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Women & Tobacco

Key Facts

• The list of diseases caused by smoking has been expanded to include abdominal aortic aneurysm, acute myeloid leukemia, cataract, cervical cancer, kidney cancer, pancreatic cancer, pneumonia, periodontitis, and stomach cancer. These are in addition to diseases previously known to be caused by smoking, including bladder, esophageal, laryngeal, lung, oral, and throat cancers, chronic lung diseases, coronary heart and cardiovascular diseases, as well as reproductive effects and sudden infant death syndrome.
   
• Lung cancer is the leading cause of cancer death, and cigarette smoking causes most cases.
   
• In 2003, an estimated 171,900 new cases of lung cancer occurred and approximately 157,200 people died from lung cancer.

Health Effects and Mortality

• Cigarette smoking kills an estimated 178,000 women in the United States annually.¹ The three leading smoking-related causes of death in women are lung cancer (44,000), heart disease (41,000), and chronic lung disease (37,500).¹
   
• Ninety percent of all lung cancer deaths in women smokers are attributable to smoking.² Since 1950, lung cancer deaths among women have increased by more than 600%. By 1987, lung cancer had surpassed breast cancer as the leading cause of cancer-related deaths in women.²
   
• Women who smoke have an increased risk for other cancers, including cancers of the oral cavity, pharynx, larynx (voice box), esophagus, pancreas, kidney, bladder, and uterine cervix.² Women who smoke double their risk for developing coronary heart disease and increase by more than ten-fold their likelihood of dying from chronic obstructive pulmonary disease.^2,3
   
• Cigarette smoking increases the risk for infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS).²
   
• Postmenopausal women who smoke have lower bone density than women who never smoked.² Women who smoke have an increased risk for hip fracture than never smokers.²

National Estimates of Tobacco Use

• An estimated 20% of adult U.S. women aged 18 years or older (more than 1 of 5) are current cigarette smokers.⁴ Cigarette smoking estimates for women by age are as follows: 18–24 years (24.6%), 25–44 years (22.8%), 45–64 years (21.1%), and 65 years or older (8.6%).⁴
   
• Prevalence of cigarette smoking is highest among women who are American Indians or Alaska Natives (40.9%), followed by whites (21.8%), African Americans (18.7%), Hispanics (10.8%), and Asians [excluding Native Hawaiians and other Pacific Islanders] (6.5%).⁴
   
• Cigarette smoking estimates are highest for women with a General Educational Development (GED) diploma (37.2%) or 9–11 years of education (30.9%), and lowest for women with an undergraduate college degree (10.5%) or a graduate college degree (6.4%).⁴
   
• Smoking prevalence is higher among women living below the poverty level (30.1%) compared with women living at or above the poverty level (19.7%).⁴
   
• An estimated 17.3% of pregnant women aged 15–44 years smoke cigarettes, compared with 31.1% of nonpregnant women of the same age.⁵
   
• The use of cigars and smokeless tobacco among adult women is generally low—1.7% of women are current cigar smokers,⁶ and 0.4% are current smokeless tobacco users.⁷

For Further Information

Office on Smoking and Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Mailstop K-50
4770 Buford Hwy., NE
Atlanta, GA 30341-3717
770-488-5705
http://www.cdc.gov/tobacco

Media Inquiries: Contact the Office on Smoking and Health press line at 770-488-5493.

Smoking Among Adults in the United States: Cancer

• Cancer is the second leading cause of death and was among the first diseases causally linked to smoking. (p. 39)
   
• Lung cancer is the leading cause of cancer death, and cigarette smoking causes most cases. (p. 61)
   
• Compared to nonsmokers, men who smoke are about 23 times more likely to develop lung cancer and women who smoke are about 13 times more likely. Smoking causes about 90% of lung cancer deaths in men and almost 80% in women. (p. 39)
   
• In 2003, an estimated 171,900 new cases of lung cancer occurred and approximately 157,200 people died from lung cancer. (p. 42)
   
• The 2004 Surgeon General’s report adds more evidence to previous conclusions that smoking causes cancers of the oral cavity, pharynx, larynx, esophagus, lung, and bladder. (pp. 42, 62, 63, 116, 166)
   
• Cancer-causing agents (carcinogens) in tobacco smoke damage important genes that control the growth of cells, causing them to grow abnormally or to reproduce too rapidly. (p. 44–45)
   
• Cigarette smoking is a major cause of esophageal cancer in the United States. Reductions in smoking and smokeless tobacco use could prevent many of the approximately 12,300 new cases and 12,100 deaths from esophageal cancer that occur annually. (p. 119)
   
