Stigma toward female smokers: gendered perceptions and moral judgment

Background This study explores the gendered perceptions surrounding female smoking in Saudi Arabia, where tobacco use is shaped not only by health concerns but also by deeply rooted social norms. Methods Employing a qualitative approach, the study draws on semi-structured interviews with 35 Saudi adults (20 women and 15 men), aged 18 and older. Results Thematic analysis revealed a clear gendered double standard in smoking-related stigma. Women’s smoking was judged more harshly than men’s and was often interpreted as a violation of femininity, modesty, moral propriety, and family reputation. Participants also linked female smoking to poor upbringing, emotional instability, and failure to meet expected reproductive or caregiving roles. In contrast, men’s smoking was largely normalised, and at times associated with masculinity, despite its recognised health risks. Viewed through gender role, patriarchal, and social control perspectives, these findings show how smoking stigma functions not only as health-related disapproval but also as a mechanism for regulating women’s behaviour and reinforcing gendered expectations. Conclusions The findings show that smoking is a socially regulated practice in Saudi Arabia, particularly for women. Tobacco control strategies should therefore be gender-sensitive, non-moralising, and culturally informed. Public health efforts should frame smoking as a health issue, avoid reinforcing gender stereotypes, and provide confidential cessation support, especially for women who may fear social judgment. Addressing these gendered double standards is important for reducing stigma and promoting more equitable health outcomes.