{
  "abstract": "Background Although female smoking prevalence in China remains low, emerging evidence suggests that social acceptance may be increasing, with tobacco marketing increasingly targeting women. This study explored women’s smoking behaviours, motivations and societal perceptions toward this in urban China.Methods Between May and October 2019, 28 semistructured focus groups were conducted in Beijing, Changsha and Shenzhen with 288 participants: 12 groups of female smokers, 6 of female former smokers, 6 of female never-smokers and 4 of men. Participants were recruited both online and offline, and smoking status was verified with a carbon monoxide monitor. Discussions were transcribed verbatim and analysed thematically using dual coding.Results Four themes emerged. First, while stigma against female smoking persisted, social acceptance is growing, especially among younger generation. Second, three initiation stages were identified: adolescence, early career and post-retirement, often triggered by peer influence, occupational stress and life transitions. Third, many female smokers concealed their behaviour, reflecting tension between shifting descriptive norms and enduring injunctive norms, which may contribute to underreporting in surveillance data. Fourth, misconceptions about smoking harms and quitting were common, with most women who smoke relying on willpower and showing limited interest in cessation support; pregnancy was one of the few strong motivators for quitting.Conclusions Findings suggest gradual normalisation of female smoking in urban China, driven by evolving gender roles and targeted marketing. Public health responses should prioritise gender-specific health education, strengthen promotion of cessation services and tighten restrictions on tobacco marketing towards women to prevent future increases in female smoking.",
  "authors": [
    {
      "affiliations": [
        "Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China",
        "School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Xiaoyun Xie"
    },
    {
      "affiliations": [
        "Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China"
      ],
      "name": "Xinbo Di"
    },
    {
      "affiliations": [
        "West Pacific Region, World Health Organization, Manila, Philippine"
      ],
      "name": "Xi Yin"
    },
    {
      "affiliations": [
        "School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Wanjia He"
    },
    {
      "affiliations": [
        "School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Sophia Siu Chee Chan"
    },
    {
      "affiliations": [
        "Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China"
      ],
      "name": "Lin Xiao"
    }
  ],
  "title": "Understanding female smoking in urban China: motivations, stigma and shifting social norms—a qualitative focus group study",
  "uid": "2865c9b2-5338-5b00-bf7a-aaa8f3683098"
}