• The combination of smoking and alcohol consumption causes most laryngeal cancer cases. In 2003, an estimated 3800 deaths occurred from laryngeal cancer. (p. 62)
   
• In 2003, an estimated 57,400 new cases of bladder cancer were diagnosed and an estimated 12,500 died from the disease. (p. 166)
   
• For smoking-attributable cancers, the risk generally increases with the number of cigarettes smoked and the number of years of smoking, and generally decreases after quitting completely. (pp. 39, 42)
   
• Smoking cigarettes that have a lower yield of tar does not substantially reduce the risk for lung cancer. (p. 61)
   
• Cigarette smoking increases the risk of developing mouth cancers. This risk also increases among people who smoke pipes and cigars. (p. 67)
   
• Reductions in the number of people who smoke cigarettes, pipes, cigars, and other tobacco products or use smokeless tobacco could prevent most of the estimated 30,200 new cases and 7,800 deaths from oral cavity and pharynx cancers annually in the United States. (p. 67)
  
   

New cancers confirmed by this report

• The 2004 Surgeon General’s report newly identifies other cancers caused by smoking, including cancers of the stomach, cervix, kidney, and pancreas and acute myeloid leukemia. (pp. 137, 167, 170, 183, 254, 324–325)
   
• In 2003, an estimated 22,400 new cases of stomach cancer were diagnosed, and an estimated 12,100 deaths were expected to occur. (p. 178)
   
• Former smokers have lower rates of stomach cancer than those who continue to smoke. (p. 182)
   
• For women, the risk of cervical cancer increases with the duration of smoking. (p. 169)
   
• In 2003, an estimated 31,900 new cases of kidney cancer were diagnosed, and an estimated 11,900 people died from the disease. (p. 166)
   
• In 2003, an estimated 30,700 new cases of pancreatic cancer were diagnosed, attributing to 30,000 deaths. The median time from diagnosis to death from pancreatic cancer is about 3 months. (p. 136)
   
• In 2003, approximately 10,500 cases of acute myeloid leukemia were diagnosed in adults. (p. 252)
   

• Benzene is a known cause of acute myeloid leukemia, and cigarette smoke is a major source of benzene exposure. Among U.S. smokers, 90% of benzene exposures come from cigarettes. (p. 252)

Citation

U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

Smoking remains the leading cause of preventable death and has negative health impacts on people at all stages of life. It harms unborn babies, infants, children, adolescents, adults, and seniors.

How Smoking Harms People of All Ages

• Toxic ingredients in cigarette smoke travel throughout the body, causing damage in several different ways. (p. 616)
   
• Nicotine reaches the brain within 10 seconds after smoke is inhaled. It has been found in every part of the body and in breast milk. (p. 616)
   
• Carbon monoxide binds to hemoglobin in red blood cells, preventing affected cells from carrying a full load of oxygen. (p. 616)
   
• Cancer-causing agents (carcinogens) in tobacco smoke damage important genes that control the growth of cells, causing them to grow abnormally or to reproduce too rapidly. (p. 44-45)
   
• The carcinogen benzo[a]pyrene binds to cells in the airways and major organs of smokers. (p. 616)
   
• Smoking affects the function of the immune system and may increase the risk for respiratory and other infections. (p. 616)
   
• There are several likely ways that cigarette smoke does its damage. One is oxidative stress that mutates DNA, promotes atherosclerosis, and leads to chronic lung injury. Oxidative stress is thought to be the general mechanism behind the aging process, contributing to the development of cancer, cardiovascular disease, and COPD. (p. 619)
   
• The body produces antioxidants to help repair damaged cells. Smokers have lower levels of antioxidants in their blood than do nonsmokers. (p. 618–619)
   
• Smoking is associated with higher levels of chronic inflammation, another damaging process that may result from oxidative stress. (p. 619)
   

U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
 

Smoking remains the leading cause of preventable death and has negative health impacts on people at all stages of life. It harms unborn babies, infants, children, adolescents, adults, and seniors.

Four Major Conclusions of the 2004 Report

• Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general.
   
• Quitting smoking has immediate as well as long-term benefits, reducing risks for diseases caused by smoking and improving health in general.
   
• Smoking cigarettes with lower machine-measured yields of tar and nicotine provides no clear benefit to health.
   
