Smoking 11Tow Worst Threat to Women's Health By Susan Okie w„m.„smo r..,, sr.,rr w,ae, Cigaretr.e smokin_g, marketed as liberated and glamorous for almost 60 years, has become the single greatest threat to the health of American women, with an impact so profound that demographers say that it may eliminate the edge in lifespan women have traditionally enjoyed . According to American Cancer Society estimates, ttis year, for the first time in U .S . history, lur .g cancer will kill more women than breast cancer, marking the first wave in a rising tide of formerly "male" diseases among female smokers . Young women in their teens and 20s nqw smoke more than young men-a trend that is especially significant because smoking creates specific threats for women and their babies : stillbirths, sudden infant deaths and miscarriages, lowered fertility, and danger of strokes and heart attacks in smokers who take birth control pills . The history of women and cigarettes is the tale of a badge df liberation with deadly hazards for the wearer, a product linked to the American ideal of slimness that keeps female users hooked in part because they fear they will gain weight if they quit . In the last three decades, while many men gave up the habit in the face of its frightening toll in disease and death, women have hung onto their privilege,to smoke and denied that the risks applied to them . In 1935, 18 percent of American women smoked . Gt 1983, the figure was almost 30 percent . The resulting health statistics are beginning to echo the words of Joseph Califano, then secretary of Health, Education and Welfare, that "women who smoke like men, die like meq" I'Women have got to stop this march to death," said Estelle Ramey, professor of physiological biology at Georgetown University MQdicalSchool . Feminists Take No Stand The women's movement has been silent on cigarettes amid mounting evidence establishing srqoking as a major woman-killer . As lung cancer becomes the new "women's disease ;' feminist leaders , are feuding over whether to attack a habit many view as a strictly persopal choice. At least one tobacco , co(npany, Philip• Morris Inc ., has bqn an eager benefactor of feminist organizations . Philip Morris also sponsors the Virginia Slims women's tennis tournaments . At thB b-ational Organization for Women, a dispute flared this year over whether to continue accepting the Most U .S . newspapers and magazines, including The Washington Post and Newsweek, continue to accept tobacco advertising . Such advertising is banned by law on television . 'n a series of interviews with epidemiologists, public-health researchers and federal officials and an examination of the latest medical and statistical findings, the magnituc/e of the problem emerges : ∎,Smoking is changing from a male to a female preserve . More women than men will be smokers in about five years if present trends continue ; according to epidemiologist Patrick L . Remington of the Centers for Disease Control . ' . Lung-cancer deaths in women have increased 350 percent in the last 35 years . By the year 2000, more women than men will die of lung cancer, a reversal of the prqsent pattern, according to Dr . Robert J . McKenna, president of the American Cancer Society . • So strong is the addiction that despite risks of miscarriage or stillbirth, 70 to 80 percent of women who smoke continue to do so while they are pregnant . • The workplace feeds the habit : Working women are more likely to smoke than housewives, according to American Cancer Society figures. ∎ Women have more trouble quitting than men-possibly because they depend on nicotine to stay slim and to banish depression. "Why haven't the people responsible for advising women . . hit this No . 1 problemY' asked Surgeon Geoeral C . Everett Koop . The tobacco industry contends that a cause-and-effect relationship hasnot been established petween cigarettes and lung cancer, heart disease, chronic lung disease, pregnanFy complications or other disorders . "No one in the industry has ever said, 'Well, cigarettes are blameless here, they are harmless, let's'not worry about it . . .'" said Walker Merryman, vice president of the Tobacco Institute . "What we are saying is . . .'Let's find out for certain . Yes, give people information about the possible health haz. ards . Let people make up their own minds about whether or not they wish to be smokers . : . . And let's admit that we don't know what we don't know.' " ~U it 1 ~C1F55 ~ • IS S Illegal on Fifth Avenue Smoking by women was illegal in many public places until the 1920s, according to Virginia L. Ernster, an epidemiologist at the University of California at San Francisco . In an article in the New York State Journal of Medicine last July, Ernster provi¢ed details that trace changing Ametican attitudes toward women's smoking . "You can't do that on Fifth Avenue," declared a New York policeman in 1904 while arresting a woman for smoking in a car . Alice Longworth, Theodore Roosevelt's daughter, was forbidden to smoke in the White House in 1910 and threatened to smoke on the roof instead . Female students crusaded in the 1920s for the right to smoke on campus as a symbol of equality, Ernstei said . "Smoking was made a cause celebre," she said . "The health risks just weren't known . . . . The decision by a woman to smoke was, in part, a rejection of a double standard ." Not until the end of that decade did manufacturers even dare to ad-vertise to women-but