this, smoking is commonly used by men as a means to stabilize their emotions and deal with stress stemming from school, work, or at home. Stressors that contribute to smoking behaviours change over the life course; for example, one primary stressor that facilitates smoking behaviour in adult men is the transition to fatherhood. While some partners of new fathers permit or encourage smoking as a way to avoid adding further stress from smoking cessation to the home, this is inherently problematic as second-hand smoke can have significant health impacts for both the newborn and mother. Consequently, research on health promotion strategies for smoking cessation in new fathers should instead rely on an idea of masculinity that encourages accountability for oneself and responsibility for the safety and care of the family.

Smoking and Men's Reluctance to Seek Medical Help

Tobacco smoking poses a significant health risk in men particularly because men are less likely than woman to seek treatment for medical issues. Despite the fact that one in two men will receive a cancer diagnosis in their lifetime, research by the Agency for Healthcare Research and Quality (AHRQ) has found that men are 24% less likely than women to seek preventative healthcare. In addition to this, a report by the United States Department of Health and Human Services found that while 74% of women had contacted a doctor within the last six months, only 59% of men had done the same. In the context of smoking, this avoidance of preventative healthcare can directly affect men's health outcomes, given that lung and other cancers caused by smoking can often be treated if detected early.

Given the profound impact that reluctance to utilize healthcare can have on men's physical health, a significant amount of research has explored the reasoning behind this trend. In his analysis on constructions of masculinity and their impacts on health, Will Courtenay summarizes his understanding of this pattern of behaviour by stating:

"By dismissing their health care needs, men are constructing gender. When a man brags, "I haven't been to a doctor in years,'' he is simultaneously describing a health practice and situating himself in a masculine arena. Similarly, men are demonstrating dominant norms of masculinity when they refuse to take sick leave from work, when they insist that they need little sleep, and when they boast that drinking does not impair their driving. Men also construct masculinities by embracing risk. A man may define the degree of his masculinity, for example, by driving dangerously or performing risky sports -- and displaying these behaviours like badges of honor. In these ways, masculinities are defined against positive health behaviours and beliefs."

It is apparent from Courtenay's research that hegemonic masculinity, which relies on narratives that deride help-seeking behaviours as feminine and weak, is a major factor in men's healthcare avoidance. Such masculinities promote risk-taking behaviours like smoking or healthcare avoidance as being powerful and manly. Traditional masculinities also promote the idea that men are fully in control of their physical bodies; thus men may associate seeking help from a doctor as a form of submission to authority.

Masculinity and Smoking in Popular Culture

"Where there's a man, there's a Marlboro" ad.

"More Doctors Smoke Camels" Campaign

From 1946 to 1954, the R.J. Reynolds Tobacco Company ran the “More doctors smoke Camels” advertising campaign. Advertisements created for the campaign featured photos of white, male doctors adorned white coats and stethoscopes, posing with cigarettes and a charming smile. The ads portrayed the cigarette-smoking doctors as authoritative, knowledgeable, paternal figures. In effect, the smoking doctors evoked the image of an ideal man for others to strive for, as doctors are considered experts at the height of rationality. The campaign began to decline in 1953 following newfound medical awareness about the health risks of cigarette smoking.

The Marlboro Man

Following the discontinuation of the “More doctors smoke” campaign, companies looked to a new set of ideals to serve as the driving force of their smoking advertisements. In 1962, this was found in the Marlboro Man, a stoic cowboy archetype who exuded “masculine confidence”.  The Marlboro Man represented a sense of individualism in the American Cold War era, a time when many men feared their way of life being impeded by a communist rule. As such, this figure asserted cigarette smoking as a way for men to assert their masculinity and independence.

Stranger Things

A more recent example in media that ties masculinity and smoking is the character of Jim Hopper in the Netflix show Stranger Things. Jim is a police officer, and his character often exhibits traits of toxic masculinity, especially in the most recent third season. For example, he expresses his emotions very violently, often yelling and taking his anger out on his physical surroundings. The show takes place in the 1980s when smoking was very common, and his character is frequently shown smoking cigarettes as a means to calm down and collect himself. Research findings have shown that positive portrayals of smoking on-screen, such as in a powerful and "manly" character like Hopper, can have a negative influence on young viewers. As a result of this, Netflix has agreed to cut back on displaying smoking on-screen.