WOMEN AND GENDER DIFFERENCES

Background

During the early decades of the twentieth century, tobacco use was primarily a male behavior. In the aftermath of World War II, smoking in women began to accelerate, going from around 18% in 1935 to a peak of 34% in 1965. Probably at least in part as a result of the publication of the 1964 Surgeon General's Report documenting the health hazards of smoking, followed by a combination of increasingly restrictive regulations and intensive public education campaigns designed to discourage smoking, the percentage of women smokers leveled off rather than continuing to rise. So to some extent, women have been the beneficiaries of changes in public policy that came too late to protect men.

Starting in 1978, smoking prevalence in women began declining to its current rate of around 22% still slightly lower than the prevalence in men (who comprise 52% of all smokers), though the two have nearly converged. Despite the dramatic reduction in smoking prevalence in women, however, there is meager cause for celebration. Early hopes that women might be spared the ravages of tobacco-related illness that men have suffered have long since been dispelled. In 1986, lung cancer surpassed breast cancer as the leading cause of cancer death in women, a change that is almost completely attributable to increases in smoking among women. Smoking is also a major contributor to other cancers, COPD, cardiovascular disease, and, especially in oral contraceptive users over 35, stroke. Approximately 170,000 women die of smoking-related causes each year.

Research on cultural and socioeconomic contributors to the initiation and maintenance of tobacco use in women, as well as on genetic factors and hormonal changes across the life cycle as they interact with smoking, will be crucial if we are to meet the special needs of women smokers, and to prevent the smoking epidemic from spreading to women in developing countries, where rates are still generally low. Moreover, an improved understanding of sex and gender differences in the biological, psychological, and behavioral mechanisms underlying women's and men's responses to nicotine is likely to result in improved, targeted interventions for both women and men. The National Cancer Institute has recently issued a wide-ranging report entitled Women, Tobacco, and Cancer: An Agenda for the 21st Century, with extensive recommendations for achieving these goals. Another important source of information on women and smoking, focusing on data specific to women and girls and on comparisons of results by gender, is the 2001 Report of the Surgeon General.

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