by Dr. Judith Mackey
Women have made great advances in the past century, but contrary to what the tobacco ads would have us believe, smoking isn't one of them. Smoking is even more dangerous for women than for men because they risk special problems related to reproduction and the development of the children. Nevertheless, women are an important new target for the tobacco industry, a potentially lucrative market waiting to be won over. Hong Kong physician Dr. Judith Mackey examines the industry's strategy and the sobering consequences.
The advertisements equate it with sophistication, emancipation and glamour. The messages suggest that women who smoke enjoy equality with men; they are confident, fit and fashionable.
But the reality behind the billboards and slick magazine messages is different, even if cigarettes are longer and slimmer, lighter and "silkier" than the macho cigarettes of the Marlboro cowboy. In real life, women smokers are as vulnerable as men to cancer, heart disease, emphysema and a host of other problems. They also risk special problems related to reproduction — from infertility to early menopause. Research links smoking during pregnancy to abnormalities in offspring that may persist well into childhood. And smoking is anything but glamorous.
Yet despite the mountain of medical evidence, women in industrialised countries are slower to give up the habit than men.
In 1955, 52 percent of men and 24 percent or women in the United States were smokers. By 1987, the proportion of men who smoked had dropped to 31 percent, while the figure for women was almost 26 percent —down from 30 percent in 1983. But more young women are taking up the habit. In many industrialised countries there are more teenage girls smoking than teenage boys. If the trend continues, women will be outsmoking men within 20 years.
The situation is reversed in developing countries, where only five percent of women smoke compared to 50 percent of men. But while the overall rate of smoking is decreasing by about one percent a year in the west, it is increasing by two percent a year in the Third World. And one of the primary targets of the powerful tobacco industry is women.
Only three percent of women in Hong Kong smoke - a figure low in comparison to many countries largely because of traditional cultural values that view smoking as unladylike. Ready to wage battle for women's loyalties is the anti-tobacco lobby, hoping to prevent a rise in smoking among girls, and the tobacco industry, eyeing the prospective female market with more than a passing interest.
Today the cigarette companies are introducing advertisements aimed at women on television screens in Hong Kong as part of their massive US$30 million annual advertising budget —657 times more than the annual publicity budget of the Council on Smoking and Health. This scenario is being repeated around Asia.
Why do girls start smoking? Apart from the influence of advertising, they light up for much the same reason as boys, studies say: the influence of peers and smoking parents, curiosity, and the urge to imitate the adult world. One reason more often quoted by girls is the desire to stay slim.
But US health publications say tobacco is so addictive that experimenting with only a few cigarettes can turn a girl into a regular smoker. One pack is all it might take to develop a substantial tolerance to nicotine — to be able to inhale deeply without coughing, to smoke without being nauseated. Only a handful of young people who begin as occasional smokers can resist moving on to regular smoking.
Apart from the addictive properties of the drug nicotine, what forces keep them hooked? Students have shown that men are more likely to smoke to enhance good times —an evening at the pub with their friends, for example. Women, on the other hand, are more likely to smoke when under emotional pressure, to hide nervousness, ease tension, reduce feelings of anxiety. Cigarettes serve as a comfort, a "crutch."
This emotional dependency makes it especially hard to quit. Many women lack self-confidence and consider themselves less capable than men of making a difficult decision and carrying it through. Another powerful motivator is the fear of gaining weight, of not measuring up to the view in many societies that to be beautiful you have to be thin.
Studies have shown that women may receive less support from their husbands and families than men who try to quit. They have been encouraged to stop smoking for the sake of their foetus or children — not for themselves. And health educators have virtually ignored women until recently. Out of 1,000 methods for stopping smoking, only 30 quoted separate success rates for men and women.
Women are just as knowledgeable about the hazards of smoking as men, but for both sexes that knowledge is woefully inadequate. A 1981 review of data from several sources by the Federal Trade Commission in the US found 50 percent of women unaware that smoking during pregnancy increases the risk of miscarriage and stillbirth. Roughly 30 percent were unaware of the relationship between smoking, oral contraceptives and heart diseases. In Japan, only 22 percent of female teenagers believe smoking is harmful to health.
The reality is that smoking kills one in four people and disables many more. No other habit, risk or consumer product is as dangerous.
Women who smoke double their chances of getting cervical cancer, according to a study published recently in the British medical journal The Lancet. Cancer of the cervix is one of the most common cancers among women.
Smoking during pregnancy —most dangerous after the fourth month —can kill or disable the foetus. Studies reported in the British Medical Journal have also pinpointed long-term effects of smoking during pregnancy on the surviving child. Children of mothers who smoked more than ten cigarettes a day were shorter in height and slower in reading, mathematics, spelling and general ability. They also exhibited behavioural abnormalities such as short attention spans and hyperactivity.
A study by two Swedish doctors last year showed that infant cot death was double among children of mothers who smoked more than ten cigarettes a day during pregnancy. Children of smokers also have more chest infections, need more operations for removal of their tonsils, and are more likely to take up the habit themselves.
Women who smoke and take birth control pills are ten times more likely to die of a heart attack or stroke than a nonsmoker not taking the pill. The older the woman, the greater the risk.
Smoking also affects fertility. When causes of infertility were sought by a group of doctors from Radcliffe Infirmary in Oxford, UK, it was concluded: "The most important finding was a consistent and highly significant trend of decreasing fertility with increasing numbers of cigarettes smoked per day."
After stopping oral contraceptives, twice as many smokers were unable to conceive than non-smokers. The message for women is, if you have any difficulty conceiving, stop smoking.
It has also been suggested that women smokers have heavier and more painful periods, and a higher incidence of premenstrual tension. And due to hormone effects, the menopause occurs almost two years earlier.
Nor is a non-smoking woman necessarily safe. Being married to a smoker or working closely with a smoker all day is not only unpleasant, but it makes her a "passive smoker" and puts her at risk of developing lung cancer.
Women's health has traditionally been thought of as gynaecology and reproduction, but smoking is easily the greatest preventable health hazard today. More women die from tobacco-related diseases in Hong Kong and in many other countries than from every known method of contraception and childbirth combined.
Source:
Consumer Lifelines (lOCU) August 17, 1989
Published by: International Organization of Consumers Unions(IOCU)
P.O. Box 1045 10830 Penang Malaysia tel: 604-371396 fax: 604-366506