The Next Wave of the Tobacco Epidemic
A perception that smoking is mainly a male problem is no longer valid. Just as the tobacco epidemic has been expanding over the last decade or so to less developed countries, women are becoming increasingly affected by this preventable public health disaster. Today, according to WHO estimates, there are about 200 million female smokers in the world.
Global and regional prevalence: It is estimated that globally, approximately 12% of women and 47% of men smoke.
* In developed countries, around one fourth of women smoke, compared to around 7% of women in developing countries. For men, the rates are 42% and 48%, respectively.
* Smoking among women is most prevalent in the Former Socialist Economies (FSE) of Central and Eastern Europe (28%), countries with established market economies (23%) and Latin American and Caribbean countries (21%).
* In all other regions less than 10% of women smoke, although in some regions women more commonly chew tobacco. However, under-reporting of smoking may be significant in countries where it is culturally unacceptable for women to smoke.
Women's smoking prevalence differs greatly from country to country. It is 25% or more in 26 countries and 30% or more in six countries:
* The country with the highest percentage of women (15 years of age and over) who smoke is Denmark - 37% (1993). It is followed by Norway - 35.5% (1994), the Czech Republic - 31% (1994), and Fiji - 30.6% (1988).
* Israel (1989) and the Russian Federation (1993) with 30% of female smokers rank fifth in this list. They are followed by Canada (1991), Netherlands (1994) and Poland (1993) with 29%.
* Greece (1994), Iceland (1994), Ireland (1993) and Papua New Guinea (1990) close the list of the top 10 with 28% of women who smoke.
Health consequences: Tobacco use has become a major danger to the health and well-being of women and girls around the world.
* At present, the widespread use of tobacco is responsible for three million deaths worldwide - or about 6% of all deaths - per year. More than half a million of these deaths occur in women.
* In several countries, lung cancer has surpassed breast cancer as the leading cause of cancer deaths among women. Already by the early 1990s, the death rate from lung cancer among women in highly industrialized countries was more than 300% higher than the level prevailing in the early 1950s.
* In India, where betel quid chewing is widespread among women, oral cancer is more common among women than breast cancer.
* In almost all countries, female deaths due to tobacco are increasing. If the prevailing trends continue, it is estimated that by 2020 the death toll will double, so that more than a million women will die each year from tobacco.
* As the tobacco epidemic among women in developing countries is at an early stage, the health consequences are not yet very evident.
Studies have shown that smoking among women presents a special problem for public health. Not only do women who smoke bear all the negative health consequences that male smokers endure, but they also experience others that are gender specific.
* Women who smoke are at increased risk of premature menopause and impaired fertility. They also have an increased associated risk of cervical cancer.
* When women smoke during pregnancy, there are also serious risks to the unborn baby. Smoking has a strong direct impact on the weight of the new-born, and as a consequence on its survival. The babies born to mothers who smoke during pregnancy weigh on the average between 200 to 300 grams less than other babies. Growth of the fetus is retarded mainly by the carbon monoxide and nicotine in cigarettes smoked by the mother.
Judging by the present trends, the number of women smokers in the world and, especially, in the developing countries - home to 80% of the world's population - will inevitably increase. There are a number of factors contributing to this phenomenon:
* In countries where reliable data are available to assess trends, they show that the tobacco epidemic among men was usually followed, after a delay of several years, by a tobacco epidemic among women. This is a pattern which has been repeated throughout the industrialized world over the course of this century.
* In an increasing number of less developed countries, smoking is linked with a cosmopolitan and affluent lifestyle. With increasing urbanization, educational and career achievement, and increasing spending power, many young women have taken up smoking.
* As smoking decreases in the West, the tobacco industry in search of new markets is making huge investments in targeting women and girls with aggressive and seductive advertising that exploits ideas of independence, emancipation, sex appeal and slimness. Such advertising erodes socio-cultural restraints which discouraged smoking among women. In many developed countries, there already is a trend towards more smoking among teenage girls than boys.
* Although the tobacco industry argues that cigarette advertising only encourages brand switching, the launching of a women's cigarette in a country where less than 2% of women under age 40 smoke provides an example of an attempt to create a market.
* Tobacco advertising revenues discourage the media from reporting the risks of smoking. This is of particular concern in developing countries, where public awareness of the harmfulness of smoking is low, sometimes nonexistent.
* If the current percentage of women who smoke increases, or even remains the same, the number of women who smoke will increase due to population growth (the female population in developing countries is projected to rise from the present 2.1 to 3.5 billion by 2025). Public health systems throughout the world will find it difficult to cope with the health consequences of this increase.
* Women-specific health education and smoking cessation programmes are rare, and principally concentrate on the effects of a woman's smoking on a fetus or child. Few programmes have encouraged women to quit smoking for the sake of their own health.
There is a need to frame women's tobacco use and exposure to second-hand smoke as a major health and social problem, and build consensus around this issue.
* International organizations (within their respective mandates), women's organizations and other nongovernmental organizations could be activated to address the problem.
* Research is needed on the effects of smoking upon women as well as how to prevent smoking among girls.
* Women's networks at local, national and international levels could be formed. These types of networks could help in the development and implementation of successful smoking prevention and cessation programmes directed at women and young girls.
* In 1990, the International Network of Women Against Tobacco (INWAT) was formed by women from around 60 countries with the aim of reducing tobacco use among women and girls in developed countries and preventing tobacco use from becoming established in developing countries, thereby averting the next wave of the tobacco epidemic.
Unless effective tobacco control measures are instituted, the patterns exhibited in industrialized countries will be repeated in the developing world.
The greatest public health opportunity to prevent noncommunicable diseases worldwide is to prevent a rise in smoking among women, especially in developing countries.
For further information, please contact Health Communications and Public Relations, WHO, Geneva. Telephone (41 22) 791 2584. Fax (41 22) 791 4858.
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© WHO/OMS, 1998