once they I did, they portrayed the cigarette as a torch of freedom and a tool of beauty . In 1928, the makers of Lucky Strike launched a campaign with-the slogan, "Reach for a Lucky Instead of a Sweet," introducing the linkage of cigarettes with slender figures that survives today in the name Virginia Slims. A survey conducted in 1935 found that 18 percent of women smoked, compared with 52 percent of inen . World War If made smoking by women acceptable, Ernster found . Female workers appeared in magazines puffing cigarettes while they . riveted battleships, and the free cigarettes distributed to soldiers r ,f'Y t7 i 1 T10399-0545 swelled the ranks of smokers . By the end of the war, a third of American women smoked-a figure that stayed almost constant through the mid-1960s and has since dropped only slightly, in sharp contrast to smoking among men, which has been declining steadily since the 1950s . A majority of American men-52 percent-were smokers in the mid1950s when the first ominous re-ports bnking cigarettes with lung cancer appeared in the press . A few years later, in 1964, surgeon general Dr. Luther Terry releasedthe historic report putting the government seal on the cancer connection . By 1983, the proportion of American men who smoked had fallen to 35 percent . Almost 30 percent of women were smokers in 1963-a drop of only 3 percentage points over 20 years . Meanwhile, statisticians have recorded a steeply rising rate of lung canc .-r in women since the 1960s. Tte American Cancer Society predicts that in 1985 more women-?8,600-will die of lung cancer than breast cancer38,400 . Annual totals for lung-cancer deaths in women have surpassed broast-cancer deaths in a dozen states, according to preliminary data . Studies show 75 percent to 90 percent of lung-cancer cases are caused by smoking . Lung cancer has long been the most common fatal cancer in men, and this year, 87,000 American men will die of it . Smoking also causes one-third of all deaths from heart disease annually . Counting its toll from cancer, heart disease, strokes and lung disorders, smoking is estimated to kill 320,000 Americans each year-more than the total American death toll from all wars fought in this century . ' So enorrnous is the impact on health that a 1083 study in Public Health Reports predicts the difference in the life expectancy of men and women-a difference of eight years in women's favor, according to 1979 census data-will soon vanish because of women's smoking patterns . The researchers found that life expectancies of nonsmoking men and women are almost identical. The higher life expectancy of women in the population at large reflects the fact that, in the past, fewer women than men were smokers, they concluded . "Wheu . . . womcn who h8vc smoked as much as inen reach the later decades of life . . . the present differences in longevity between salc, as ihc uumber of madc ni,iokers cleclined . The FTC report concluded that the pitch is wdrking . In 1983, more men and women will disappear," the _ report predicted . than 74 billion "women's' cigarettes Georgetown's Raniey, a specialwere sold, and women's brands acist on differences between the counted for 12 .8 percent of sales . sexes, said at least half of women's Tobacco industry spokesmen greater longevity is explained by deny that cigarette advertising life style differences . makes smokers out of nonsmokers . "There is no question that for 'both sexes, the major contributing factor affecting health is smoking," she said . That conclusion is especially ominous for younger women, who are smoking in greater numbers than men their age. In this year's druguse survey of high school seniors for the National Institute on Drug Abuse, 31 .4 percent of girls had smoked in the preceding month compared with 28.2percent of boys . More girls than boys have been smokers in every year since 1976. "What our advertising is designed to do is competitive switching," said David Fishel, vice president for public relations of RJ . Reynolds. "The general agreement is that advertising is not going to get someone to start doing something ." Smoking researchers agree there is no proof that advertising makes people start smoking but say that it may play a role . A key factor keeping women from quitting-and possibly a motive for some to start-is nicotine's ability to suppress hunger . "It's well known that women in our society are much more weightconscious than men," said Ellen Gritz, associate director for research in cancer control at UCLA's cancer center . "Cigarettes are used to regulate weight . People smoke instead of eating, and also use cigarettes to . . . end a meal ." Quitters not only lose the appetite suppression of nicotine, they Young White Women Remington said recent CDC data show a sharp increase in smoking among Women in their early 20s . Young white women have the highest smoking rate-40 percent-of any group in the nation . Young blacks of both sexes smoke less than whites, and Hispanics snroke' less than either group, although smoking is increasing among young Hispanic women . Remington predicted that today's young women will fall victim to heart disease, lung cancer and other smoking-related illnesses in record numbers. "You'll see them with very high rates of smoking and cigarette mortality," he said . "It will really be an epidemic in 20 years among womei> .