• The list of diseases caused by smoking has been expanded to include abdominal aortic aneurysm, acute myeloid leukemia, cataract, cervical cancer, kidney cancer, pancreatic cancer, pneumonia, periodontitis, and stomach cancer. These are in addition to diseases previously known to be caused by smoking, including bladder, esophageal, laryngeal, lung, oral, and throat cancers, chronic lung diseases, coronary heart and cardiovascular diseases, as well as reproductive effects and sudden infant death syndrome.
   

U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
 

Smoking remains the leading cause of preventable death and has negative impacts on people at all stages of life. It harms unborn babies, infants, children, adolescents, adults, and seniors.

Overall Mortality

• Tobacco use is the leading preventable cause of death in the United States.¹ Cigarette smoking causes an estimated 440,000 deaths, or about 1 of every 5 deaths, each year.^2,3 This estimate includes 35,000 deaths from secondhand smoke exposure.²
   
• Cigarette smoking kills an estimated 264,000 men and 178,000 women in the United States each year.²
   
• More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.^2,4
   
• On average, adults who smoke cigarettes die 13–14 years earlier than nonsmokers.²
   
• Based on current cigarette smoking patterns, an estimated 25 million Americans who are alive today will die prematurely from smoking-related illnesses, including 5 million people younger than 18.⁵
  
   

Mortality from Specific Diseases

• Lung cancer (124,000), heart disease (111,000), and the chronic lung diseases of emphysema, bronchitis, and chronic airways obstruction (82,000) are responsible for the largest number of smoking-related deaths.²
   
• The risk of dying from lung cancer is more than 22 times higher among men who smoke cigarettes and about 12 times higher among women who smoke cigarettes compared with never smokers.⁶
   
• Since 1950, lung cancer deaths among women have increased by more than 600%.¹ Since 1987, lung cancer has been the leading cause of cancer-related deaths in women.¹
   
• Cigarette smoking results in a two- to three-fold increased risk of dying from coronary heart disease.⁶
   
• Cigarette smoking is associated with a ten-fold increased risk of dying from chronic obstructive lung disease.⁶ About 90% of all deaths from chronic obstructive lung diseases are attributable to cigarette smoking.^1,6
   
• Pipe smoking and cigar smoking increase the risk of dying from cancers of the lung, esophagus, larynx, and oral cavity.⁷ Smokeless tobacco use increases the risk for developing oral cancer.⁸

Cigarette Smoking-Related Mortality

Cigarette smoking is the single most preventable cause of premature death in the United States. Each year, more than 400,000 Americans die from cigarette smoking. In fact, one in every five deaths in the United States is smoking related. Every year, smoking kills more than 276,000 men and 142,000 women.¹

• Between 1960 and 1990, deaths from lung cancer among women have increased by more than 400%—exceeding breast cancer deaths in the mid-1980s.² The American Cancer Society estimated that in 1994, 64,300 women died from lung cancer and 44,300 died from breast cancer.³
   
• Men who smoke increase their risk of death from lung cancer by more than 22 times and from bronchitis and emphysema by nearly 10 times. Women who smoke increase their risk of dying from lung cancer by nearly 12 times and the risk of dying from bronchitis and emphysema by more than 10 times. Smoking triples the risk of dying from heart disease among middle-aged men and women.¹
   
• Every year in the United States, premature deaths from smoking rob more than five million years from the potential lifespan of those who have died.¹
   
• Annually, exposure to secondhand smoke (or environmental tobacco smoke) causes an estimated 3,000 deaths from lung cancer among American adults.⁴ Scientific studies also link secondhand smoke with heart disease.
  
   

References

1. Centers for Disease Control and Prevention. Smoking-attributable mortality and years of potential life lost — United States, 1990. Morbidity and Mortality Weekly Report 1993;42(33):645-8.
2. Centers for Disease Control and Prevention. Mortality trends for selected smoking-related and breast cancer — United States, 1950-1990. Morbidity and Mortality Weekly Report 1993;42(44):857, 863-6.
3. American Cancer Society. Cancer Facts & Figures — 1996. Atlanta (GA): American Cancer Society, 1996.
4. U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Washington (DC): U.S. Environmental Protection Agency, Office of Health and Environmental Assessment, Office of Research and Development. EPA/600/6-90/006F. December 1992.

