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Smoking Among Women

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One of the largest public health opportunities available to governments in the 21st century is to prevent an increase in smoking among women in low- and middle-income countries.

Percentage of adult females who smoke daily, age ≥15, 2013

Approximately 176 million adult women worldwide are daily smokers. Smoking rates in women significantly decreased from 1980 to 2013 in several high-income countries. However, smoking among women is still more common in high-income than in low- and middle-income countries. In Oceania and Europe, smoking rates in women significantly decreased from 1980 to 2013 in several countries, including Australia, New Zealand, the United Kingdom, Ireland, the Netherlands, and the Nordic countries. Nevertheless, several other countries in those continents have shown little decline or even an increase in smoking rates in women. Female smoking rates in several North American countries dropped by 50% or more from 1980 to 2013, but the rates showed no significant change in most South American countries in the same period.

Although smokeless tobacco use by south Asian women is relatively common (See Smokeless Tobacco), female cigarette smoking in most Asian and African countries is traditionally uncommon. Furthermore, smoking rates decreased in several Asian and African countries from 1980 to 2013. However, appropriate tobacco control programs must be in place to prevent an increase in smoking rates among women in the future to ensure that low- and middle-income countries will not follow the pattern of the global smoking epidemic. In this model, first the male smoking prevalence substantially increases, and over the following 3¬–5 decades smoking rates increase among women. The example of Japan shows that this second stage of the epidemic (the increase in female smoking prevalence) is not inevitable.

Tobacco companies attempt to link smoking to women’s rights and gender equality, as well as glamor, sociability, enjoyment, success, and slimness. They use various strategies to promote the social acceptability of smoking in women, including product development (e.g. flavors and aromas), product design (e.g. packs that are more appealing to women) and advertising, involvement in social responsibility programs, and using the influence of popular media.

Some people, especially women, smoke in order to lose or control weight. Healthy diet and exercise have shown to be more efficient and less harmful ways to control weight or obesity, with additional benefits beyond weight control alone.

Sources

Global Adult Tobacco Survey. Centers for Disease Control and Prevention (CDC). [cited 2014 May 29].

Institute for Health Metrics and Evaluation (IHME). University of Washington. Smoking prevalence data, 2013. 2012 Data are linked. 2013 estimates are available from IHME.

Koh-Banerjee P, Chu NF, Spiegelman D, Rosner B, Colditz G, Willett W, et al. Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 587 US men. The American journal of clinical nutrition. 2003;78(4):719-27.

May AM, Romaguera D, Travier N, Ekelund U, Bergmann MM, Kaaks R, et al. Combined impact of lifestyle factors on prospective change in body weight and waist circumference in participants of the EPIC-PANACEA study. PloS one. 2012;7(11):e50712.

Pigeyre M, Duhamel A, Poulain JP, Rousseaux J, Barbe P, Jeanneau S, et al. Influence of social factors on weight-related behaviors according to gender in the French adult population. Appetite. 2012;58(2):703-9.

Reis JP, Loria CM, Sorlie PD, Park Y, Hollenbeck A, Schatzkin A. Lifestyle factors and risk for new-onset diabetes: a population-based cohort study. Annals of internal medicine. 2011;155(5):292-9.

Weekley CK, 3rd, Klesges RC, Reylea G. Smoking as a weight-control strategy and its relationship to smoking status. Addictive behaviors. 1992;17(3):259-71.

WHO Regional Office for Europe. Empower Women –Combating Tobacco Industry Marketing in the WHO European Region. 2010.

Trend, USA

Estimated smoking prevalence and smoking-attributable mortality, USA, 1900–2010

 

In high-income settings, smoking and smoking-related deaths in women follow the patterns in men by about three decades—but this is not inevitable.

Trend, Japan

Age-standardized smoking prevalence and lung cancer mortality, Japan, 1950–2010

In Japan, female smoking has not followed the global epidemic model.

Underreporting of Use

Underreporting of tobacco use among women in South Korea, 2008

“The disease risks from smoking by women [in the United States] have risen sharply over the last 50 years and are now equal to those for men for lung cancer, chronic obstructive pulmonary disease, and cardiovascular diseases.”–U.S. Surgeon General Report 2014

“One [hypothesis] is the greater concern women have that if they stop smoking they will gain weight. THIS FEAR UNDOUBTEDLY PREVENTS MANY WOMEN from desiring to stop smoking.” –Lorillard 1973

From 1996 to 2013, the number of countries with daily smoking prevalence of ≥20% in females has dropped from 40 to 27.

3M+

Countries with 3,000,000 or more daily smoker females, age ≥ 15 years, in millions, 2013

17.7 | UNITED STATES
12.2 | CHINA
12.2 | INDIA
9.9 | RUSSIA
8.6 | BRAZIL
6.9 | GERMANY
6.4 | FRANCE
5.4 | JAPAN
5.2 | ITALY
4.9 | UNITED KINGDOM
4.2 | SPAIN
3.9 | POLAND
3.9 | TURKEY

“As globalization brings iPhones, movies, and fashion to the developing world, it also brings… THE LIES OF TOBACCO COMPANIES in need of new female customers. I know these lies because I heard them all – smoking makes you stylish or attractive or independent. No on all counts – smoking kills, plain and simple.” –Nancy G. Brinker, founder of the Susan G. Komen for the Cure Foundation, 2010

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