{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:54:56Z","timestamp":1793397296360,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"name":"WHO","award":["WPCHN1814405"],"award-info":[{"award-number":["WPCHN1814405"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,6]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2019s smoking behaviours, motivations and societal perceptions toward this in urban China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110684","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:30:23Z","timestamp":1769772623000},"page":"e110684","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Understanding female smoking in urban China: motivations, stigma and shifting social norms\u2014a qualitative focus group study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3189-5583","authenticated-orcid":false,"given":"Xiaoyun","family":"Xie","sequence":"first","affiliation":[{"name":"Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China"},{"name":"School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinbo","family":"Di","sequence":"additional","affiliation":[{"name":"Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Yin","sequence":"additional","affiliation":[{"name":"West Pacific Region, World Health Organization, Manila, Philippine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanjia","family":"He","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6349-3717","authenticated-orcid":false,"given":"Sophia Siu Chee","family":"Chan","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Xiao","sequence":"additional","affiliation":[{"name":"Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026013003301601000_16.1.e110684.1","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"397","author":"Reitsma","year":"2021","journal-title":"The Lancet"},{"key":"2026013003301601000_16.1.e110684.2","unstructured":"National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health . The health consequences of smoking\u201450 years of progress: a report of the surgeon general. 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