Surgeon General Reports on Smoking and Women and Girls

Women now account for 39% of all smoking-related deaths each year in the United States, a proportion that has more than doubled since 1965, according to a report on women and smoking released today by Surgeon General David Satcher, MD, PhD.

The report concludes the increased likelihood of lung cancer, cardiovascular disease, and reproductive health problems among female smokers makes tobacco use a serious women's health issue.

Meanwhile, increased marketing by tobacco companies has stalled progress in smoking cessation by women, and recent increases in smoking among teenage girls threaten to wipe out any progress that has been made in the last few decades, he noted.

"In the early decades smoking prevalence was more prominent among men, and it took nearly 25 years before the gap narrowed and smoking became commonplace among women," General Satcher said. "Women not only share the same health risk as men, but are also faced with health consequences that are unique to women, including pregnancy complications, problems with menstrual function, and cervical cancer."

Women and Smoking: A Report of the Surgeon General summarizes patterns of tobacco use among women, factors associated with starting and continuing to smoke, the health consequences of smoking, tobacco marketing targeted at women, and cessation and prevention interventions.

"Smoking is a critical women's health issue that must be addressed on all fronts," HHS Secretary Tommy G. Thompson said. "We must begin this battle in schools before girls even begin to smoke, and we must share with teenage girls that smoking is not only harmful, but it is not glamorous. Society must not glorify smoking."

"In addition, we must provide information to women and minority groups detailing the harmful affects of smoking as well as the benefits of smoking cessation. The facts are clear: smoking significantly reduces life expectancy and hampers quality of life," said Secretary Thompson.

Since 1980, nearly 3 million U.S. women have died prematurely from smoking. The new report calls for stronger national and local efforts, particularly from women's groups, to push for the implementation of proven solutions to reduce and prevent tobacco use among women and girls.

The report calls for increasing public awareness of the devastating impact of smoking on women's health; exposing and countering the tobacco industry's targeting of women; encouraging public health policymakers, educators, medical professionals, and women's organizations to work for policies and programs that deglamorize and discourage tobacco use; reducing disparities related to tobacco use and its health effects among different ethnic/racial populations; decreasing nonsmokers' exposure to environmental tobacco smoke; and mounting comprehensive statewide tobacco control programs proven to be effective in reducing and preventing tobacco use.

Developed by HHS' Centers for Disease Control and Prevention (CDC) to document the impact of smoking on women's health in the U.S., the report also provides analyses of the global impact of smoking on women.

"We estimate that smoking prevalence among women varies markedly worldwide from as low as 7% in developing countries to 24% in developed countries," CDC Director Jeffrey P. Koplan, MD, said. "The rise in smoking among women around the world has coincided with aggressive Western-style tobacco advertising. One of the most common themes used in developing countries is that smoking is both a passport to and a symbol of a woman's emancipation, independence, and success."

Koplan added, "We have firm evidence of a direct association between tobacco marketing and smoking prevalence. Earlier this month, the Federal Trade Commission reported that cigarette companies spent $8.24 billion on advertising and promotions in 1999 in the United States, a 22.3 percent increase from the $6.73 billion spent in 1998. Fortunately, we have proven science-based evidence that counter-marketing strategies can be a powerful tool to change social norms. The CDC is committed to working globally to create a broad framework to curb the global epidemic of tobacco-related disease, particularly as it relates to women and young people."

The report outlines key solutions for preventing and reducing smoking among women, including:

Encouraging quitting for women of all ages.
Quitting results in immediate health benefits for both light and heavy smokers, including improvements in breathing and circulation. The excess risk of coronary heart disease is substantially reduced after one or two years of smoking cessation. The increased risk for stroke associated with smoking is reversible after quitting smoking. When smokers quit, their lungs begin to heal and their risk of lung disease drops. Smoking cessation also improves quality of life and physical functioning.

Implementing science-based smoking cessation interventions into widespread clinical practice.
This action would be as cost-effective as other medical interventions such as mammography and treatment of high blood pressure.

Enacting comprehensive statewide tobacco control programs.
Results from states such as Arizona, California, Florida, Maine, Massachusetts, and Oregon show that science-based tobacco control programs have successfully reduced smoking rates among women and girls. California is now starting to observe the dramatic public health benefits of its sustained efforts. Between 1988 and 1997, the incidence rate of lung cancer among women declined by 4.8 percent in California but increased by 13.2 percent in other regions of the U.S.

Encouraging a more vocal constituency on issues related to women and smoking.
Concerted efforts are needed from women's and girls' organizations, women's magazines, public health policymakers, medical groups, and volunteer organizations to call public attention to lung cancer and other smoking-related diseases among women, and to call for policies and programs that deglamorize and discourage tobacco use. This effort should draw from the success of advocacy campaigns to reduce breast cancer.

"Despite the overwhelming evidence of effective tobacco use intervention strategies, we clearly have a long way to go to meet our public health objectives of cutting smoking in half among women and girls," General Satcher said. "We know more than enough to prevent and reduce tobacco use. Now we must commit the attention and resources to translate this knowledge into action to save women's lives."

A full copy of Women and Smoking: A Report of the Surgeon General and other related information is available through the CDC's Web site. A special consumer-focused section on quitting smoking is now available on the National Women's Health Information Center Web site at, http://www.4woman.gov, sponsored by the HHS Office on Women's Health.