April 4, 2001

Smoking-related illness among women and teen-age girls is "a full-blown epidemic," and women now account for 39 percent of all smoking-related deaths each year in the United States, according to the surgeon general.

INTELIHEALTH FEATURE -

Smoking-related illness among women and teen-age girls is "a full-blown epidemic," and women now account for 39 percent of all smoking-related deaths each year in the United States, according to the surgeon general.

In releasing the federal government's first report on women and smoking since 1980, Surgeon General David Satcher, M.D., Ph.D., called for cooperative efforts by women's and girls' organizations, women's magazines, state governments, researchers, doctors and others to "deglamorize and discourage tobacco use."

Since 1980, about 3 million U.S. women have died prematurely from smoking-related illnesses and cigarette-caused burns, according to the report. Lung cancer is the leading cause of female cancer deaths in the United States and accounts for 25 percent of all cancer deaths in women, the report states.

"We know more than enough to prevent and reduce tobacco use," Dr. Satcher said at a news conference in Washington, D.C. "Now we must commit the attention and resources to translate this knowledge into action to save women's lives."

Among the possible models for action, the report cites a comprehensive antismoking campaign in California that between 1988 and 1997 helped to reduce the incidence of lung cancer among women by 4.8 percent at the same time the rate in other regions increased by 13.2 percent. More such statewide programs should be implemented, the report states.

JoAnn Manson, M.D., a professor of medicine at Harvard Medical School who is an investigator in several major women's health studies, said she welcomed the report.

"I definitely think it's an important report because it aggregates the evidence, and the evidence is overwhelming," said Dr. Manson, who is chief of preventive medicine at Brigham and Women's Hospital in Boston.

"I do believe that smoking needs to be deglamorized," she added. "That appears to be one of the most important ways to reduce smoking among adolescents." She said it can be helpful for teen-age peers and for celebrities, particularly those popular with young people, to speak against smoking.

Secretary of Health and Human Services Tommy Thompson emphasized the same theme. "We must begin this battle in schools before girls even begin to smoke, and we must share with teen-age girls that smoking is not only harmful, but it is not glamorous," he said at the news conference. "Society must not glorify smoking."

Adding a touch of glamour to the antismoking cause, model Christy Turlington appeared with Dr. Satcher and Thompson and told the story of her own teen-age addiction to tobacco and how she overcame it.

The new report, prepared by the U.S. Centers for Disease Control and Prevention, summarized the statistical trends in smoking among women and girls and the demonstrated effects of smoking on women's health.

The findings include:

• The once-wide smoking gender gap between men and women narrowed to only about 5 percentage points by the mid-1980s. In 1998, 22 percent of women and 26.4 percent of men called themselves smokers.



• Among teen-agers, the gender gap is even narrower. The percentage of high school senior girls who said they had smoked in the past month dropped to a low of 25.8 percent in 1992 but rebounded to 35.3 percent in 1997, before dropping to 29.7 percent in 2000. The same survey, from the University of Michigan, found that 32.8 percent of senior boys were smokers.



• Smoking prevalence is almost three times higher among women with nine to 11 years of education (32.9 percent) than among those with 16 years or more (11.2 percent).



• Women who smoke face an increased risk of not only lung cancer but also coronary heart disease, stroke, abdominal aortic aneurysm, chronic obstructive pulmonary disease and cancers of the cervix, bladder, upper throat and tongue.



• Smoking also produces several other harmful effects that particularly affect women. Women who smoke have greater rates of infertility and other problems in conception, and if they smoke during pregnancy they face an increased risk of numerous complications for themselves and their babies. After menopause, women who smoke have less bone density and an increased risk of hip fractures compared with women who do not smoke.

Citing the effects on fertility and bone density, Dr. Manson from Harvard said, "In many ways women are even more susceptible than men to health risks from tobacco."

She said doctors, including pediatricians, should make a point of specifically urging patients to avoid smoking or quit smoking. "There's evidence that a physician telling patients that it's tremendously important for them to quit smoking can be effective," she said.