Approximately 28% of all men and 22% of all women are current cigarette smokers. Factors that influence smoking initiation, addiction, and smoking cessation as well as the health consequences of smoking are generally similar in men and women.
Many women start to smoke as teenagers. Current figures indicate that, in 2000, about 30% of high school
senior girls have smoked in the past month. Reasons for starting to smoke include smoking for a calming and relaxing effect, smoking to lose weight, smoking as a social activity at parties or dinners, and smoking to increase alertness. According to the Centers for Disease Control, the prevalence of current smoking in women is associated with their educational level, poverty level, and racial/ethnic group. Women with 9-11 years of education smoke more cigarettes than women with 16 or more years of education (33% vs. 11%). Women living below the poverty level smoke more cigarettes than those living at or about the poverty level (30% vs. 22%). Lastly, in 1997-1998, the rates of smoking in the major racial/ethnic groups were as follows:
- American Indian or Alaskan Native—34.5%
- African American—21.9%
- Asian/Pacific Islander—11.2%
Two reasons that are often cited for the high rate of smoking in women include: (a) extensive, targeted marketing by the tobacco industry and (b) the addictive quality of nicotine. Since the 1920s, women have been extensively targeted in cigarette advertisements. Marketing efforts on television and in magazines generally presented the woman smoker as an independent, successful, stylish, and intelligent person. Also, regardless of the quantity of cigarettes smoked, smoking is addictive for many women. Nicotine appears to be the primary addictive agent in cigarette smoking. According to the American Lung Association, nicotine reaches the brain just 7 seconds after inhalation, causing a “high,” pleasurable or calming effect. However, nicotine is metabolized quickly; smokers soon need more and more nicotine in their system to get similar effects. Shortly after, average smokers are smoking 1-1- packs of cigarettes a day; they soon become addicted to nicotine and experience withdrawal symptoms when they try to stop smoking. (See Nicotine entry for more details about its addictive properties.)
Thirty years ago, the Surgeon General’s Office first reported on the bad health consequences of cigarette smoking. Since then, cigarette smoking has been associated with disease, disability, and death. According to recent estimates, one of every five deaths in the United States is smoking related. The leading causes of the approximately 430,000 smoking-related deaths each year are lung cancer, chronic obstructive pulmonary disease, and ischemic heart disease.
In his 2001 report, the Surgeon General writes “Clearly, smoking-related disease among women is a full-blown epidemic.” Complications of smoking include increased risk for stroke, other cardiovascular and respiratory diseases, and cancer of the mouth, pharynx, larynx, and esophagus. Women smokers also seem to have an increased risk for conception delay, infertility, ectopic pregnancy, spontaneous abortion, and preterm delivery. Clinical studies in both men and women have examined nicotine’s effect on the endocrine system. Several disorders that may be associated with cigarette smoking in women include menstrual dysfunction, early menopause, estrogen deficiency disorders, and osteoporosis.
Economically, an estimated $80 billion of total U.S. health care costs each year is attributable to smoking. This figure increases to $138 billion when additional costs from smoking-related fires, medical care costs from secondhand smoke, and care of babies born to smoking mothers are considered.
SMOKING DURING PREGNANCY
According to the 2001 Surgeon General’s Report on Women and Smoking, estimates of women smoking during pregnancy range from 12% to 22%. Smoking during pregnancy is associated with increased risk for preterm delivery and lower than average infant birth weight. Therefore, recommendations for pregnant smokers include: stop smoking throughout the pregnancy, obtain self-help materials from your physician/obstetrician, and participate in a stop-smoking program.
According to the National Institute on Drug Abuse, nearly 35 million people make a serious attempt to quit smoking each year. About 7% of those who try to quit on their own succeed, defined as being able to stop smoking for more than 1 year. Many smokers try to quit about 7-8 times before they are successful; these numbers mean that most persons return to smoking after a few days of attempting to quit. These high relapse rates
reflect nicotine addiction and the resultant difficulty in quitting smoking. Ex-smokers quickly experience mood changes, irritability, and cravings as they withdraw from nicotine. Also, withdrawal symptoms are usually worst during the first few days of abstinence.
Because of the physiological discomforts of nicotine withdrawal, there are numerous methods available that can assist smokers with their cessation efforts. The methods include: self-help materials (many of these can be obtained free from the National Cancer Institute or the American Lung Association), counseling (individual, group, and telephone), and pharmacotherapy. Unfortunately, many insurance companies do not provide coverage for these efforts to quit.
Most persons who try to quit smoking under the care of a physician are encouraged to use one or more of the available pharmacotherapies (although special medical circumstances such as pregnancy/breastfeeding may limit the physician’s recommendations). Firstline pharmacotherapy methods include nicotine replacement (gum, patch, inhaler, and nasal spray) and Bupropion SR (Zyban/Wellbutrin), which needs a prescription. These pharmacotherapies have been approved by the U.S. Food and Drug Administration (FDA) for their use for smoking cessation. Studies of Nicotine Replacement Therapy (NRT) and Bupropion SR indicate that these pharmacotherapies are also prescribed to alleviate depressive symptoms or to delay weight gain following smoking cessation.
In women, factors that are associated with success at smoking cessation include pregnancy, weight gain, and social support. Many women stop smoking during pregnancy. However, at least two thirds of women who stop smoking during pregnancy are smoking again by 12 months after delivery. Also, many women worry that they will gain weight if they quit smoking. Studies indicate that the majority of people who quit smoking do gain weight, but the health consequences of continuing to smoke far outweigh the consequences from the weight gain. Lastly, family and friends who support the smoker’s cessation effort help improve cessation rates.
Social attitudes toward cigarette smoking have changed dramatically over the last 30 years. According to the American Lung Association, smoking used to be thought of as “cool”; now it has become less socially acceptable. In fact, most states restrict smoking by law in public places, while many workplaces have no-smoking policies.
The 2001 Surgeon General’s Report on Women and Smoking concludes that what is needed to reduce smoking among women include the following:
- Increased awareness of the impact of smoking on women’s health
- Expose and counter the tobacco industry’s targeting of women
- Conduct further studies of the relationship between smoking and health outcomes
- Support efforts to reduce exposure to environmental tobacco smoke among women (see entry on Tobacco)