Since everyone already knows that smoking causes lung cancer and heart disease, what’s new about women and smoking?

What you may not know is that women, regardless of their age, can be harmed by smoking – smoking contributes to infertility, anxiety, blindness and osteoporosis, to name just a few of the many health consequences. Women who smoke during pregnancy not only endanger themselves, but their babies. Mothers who smoke around their children also put their kids’ health at risk.

The good news is that it’s never too late to join the ever-increasing ranks of healthy nonsmokers.

This issue brief will help you better understand why smoking is particularly bad for women, how women have been persuaded to smoke, and, if you or someone you care about smoke, help you find resources to quit.

The Beginning: Girls and Smoking
Smoking is a habit that almost always begins in youth -- usually before age 16. If a teen graduates from high school without ever smoking regularly, he or she probably never will.

Over the last 30 years, the percentage of teens that smoke has decreased, increased, and then decreased again. For example, 40% of high school senior girls were current smokers in 1977, decreasing to 26% in 1992, increasing to 35% in 1997, and then decreasing to 21% in 2002.

The bad news is that while boys and girls are equally likely to start smoking, the health implications for girls and women are worse. Symptoms of addiction can appear in young people within days or weeks after smoking first begins, well before daily smoking has started. The Surgeon General’s 2001 Report on Women and Smoking concludes that young women ages 18 to 24 were more likely than young men to report that they experienced symptoms of nicotine dependence.

Targeting Girls and Women
While girls and boys today have roughly equal chances of becoming smokers, this “equality” is a fairly recent phenomenon, and it didn’t happen by chance. At the start of the 20th century, female smokers were rare. Smoking was equated with poor character, low social status, and prostitution. In fact, the stigma of women smoking was so great that that Congress considered banning women from smoking in the District of Columbia in 1921.

In 1928, George Washington Hill, president of American Tobacco, said that persuading women to smoke “will be like opening a new gold mine in our front yard.'' American Tobacco targeted women with its “Instead of a sweet, reach for a smoke” advertising campaign. It worked. Rates of female smokers soared.

The introduction of “women’s cigarettes” in the late 1960s and early 1970s coincided with sharp increases in the number of girls aged 12-17 who began smoking, according to the Surgeon General’s report. Virginia Slims successfully capitalized on the burgeoning women’s movement with its slogan “You’ve come a long way, baby.” Between 1967 and 1973, smoking rates more than doubled among 12-year-old girls.
Cigarette marketers target girls in several ways. In addition to depicting women smokers as beautiful, independent and fun, cigarette ads continue to send the subliminal message that smoking helps a girl keep her weight down, just as it did in the 1920s. Marketing cigarettes as “slims” or “thins” subtly reminds girls and women that smoking will help control weight. One study found that girls who dieted more than once per week were four times as likely to become smokers.

Although cigarette ads are prohibited in children’s or teen magazines, billions of dollars are spent on ads in TV Guide, Rolling Stone, Sports Illustrated, and many other magazines that are widely read by children and teenagers. For example, one survey found that cigarette companies advertise heavily in magazines with large youth readerships, such as People magazine. Though technically aimed at adults, 35% of People’s readers are teens.

Women and Smoking
Today, 21% of adult women in the U.S. smoke, compared to 26% of men -- but this gender difference is closing. Women’s health shows the results. Since 1987, lung cancer has surpassed breast cancer as the leading cause of cancer deaths among women in the United States. Smoking is directly responsible for 87% of all lung cancer cases in America each year.

Smoking causes heart disease – the #1 killer of women in the U.S. Smoking causes or contributes to chronic respiratory diseases such as emphysema and chronic bronchitis, and many kinds of cancer. It also increases the chances of stroke, blindness, early menopause, osteoporosis and infertility.

Smoking affects how you look and feel
Smoking also can harm a woman’s appearance and mental health. Smokers have more facial wrinkles, gum disease, dental decay, and halitosis (bad breath). The Surgeon General’s Report concluded that smokers are more likely to be depressed than nonsmokers, and that women with anxiety disorders are more likely to smoke.

Do women smoke because they are anxious or does smoking increase anxiety? Many smokers believe that smoking is relaxing, but recent research indicates that smoking tends to increase a young woman’s stress level rather than reducing it. One reason is that smoking can impair respiration, which can contribute to panic attacks. Nicotine itself increases feelings of anxiety, but can trick the smoker into believing that smoking is relaxing. In fact, addiction to nicotine causes stress, which is then alleviated by smoking. Although anxiety temporarily increases when an individual stops smoking, a few weeks later her anxiety level will be lower than it was when she was smoking.

