Did cigarette vouchers increase female smokers in China?

From 1960 to 1980, a voucher was required to purchase cigarettes in China. The Chinese government issued vouchers to ration cigarettes, without informing its citizens that smoking was unhealthy. These vouchers were available to all adults, and allowed them to purchase specified numbers of cigarettes. As a result, a number of nonsmokers started smoking during the voucher period.

This study included 229 female and 1165 male smokers from the China Health and Nutrition Survey 1989-2006, which provides the year in which each respondent began smoking. The percentages of male and female smokers who started smoking during the voucher period were compared using the chi-square test. Logistic regression analysis was used to study the relative risk of smoking initiation by women during the voucher period, while adjusting for confounding variables.

During the voucher period, 46% of female smokers and 39% of male smokers started smoking (p=0.05). Women who did not have a regular job or were less educated were more likely to start smoking. The relative risk of female smokers to have initiated smoking during the voucher period was 4.75, with a p<0.01 in the logistic regression.

China's policy of issuing vouchers to ration tobacco consumption had the unintended consequence of encouraging smoking, particularly among women. Issuing cigarette vouchers to every adult, combined with the inexpensive prices of cigarettes, led more women to initiate smoking. Women with low SES were particularly likely to initiate smoking.