Factors Associated with Smoking Among Women in Hong Kong: Findings from an Updated Literature Review and a Historical Population-Based Survey

Background: Although overall smoking prevalence has declined in Hong Kong Special Administrative Region (SAR), China, smoking among women has not decreased and has slightly increased. This study examined factors associated with women’s smoking using survey data and a literature review. Methods: Literature published through February 14, 2025 was reviewed. Survey data came from a population-based telephone survey conducted in 2011–2012 among women aged 15–64 years in Hong Kong, China. Among 3,044 respondents, 503 were current smokers, 509 ex-smokers, and 2,032 non-smokers. Multivariable logistic regression was used to assess associations of smoking status with sociodemographic characteristics, smoking-related knowledge and attitudes, and health behaviors. Results: Current smoking was associated with perceiving smoking as acceptable for women (OR [95% CI], 5.59 [3.81, 8.20]), believing smoking reduces stress (6.64 [4.46, 9.89]), and alcohol use (1.95 [1.57, 2.41]), whereas non-smoking was associated with greater awareness of smoking-related harms (6.53 [4.22, 10.10]). The review also identified behavioral, psychological, gender-related, structural, and environmental influences which aligns with the findings of the survey. . Conclusion: Women’s smoking in Hong Kong appears to be shaped by gender norms, perceived stress-relief benefits, and clustered risk behaviors rather than by knowledge alone. Gender-specific smoking risks communication and targeted tobacco control campaigns are needed.