WELCOME

Introduction

Asthma

Cancer

Diabetes

Heart disease
and Stroke

Obesity

Nutrition

Physical
Activity

Tobacco
Use

Appendixes

Tobacco Use

Tobacco use is women’s public enemy No. 1.  It is the single most preventable cause of death and disease, resulting in more than 440,000 premature deaths annually in the United States.  Women now account for 39 percent of all smoking-related deaths each year in the United States, a proportion that has more than doubled since 1965.  Since 1980, nearly three million U.S. women have died prematurely from smoking.¹ 

Smoking can cause chronic lung disease, coronary heart disease, and stroke, as well as cancer of the lungs, larynx, esophagus, mouth, and bladder.  In addition, smoking contributes to cancer of the cervix, pancreas, and kidneys.²

As shown in the map Current Smoking Status of Women, current smoking rates among women ages 18 through 44 years vary greatly by State and by region. The highest rates of current smoking occur in Kentucky (34.4 percent) and West Virginia (34.1 percent). Utah has the lowest rate, 13.3 percent.

Cigarette smoking is a habit that greatly increases a woman’s chances of developing cardiovascular disease. Smoking by women causes almost as many deaths from heart disease as from lung cancer.

A woman who smokes is two to six times more likely to suffer a heart attack than a nonsmoking woman. The risk increases with the number of cigarettes smoked each day. Smoking also boosts the risk of stroke.

Smoking cessation also has benefits for reducing chronic lung conditions, including asthma, cancer, and chronic obstructive pulmonary disease.  Women who quit smoking actually reap greater benefits to their lungs than men.³

The consequences of secondhand smoke affect women as well.  A known human carcinogen, secondhand smoke is responsible for some 3,000 lung cancer deaths annually in nonsmokers and an estimated 35,000 deaths annually from cardiovascular disease. Current cigarette smoking among black and white females has declined since the late 1980s.  However, younger Hispanic and Asian American women have made little progress in reducing consumption or have actually increased it.⁴ 

As the chart Percent of Women Ages 18 and Older by Race/Ethnicity Who Currently Smoke shows, current rates ranged from a low of 10 percent for Asian/Pacific Islander women to a high of 32 percent of American Indian/Alaska Native women.  Rates vary widely by reservation, with the northern Plains States reporting the highest (43 percent of American Indian women). Rates also vary by age, income, and education, with higher socioeconomic status associated with lower rates within racial/ethnic groups.⁴   (For more information on women and smoking by racial/ethnic groups, click here.)

Efforts to promote smoking cessation have the potential to prevent substantial death and illness in the U.S. population as a whole and in women of all ages:

	One year after quitting, a person’s additional risk of heart disease is reduced by half.
	After 15 years this risk equals that of a person who never smoked.

Within 10 years of quitting smoking, a former smoker’s risk of developing lung cancer is 30 to 50 percent below that of a current smoker. The benefits are even greater for individuals who quit smoking before the age of 50. Their risk of dying in the next 15 years is half that of a person who smokes.⁵

The key solutions for preventing and reducing smoking among women include:¹

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 1 or 2 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 United States.

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.

Underlying the promise of Steps to Healthier Women is this premise:  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.

Steps to Healthier Women – Tobacco Use

Effective and comprehensive tobacco prevention and reduction efforts are both individual and population based.  The goals are to prevent women from starting to use tobacco, helping women quit using tobacco, reducing exposure to secondhand smoke, and identifying and eliminating disparities in tobacco use among population groups.  These specific elements are essential:

	Policy and regulatory strategies
	Community participation
	Public and private partnerships
	Strategic use of media
	Development of local programs
	Coordination of statewide and local activities
	Linkage of school-based activities to community activities
	Use of data collection and evaluation techniques to monitor program impact

Tobacco Use During Pregnancy

Increasing smoking cessation during pregnancy is an objective with substantial health and economic benefits:  Reducing smoking prevalence among pregnant women by one percentage point over 7 years would prevent 57,200 low birth weight deliveries and save $572 million.⁶

	Women who smoke have increased risks for conception delay and for both primary and secondary infertility.
	Women who smoke may have a modest increase in risks for ectopic pregnancy and spontaneous abortion.
	The risk for both stillbirth and neonatal deaths and the risk for sudden infant death syndrome (SIDS) are increased among the offspring of women who smoke during pregnancy.
	Infants born to women who smoke during pregnancy have a lower average birth weight and are more likely to be small for gestational age than are infants born to women who do not smoke.
	Women smokers are less likely to breastfeed their infants than are women nonsmokers.

Women who quit smoking before or during pregnancy reduce the risk for adverse reproductive outcomes, including conception delay, infertility, preterm premature rupture of membranes, preterm delivery, and low birth weight.

Adverse effects of secondhand smoke on children include respiratory infections such as bronchitis and pneumonia, increased prevalence of fluid in the middle ear, reduced lung function, increased frequency and severity of symptoms in asthmatic children, and increased risk for asthma in children with no previous symptoms.