Smoking and Pregnancy
Sadly, many women continue to smoke during pregnancy, despite known, widely publicized hazards to both the smoker and the fetus. The best estimates available indicate that between 12 -20% of pregnant women and girls smoke cigarettes. The carbon monoxide from tobacco use can reduce the amount of oxygen for the developing fetus and nicotine can reduce blood flow to the uterus. Pregnant women who smoke are more likely to experience life-threatening complications of pregnancy, such as a pregnancy that implants in the fallopian tube instead of the uterus, and premature labor. The Surgeon General’s Report on Women and Smoking concludes that 10% of all infant deaths during pregnancy are linked to smoking. Pregnant women who smoke also increase the risk to their fetus for stillbirth, low birth weight, premature birth, and sudden infant death syndrome (SIDS).

WOMEN’S AND GIRLS’ ORGANIZATIONS AND SMOKING
The increased attention to the special risks of smoking for women has resulted in a number of projects that focus on supporting tobacco cessation efforts specifically for women. Many of these efforts are being conducted by women’s organizations, some of whom had not focused on this issue in the past. Here are a few noteworthy examples:

References:

Amos, A and Haglund, M., “From social taboo to "torch of freedom": the marketing of cigarettes to women,” Tobacco Control. 2000 Mar;9(1):3-8.

Austin, S., Gortmaker, S. “Dieting and Smoking Initiation in Early Adolescent Girls and Boys: A Prospective Study,” American Journal of Public Health 2001; 91:446-450.

Centers for Disease Control, State-Specific Prevalence of Current Cigarette Smoking Among Adults -United States, 2002, MMWR January 9, 2004 / Vol. 52 / No. 53

Centers for Disease Control, Tobacco Use among Middle and High School Students - United States, 2002 MMWR Highlights November 14, 2003 / Vol. 52 / No. 45

DiFranza, J. R. et al, “Initial Symptoms of Nicotine Dependence in Adolescents,” Tobacco Control 9: 313-19 (September 2000)

Johnson, J et al, “Association Between Cigarette Smoking and Anxiety Disorders During Adolescence and Early Adulthood” Journal of the American Medical Association. November 8, 2000, Vol 284, No. 18, 2348-2351

Martin JA, Hamilton BE, Ventura SJ, Menacker F and Park MM. (2001) Births: Final data for 2000. National Vital Statistics Reports, 50(5), 11-12.

National Tobacco-advertising Telephone Survey of Teens and Adults. Tobacco-Free Kids, 2000.

Women and Smoking: a Report of the Surgeon General. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Office of the Surgeon General; Washington, D.C. 2001

 

Benefits of Quitting Here are just 10 of the many health benefits that start the day you stop. 1. You are less likely to become blind. If you stop smoking, you will be less likely to ever develop cataracts, a major cause of blindness. Quitting may also decrease your risk of macular degeneration, another frequent cause of blindness. 2. You’ll live longer -- much longer! Women who die of a smoking-related disease lose, on average, 14.5 years of life. Women who stop smoking can get many of those years back – improving the chances that you will live to enjoy your grandchildren and even great grandchildren. 3. Less likely to have a stroke. Heavy smokers (2 packs a day or more) are twice as likely to have a stroke as light smokers (half a pack a day). That means that even if you have trouble quitting, reducing the number of cigarettes could save your life. 4. Less likely to have a heart attack. Women who smoke are more than twice as likely as other women to have a heart attack. Your risk of having a heart attack increases with the number of cigarettes you smoked, so stopping today makes a difference. 5. Less likely to die from lung cancer. You knew this, but did you know that lung cancer kills more women than any other cancer -- and that almost nine out of ten of these deaths are linked to smoking? The numbers of women dying of lung cancer have increased by 600% since 1950, as the number of women smokers has increased. The sooner you stop smoking, the less likely you are to get lung cancer. 6. Your spouse and your children will be less likely to die from lung cancer or heart disease. If you think you’re the only one who benefits from your quitting, think again. Environmental tobacco smoke kills spouses and children by increasing their risk of lung cancer and heart disease even if they never smoked. Your quitting can save their lives. 7. Fewer wrinkles. The Surgeon General doesn’t usually talk about wrinkles, but his report on women and smoking concludes that smokers have more facial wrinkles. 8. You may cheer up and relax. You might think that smoking is relaxing, but think again. Research shows that women who smoke are more depressed and more anxious. Adolescents who smoke are more likely to have phobias or be anxious as adults. So, quitting may make you happier as well as healthier. 9. Save money. Think of all the money you’ll save by giving up smoking. A good strategy is to put aside the money you save every day, and use it to buy something special to reward yourself for quitting. (Don’t wait too long-- rewards every few days or every week will help you maintain your will power.) 10. Save your baby. Women who want to have a baby have even more reasons to quit. Women who smoke are more likely to have a stillborn child or an infant who dies from Sudden Infant Death Syndrome (SIDS). Quitting will increase the amount of oxygen your baby will get, increase the chance your baby’s lungs will work well, have fewer asthma and wheezing problems, and improve your baby’s chances of being born healthy, instead of too early.