° Why so many women adopt the habit, and why-according to some studies-wonten are less successful at quitting than men are matters of speculation . Experts mention several theories, among them nicotine's ability to abate hunger and depression, and the growth of cigarette advertising aimed at women . Women have become a prime market for the tobacco industry . In 1983, cigarette companies spent almost $2 .65 billion in advertising, according to a Federal Trade Commission report released last June . Several brands, including Philip Morris' Virginia Slims, RJ . Reynolds' More, Liggett Group's Eve and Lorillard's Satin, were designed to appeal exclusively to women . Advertising for such brands totaled $329 million . Targeting of women has intensified since the 1970s ; as also crave sweets, Gritz said . She said studies show that people who quit smoking do gain weight, and those who quit permanently gain more than those who quit and then go back to the habit . Cigarette manufacturers have exploited this aspect of their product since the 1920s. "'1 don't think the name Virginia Slims is a mistake," said John Pinney, director of Harvard's Institute for the Study of Smoking Behavior and Policy . Guy L . Smith, vice president for corporate affairs of Philip Morris USA, said the name was chosen to describe the shape of the product, not to suggest the shapes of its users. "The diameter of a Virginia Slim is less than the diameter of a standard cigarette-or slimmer," he said . "There is no subliminal message." Regulates Mood Another factor in addiction, speculated to be more influential in women than men, is nicotine's calming effect .'"Nicotine . . . has the capacity to produce relaxation as well as stinuilation," Gritz said . Many smokers rely on it for "puff-by-puff regulation of mood ." Gritz suggested that, since women report depression more frequently than men, they may rely more on smoking as an emotional support . p , -) n ~ - - T10399-0546 Asked whether the industry viewed nicotine as addictive, the Tobacco Institute's Merryrnan said, "I think there is evidence to that effect . There is also indisputable evidence that in the past 20 years 30 million people have quit smoking . And in excess of 90 percent of them . . have done so on their own . I( that mimics addictive behavior, then I don't understand anything about addiction," Government and private agencies are trying to reduce smoking by both men and women . Koup has called for "a smoke-free society by the year 2000," although the Reagan administration has not made this a goal . Notably absent from the fray are most feminist organizations, which have not 'put women's smoking on their political agendas, although they have been active on other health fronts, such as contraceptives and toxic-shock syndrome . "If you look at all the things theyget mad about in women's health issues and add all the consequences together, you can put the damages in your left ear compared to those from women smoking," Ramey said . Pinney, who edited the 1980 surgeon general's report on the health consequences of smoking for women, was discouraged by the failure of women's groups to react to it . "I would like to know . . . why the bell they didn't ;" he said . NOW Accepts Ads Money is one suggested reason . Ernster criticized the National Organization for Women for accepting advertising from Philip Morris at its national conventions. Denise Fuge, a member of NOW's governing board, said she introduced a resolution at a board meeting this year to stop accepting ads from the tobacco industry. Ads for alcoholic beverages were added, and Fuge said it was defeated for political reasons . "It's quite a hot issue in our organization right now," said Lois Reekitt, executive vicg president of NOW . According to figures Reckitt provided, NOW received $8,750 from Philip Morris or its subsidiaries between 1979 and 1985 for advertising in its convention program books . Reckitt said NOW's annual operating budget is $5-5 million . Philip Morris ran a full-page ad each year on either the back cover or inside front cover of the book . Miller Brewing Co . and Benson and Hedges, subsidiaries of Philip Morris, each took one full page ad during one of those years . The 1985 Philip Morris ad, on the back cover ;features a quotation from former congresswoman Shirley Chisholm and the words, . . Philip Morris Inc . salutes the National Organization for Women ." The cigarettes and beverages manufactured by the company are listed at the bottom . Fuge said NOW has hestitated to make smoking an issue because it is a matter of personal choice . "We have many fine women in NOW who are heavy smokers . They contribute an inunense amount," she said . "We cannot deny women . We can :educate them ." Other women's organizations also find smoking a difficult issue to confront . Victoria Leonard, execuGve director of the National Women's Health Network, said her group protested at last year's Virginia Slims tennis tournament and "is going to do more," but added, "It's the kind of thing that I just wish would go away ." She said that the new preeininence of lung cancer in women may force feminist groups to get involved . "If it [lung cancer] surpasses breast cancer, it may be the straw that broke the camel's back," she said. , a Ias taxcIt r OF , ;=~a. ;~c,o o~xe c<rft ~r1c~t~~ ~, k .., .w. Wt r v ~0 . fCGLxca- 1 . ,`or .a .~ ~ , . IRO N LUNG AND BREAST CANCER DEATHS . (~.UCKY' ~ ~ „:.,teqo~ DEATHS PER 1,000 WOMEN 25 .SZ(1~C~::~-] `~it's toasted 20Ft 30 1950 1955 1960 1965 19/0 1975 1980 1985 n `f" 0 ~ -f T10399-0548