Document 5061

Smoking 11Tow Worst Threat to Women's Health
By Susan Okie
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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.' "
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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
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
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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
"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
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 ~ - -
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.
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