Global Perspective
Globally, smoking among women has primarily been driven by aggressive marketing employed by players in the tobacco industry. Carpenter, Connolly, Ayo-Yusuf, & Wayne (2013) notes marketing strategy employed by tobacco companies have mainly been anchored on the idea of emancipation. Images such as vitality, elegance, sophistication, and modernity are primarily used in marketing campaigns and materials. Besides, Samet & Yoon (2010) observes some companies have gone ahead to produce cigarettes that are solely targeted at women. Another risk factor among women smokers is friends and family members who do smoke. Samet & Yoon (2010) notes most women start smoking in their adolescent, when they are shaping their personality, and are most vulnerable. Moreover, Mathers & Loncar (2014) are of the view that having mothers who smoke will likely make their daughters smokers because of easy availability of cigarettes. Aside from that, MacFadyen, Hastings, & MacKintosh (2012) notes smoking among women has mainly been driven by ignorance. Many women smokers do not have the right information, while their perception of benefits derived from smoking also tends to be stronger (Mathers & Loncar, 2014). Hence, the urge to quit smoking is lower compared to the need to continue. However, Samet & Yoon (2010) notes most women smokers tend to stop during their pregnancy period. While these studies shows the prevalence of women smoking, it does little to show why women find it difficult to quit smoking, and whether this difficulty is unique to ladies.

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Smoking among women has almost similar effects to that in men. Some of these include; emphysema, chronic bronchitis, infertility and cardiovascular diseases as well as cancer (Benowitz, 2013). Also, Mathers & Loncar (2014) notes women smokers are also likely to face pregnancy and postpartum complications. Smoking increases the risk of developing certain types of cancers such as vulva cancer, ovarian cancer and colorectal cancer in women (Benowitz, 2013). While these studies make it clear that smoking among women has dangerous consequences, it does not show the prevalence of women smokers and why women smokers find it hard to quit smoking.

Regional Perspective
Cigarettes smoking among women in the Middle East is a practice that is much more concealed due to religious obligation. Azab, et al. (2012) notes Islam demands that its adherents watch their health. Smoking is seen as something that is ‘unladylike’ and which has a potential of ruining one’s reputation and make it difficult to find a husband (Mohammad & Kakah, 2012). However, this does not mean that women do not smoke. Those who smoke do so in a somewhat concealed manner. However, Chaaya, Jabbour, El-Roueiheb, & Chemaitelly (2013) notes shisha smoking is much more acceptable in the society, and there is widespread usage among women. In fact, Labib et al. (2013) note shisha smoking among women is widely accepted and even encouraged. Azab, et al. (2012) notes one of the factors that have encouraged shisha smoking is engraved within Arabic folklore. With that in mind, there is very little information about the health effects. In fact, Labib et al. (2013) note shisha smoking is seen as a safe form of smoking tobacco, and more often women will be spotted in public smoking. However, smoking has been linked to cardiovascular diseases such as high blood pressure, and cancers such as bladder cancer, pancreatic cancer, and esophageal carcinoma.

With regards to push factors, Azab et al. (2012) note social pressures play an essential role in encouraging women to start smoking. Besides, while the family plays a critical role in shaping behavior, Chaaya et al. (2013) are of the view family pressure against smoking is mostly lacking. Moreover, Labib et al. (2013) note anti-smoking campaigns appear to be primarily targeted at cigarettes, and hence a perception that shisha smoking is safe. Lastly Chaaya, et al (2013) do link smoking in the Arabic world to women empowerment. Women have always been subjugated, and anything seen as a privilege is likely to be quickly taken up and exploited as a way of celebrating newfound freedom. While these articles capture the issue of smoking among women, they do not give us a sense of prevalence of this problem. Besides, they do not give a sense in which women may find it difficult to quit smoking and therefore how hard it will be to implement intervention mechanism.

Saudi Arabia
In Saudi Arabia, about 5 percent of adult populations smoking either cigarettes or shisha are women (Al-Turki et al., 2012). At the same time, over half of all women smoking in Saudi Arabia do smoke cigarettes, while only about 43.2 percent of the women smoke shisha (Maziak, 2011). One of the key reasons that promote initiation of women into smoking is having a parent who is a smoker. This is a huge factor because the cigarettes become readily available. In the case of shisha, Maziak (2011) notes the society does not frown upon it, and mothers who smoke are likely to have a daughter also smoking. Imitation into smoking is as a result of peer pressure, though this forms a small portion of the population (Azab et al., 2012). However, it will be important to look at the relationships between parent smoking and daughters’ vulnerability. This was not explained in the studies. In Saudi Arabia, smoking has been associated with a number of diseases and death. As a result, since 2002, the government has been on the forefront to intensify programs aimed at controlling the number of people who smoke. These measures were later taken seriously in 2005 when the kingdom joined the WHO Framework Convention on Tobacco Control.

Quitting smoking has also not been successful among women. Jarallah et al. (2013) note that even though most of the countries of the Gulf, including Saudi Arabia have increased prices of tobacco products by up to 200 percent, the number of smokers has kept on rising. In the case of women in Saudi Arabia, Azab et al. (2012) note the broader exposures of foreign culture has been instrumental in the maintenance of smoking. Hence, there is a sense that smoking is one way of emancipating themselves and crafting an identity they can be proud of as women. However, on overall terms, it will still be important to find out why women find it difficult to quit smoking. The exposure to foreign culture may not be the only reason, considering Saudi Arabia is still a deeply conservative society.

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