Resources:

The American Cancer Society (www.cancer.org) offers information about women and smoking and free brochures you can order by phone or online.

The American Legacy Foundation (www.americanlegacy.org) is the national, independent public health foundation established as a result of the 1998 tobacco settlement. Circle of Friends (www.join-the-circle.org) is their program to support women who are trying to quit smoking and to highlight the toll of tobacco-related disease on American women. Great Start (www.americanlegacy.org/greatstart) is their national campaign aimed at helping expectant mothers quit smoking. Through the toll-free quitline (1-866-66-START) pregnant smokers can receive free telephone counseling sessions in English or Spanish.

Asian Pacific Partners for Empowerment and Leadership (www.appealforcommunities.org) is a national network of organizations and individuals working towards tobacco-free Asian American and Pacific Islander (AA/PI) communities. Its "Creating New Mountains Tobacco Control Leadership Program" specifically addresses diverse tobacco control issues for AA/PI communities.

The Asian and Pacific Islander Tobacco Education Network (www.apiahf.org/programs/apiten/index.htm) has many resources, including quitline services in various languages spoken in AA/PI communities.

Black Women's Health Imperative (www.blackwomenshealth.org) works for the improved health status of African American women. Their website has information on smoking; go to the organization's home page , click on "Search," and type in "smoking."

California African American Tobacco Education Network (www.cbhn.org/CTEP.html), part of the California Black Health Network, has a list of celebrities who have died from smoking related illnesses, features a cessation program of the month and lots of other interesting information and links.

Campaign for Tobacco Free Kids (www.tobaccofreekids.org) maintains fact sheets on various topics relating to girls and smoking, and links to national campaigns to prevent youth from starting to use tobacco.

The Center for Disease Control has a website section in Spanish (www.cdc.gov/tobacco/SpanishSplash.htm), devoted to inform Spanish-speaking individuals about smoking and quitting. It also has many links to quitting resources geared toward this specific group.

Freedom From Smoking® Online (www.lungusa.org/ffs/) is a popular online cessation clinic. The program is based on the American Lung Association's Freedom From Smoking®. The online clinic can be accessed day or night, seven days a week.

The National Alliance for Hispanic Health (www.hispanichealth.org/) provides health information (in English and Spanish) particularly pertaining to the Hispanic population. It also supports a helpline called "Su Familia," 1-866-Su-Familia (1-866-783-2645).

The National Partnership to Help Pregnant Smokers Quit (http://helppregnantsmokersquit.org) is a coalition of diverse organizations that have joined forces to increase the number of pregnant smokers who quit smoking. The Partnership's website includes information on smoking cessation for women and their health care providers, e-cards to send to pregnant women to reinforce their attempts to quit smoking, and legislative and policy goals and objectives.

The National Women's Health Information Center (www.4woman.gov) is a service of the Office on Women's Health in the Department of Health and Human Services. The site can help you link to, read, and download a wide variety of women's health-related material developed by the Department of Health and Human Services, other Federal agencies, and private sector resources.

The Office of the Surgeon General (www.surgeongeneral.gov/tobacco/default.htm) provides a variety of information on smoking, including recent public health press releases and statements, and free downloadable toolkits for smokers. Many resources are in both English and Spanish. There is also a section of clinician materials useful for health professionals. The Surgeon General’s 2001 report on Women and Smoking can be found at www.surgeongeneral.gov/library/womenandtobacco/.

Smokefree.gov is intended to help you or someone you care about quit smoking. You can get immediate assistance in the form of an online step-by-step cessation guide, local and state telephone quitlines, National Cancer Institute's national telephone quitline, National Cancer Institute's instant messaging service, and publications that may be downloaded or ordered.

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