The role of masculinities in shaping male smoking behaviour: A life course perspective
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INTRODUCTION: In many countries, smoking rates are higher among men than women, highlighting the importance of focusing on factors that influence smoking prevalence among men. In Indonesia, men’s smoking prevalence was more than ten times higher than women’s, and steep increases in prevalence have been observed among boys during adolescence. Aspects of masculinities may underpin their smoking behaviours, which may then persist throughout their life course. This thesis aimed to explore these masculinities related to smoking behaviours across men’s life-course. METHODS: A scoping review was undertaken to determine the main themes in the literature and identify gaps in the knowledge of the relation between masculinities and smoking behaviours to achieve the initial objective. Key life stages in the formation and changes of perspectives on masculinities and their relation to smoking were the focus of the following stages of the study. The second stage examined the importance of smoking-related beliefs among adolescents aged 12 to 16 years. This examination was conducted utilising data from the Global Youth Tobacco Survey and employing principal component analysis to combine items related to more conceptual and meaningful components. Two components were derived and analysed against five smoking outcomes using multivariate logistic regression. The third stage of the study focused on another important life stage for men that redefines their perceptions of masculinities. This stage explored the relationship between masculinities and smoking outcomes using data from the United Nations Multi-Country Study on Men and Violence. The relation between masculinities of men aged 18–49 years, represented by fatherhood, and smoking status and cigarettes smoked per day (CPD) was analysed by employing logistic regression and zero-inflated negative binomial regression. FINDINGS: The main themes identified in the scoping review were belief about masculine characteristics, external discouragement to smoke, external encouragement to smoke, psychological attachment, and the life maturation effect. However, a disproportionate number of studies were conducted in the Southeast Asia and Western Pacific regions, leaving gaps in understanding how masculinities relate to smoking behaviour in those contexts. In Indonesia, the smoking prevalence almost tripled between the ages of 12 and 16 years and the measures of beliefs that favour smoking tended to increase year on year. Smoking-related beliefs were linked to two components, perceived social benefits and perceived harms, associated with ix smoking in opposite ways and represent the masculine tendencies of risk-taking and risk minimisation. These tendencies are gradually reduced, which could be observed among some men, especially after they had children. As a result, some fathers smoked fewer cigarettes per day (CPD), especially when sharing the financial responsibility for their family equally with their spouse. CONCLUSIONS: Key aspects of masculinities that underpin men’s smoking behaviour were identified. The life maturation effect was a key aspect discussed in this thesis to portray the dynamic of masculinities across men’s life-course. During adolescence, boys having beliefs of perceived harms of smoking remain high even though the beliefs of social benefits continue to increase with age, suggesting that boys minimise the harms of tobacco. During adulthood, factors related to masculinities of fatherhood, such as the breadwinner role, occupation and shared income, had a significant association with men’s smoking status and CPD. When financial responsibility is considered a source of stress for men, sharing the financial family burden helps men smoke fewer CPD. Therefore, fatherhood offered a new perspective for examining the smoking problem among adult men, and the smoking prevention programme in Indonesia is worth exploring in the future.