June 2001

urrently about 22 million (22 percent) of women aged 18 years and older(1) and at least 1.5 million adolescent girls(2) in the United States smoke cigarettes. The gap in smoking prevalence between men and women has narrowed dramatically in recent years. Although male smoking prevalence dropped 24 percentage points between 1965 and 1993, the prevalence of female smoking dropped only 11 percentage points during the same period.(3)
 

Smoking Prevalence

• Daily smoking rates among female high school seniors have increased from 17.9 percent in 1991 to 23.6 percent in 1997.(4)

• Smoking rates among U.S. women aged 18 years and older vary considerably by racial/ethnic groups: American Indian/Alaskan Native, 35 percent; white, 24 percent; black, 24 percent; Hispanic, 15 percent; and Asian/Pacific Islander, 4 percent.(1)

• Women are beginning to smoke at younger ages, increasing their risks of developing smoking-related diseases.(2)

• The more formal education a woman receives, the less likely she is to be a smoker. In 1995, 40 percent of women between the ages of 25 and 44 who did not finish high school were smokers; 34 percent of high school graduates were smokers; 24 percent of those with some college were smokers; and only 14 percent of those who graduated from college were smokers.(5)
   

Special Health Risks

• Between 1960 and 1990, the death rate from lung cancer among women increased by more than 400%, and the rate is continuing to increase. In 1987, lung cancer surpassed breast cancer as the number one cause of cancer deaths among women.(6) The American Cancer Society estimated that in 1998, lung cancer killed 67,000 women, and breast cancer killed 43,500 women.(7)

• More than 152,000 women died from smoking-related diseases in 1994.(8)

• Smoking has a damaging effect on women's reproductive health and is associated with reduced fertility and early menopause.(9)

• Women who smoke during pregnancy subject themselves and their developing fetus and newborn to special risks, including pregnancy complications, premature birth, low-birthweight infants, stillbirth, and infant mortality.(9)

• Between 8,000 and 26,000 children are diagnosed with asthma every year in the United States. The odds of developing asthma are twice as high among children whose mothers smoke at least 10 cigarettes a day. Between 400,000 and 1 million asthmatic children have their condition worsened by exposure to secondhand smoke.(10)

• Research suggests intrauterine exposure and passive exposure to secondhand smoke after pregnancy are associated with an increased risk of Sudden Infant Death Syndrome (SIDS) in infants.(11)

• For every dollar invested in smoking cessation for pregnant women, about $6 is saved in neonatal intensive care costs and long-term care associated with low-birthweight deliveries.(12)
   

Smoking Cessation

The health benefits of quitting smoking far outweigh any risks from weight gain caused by quitting smoking. Research shows that the average weight gain after quitting smoking is only five pounds and that it can be controlled through diet and exercise.(9)
 

References

1. Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 1995. Morbidity and Mortality Weekly Report 1997;46(51):1217-1220.
2. U.S. Department of Health and Human Services, Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.
3. Giovino GA, Schooley MW, Zhu BP, et al. Surveillance for selected tobacco use behaviors—U.S. 1900-1994. Morbidity and Mortality Surveillance Summary-- 3, 1994.
4. Johnson LD, Bachman JG, O'Malley PM. National Survey Results on Drug Use from the Monitoring the Future Study. 1975-1997. Ann Arbor (MI): Institute for Social Research, University of Michigan, 1998.
5. Centers for Disease Control and Prevention. Office on Smoking and Health, unpublished data.
6. Centers for Disease Control and Prevention. Mortality trends for selected smoking-related cancers and breast cancer—United States, 1950-1990. Morbidity and Mortality Weekly Report 1993;42:857,863-866.
7. American Cancer Society, Cancer Facts & Figures—1998, Atlanta, Georgia: American Cancer Society, 1998.
8. Centers for Disease Control and Prevention. Cigarette smoking-attributable mortality and years of potential life lost—United States, 1990-1994. Morbidity and Mortality Weekly Report 1997;46:444-451.
9. U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation. Rockville, MD. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS publication no. (CDC) 90-8416, 1990.
10. U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. U.S. Environmental Protection Agency, Office of Research and Development, Office of Air and Radiation. EPA/600/6-90/006F, 1992.
11. Schoendorf KC. 1992. Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics 1992;90:905-908.
12. Marks JS, Koplan JP, Hogue CJR, Dalmat ME. A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women. American Journal of Preventive Medicine 1990;6:282-89.
     

For more information regarding women and tobacco, contact your local chapters of the American Heart Association, American Lung Association, and the American Cancer Society.

Or visit Thrive online.com http://thriveonline.oxygen.com/medical/smoking/7_myths/ 
At this site Christy Turlington highlights, Women & Smoking, and the "Seven Deadly Myths." 

Office on Smoking and Health
National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention

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