Vice Admiral Richard H. Carmona M.D., M.P.H., F.A.C.S. United States Surgeon General (2002 - present)

1. Vice Admiral Richard H. Carmona M.D., M.P.H., F.A.C.S. United States Surgeon General (2002 - present) Dr. David Satcher, M.D., Ph.D. United States Surgeon General (1998 – 2002) This report was developed under Dr.Satcher

2. Learning objectives • To introduce the readers to the report of the Surgeon General on women and smoking • To understand the burden, patterns and health consequences of tobacco use among women and girls • To understand the factors influencing tobacco use and the efforts to reduce tobacco use among women

3. The burden • In 1999, approximately 165,000 women died prematurely from smoking-related diseases, like cancer and heart disease. Women also face unique health effects from smoking such as problems related to pregnancy. • About one in every four cancer deaths among women is due to lung cancer.

4. The trends • In the 1990s, the decline in smoking rates among adult women stalled and, at the same time, rates were rising steeply among teenaged girls, blunting earlier progress. • Smoking rates among women with less than a high school education are three times higher than for college graduates. • Nearly all women who smoke started as teenagers - and 30 percent of high school senior girls are still current smokers.

5. The hope • We have the solutions for preventing and reducing smoking among women. • Quitting smoking has great health benefits for women of all ages. • The voice of women is needed to counter tobacco marketing campaigns that equate success for women with smoking.

6. " When calling attention to public health problems, we must not misuse the word ‘epidemic.’ But there is no better word to describe the 600-percent increase since 1950 in women’s death rates for lung cancer, a disease primarily caused by cigarette smoking. Clearly, smoking-related disease among women is a full-blown epidemic.“ -David Satcher, M.D., Ph.D. Surgeon General (1998-2002)

7. Women and Smoking Women and Smoking: a Report of the Surgeon General makes its overarching theme clear–smoking is a woman’s issue.

8. Women and Smoking A number of things need to be acted on to curb this epidemic of smoking and smoking-related diseases: • Increase awareness of the impact of smoking on women’s health and counter the tobacco industry’s targeting of women. • Support women’s anti-tobacco advocacy efforts and publicize that most women are nonsmokers. • Continue to build the science base for understanding the health effects of smoking on women in particular.

9. Major Conclusions of the Surgeon General’s Report • The once-wide gender gap in smoking prevalence has narrowed. • Smoking prevalence is nearly three times higher among women who have only 9 to 11 years of education than among women with 16 or more years of education. • In 2000, 29.7 percent of high school senior girls reported having smoked within the past 30 days.

10. Major Conclusions of the Surgeon General’s Report • Since 1980, approximately 3 million U.S. women have died prematurely from smoking related causes. • Women who smoke experience gender-specific health consequences. • Lung cancer is now the leading cause of cancer death among U.S. women. About 90 percent of all lung cancer deaths among women who continue to smoke are attributable to smoking.

11. Major Conclusions of the Surgeon General’s Report • Quitting smoking is beneficial at all ages. National survey data show that women are quitting at rates similar to or even higher than those for men. • Smoking during pregnancy remains a major public health problem. • Tobacco industry marketing is a factor influencing susceptibility to and initiation of smoking among girls.

12. Prevalence of current smoking among women aged 18 years or older, all women, by education (1998), and by race/ethnicity (1997-1998), United States. Source: National Health Interview Survey, 1997-1998.

13. 35 Age-adjusted death rates for lung cancer and breast cancer among women, United States, 1930–1997 Rate per 100,000 women 30 Breast cancer 25 20 15 10 Lung cancer 5 0 1930 1978 1984 1990 1996 1936 1942 1948 1954 1960 1966 1972

14. Patterns of Tobacco Use Among Women and Girls • The prevalence of current smoking among women was 22 percent in 1998. • Much of the progress in reducing smoking prevalence among girls in the 1970s and 1980s was lost with the increase in prevalence in the 1990s.

15. Patterns of Tobacco Use Among Women and Girls • Smoking during pregnancy appears to have decreased from 1989 through 1998. • Smoking prevalence among women varies markedly across countries. • Thwarting further increases in tobacco use among women is one of the greatest disease prevention opportunities in the world today.

16. Health Consequences of Tobacco Use Among Women • Increased annual risk for death. • Increased risk for lung cancer • Increased risk for cancers of the oropharynx, bladder, liver, colon and rectum, cervix, pancreas and kidney. • Smoking is a major cause of coronary heart disease among women.

17. Health Consequences of Tobacco Use Among Women • Increased risk for stroke and subarachnoid hemorrhage. • Increased risk for death from ruptured abdominal aortic aneurysm. • Increased risk for peripheral vascular atherosclerosis. • Cigarette smoking is a primary cause of COPD among women.

18. Health Consequences of Tobacco Use Among Women • Adolescent girls who smoke have reduced rates of lung growth • Adult women who smoke experience a premature decline of lung function. • Increased risks for conception delay and infertility. • Modest increase in risks for ectopic pregnancy and spontaneous abortion.

19. Factors Influencing Tobacco Use Among Women • Parents or friends who smoke • Stronger attachments to peers and friends, than to parents and family • Lower education and employment levels • Social support for stopping

20. Tobacco and advertisement Women have been extensively targeted in tobacco marketing. Tobacco companies have produced brands specifically for women.

21. Tobacco and advertisement • Tobacco marketing for women is dominated by themes of both social desirability and independence, which are conveyed through ads featuring slim, attractive, athletic models. • Tobacco industry marketing, including product design, advertising, and promotional activities, is a factor influencing susceptibility to and initiation of smoking.

22. Tobacco and advertisement The myth created by advertising The reality

23. Efforts to Reduce Tobacco Use Among Women • Researchers to date have not found consistent gender-specific differences in the effectiveness of intervention programs for tobacco use. • A higher percentage of women stop smoking during pregnancy, both spontaneously and with assistance, than at other times in their lives. Using pregnancy-specific programs can increase smoking cessation rates. • Successful interventions have been developed to prevent smoking among young people, but little systematic effort has been focused on developing and evaluating prevention interventions specifically for girls.

24. Efforts to Reduce Tobacco Use Among Women Successful interventions have been developed to prevent smoking among young people, but little systematic effort has been focused on developing and evaluating prevention interventions specifically for girls.

25. For more information: To obtain a copy of Women and Smoking: A Report of the Surgeon General full report or executive summary or for additional copies of this At A Glance, please call CDC’s Office on Smoking and Health at (770) 488-5705 and press 3 to speak with an information specialist. This report, along with supporting documents, is available on-line at the Office on Smoking and Health Web site atwww.cdc.gov/tobacco.

26. Smoking is a custom loathesome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs and in the black stinking fumes thereof nearest resembling the horrible Stygean smoke of Hell. - King James of England