Seeing Through Smoke Screen: Women at Higher Risk

Women have come a long way as far as the intensity of tobacco advertising targeted at them, especially teen-agers. Now, lung cancer kills more women than breast, uterine and ovarian cancer combined. First of a two part-series.

Photo of hand with a cigarette

(WOMENSENEWS)-Ann Houston lovingly placed a photograph of her mother on a memorial wall in Denver featuring women whose lives have been cut short by the use of tobacco. Next to it, she attached a brief passage on her mother's 30-year history of smoking and her recent struggle with cancer that finally claimed her life.

“Although it was a difficult thing for me to do,” said Ms. Houston in a recent interview. “I know it is a story she would want me to tell to women and girls.” Her mother, a 60-year-old middle school teacher who taught in North Carolina for more than 30 years, had started speaking about the dangers of smoking to young girls two years ago. That was after she recovered from oral cancer, after two surgeries and 28 courses of radiation treatment.

Her family was devastated last July when she was diagnosed with lung cancer. She died within weeks. “My mother was one of the unlucky ones,” said Houston, explaining that her mother actually had stopped smoking almost 13 years ago. “People don't realize the consequences that taking up smoking as a teen-ager can have. It's possible to wait too long to quit.”

Four families in New York City, including the relatives of 35-year-old Joan Foglia, who died of lung cancer, also recently added the faces and stories of their loved ones to the memorial wall, “Their Story,” a project of the National Coalition FOR Women AGAINST Smoking. After leaving New York, “Their Story” embarked on a national tour with photo and story placements in every state.

Big Tobacco Has Dulled the Public's Sense of Danger

“‘Their Story' is a way of shaking up the American public to the horrifying dangers of smoking,” says Joanne Kildare who heads the Coalition, “because the public's sense of danger has been dulled after decades of aggressive and misleading advertising by the tobacco industries.”

Dr. Don Gemson, chair of New York City's Coalition for a Smoke-Free City adds, “It's one thing to know that 450,000 Americans die yearly as a result of tobacco use. It's quite another to see the photos, read the stories and meet the families of the people behind those statistics.”

Each day, tobacco's female victims are replaced by an estimated 1,500 new female smokers, the majority of them between 12 and 14 years old.

Cigarette smoking is the leading cause of preventable disease and death in U.S. women. Each year, more than 140,000 women die prematurely of tobacco-related illnesses, including various cancers and heart and respiratory diseases, according to the Centers for Disease Control and Prevention.

Although most Americans don't know it, lung cancer, not breast cancer is the leading cause of cancer death among women, killing approximately 65,000 women annually in the United States, more than breast, uterine and ovarian cancers combined. In fact, women's lung cancer deaths have risen 550 percent since 1950, according to the American Association for Cancer Research.

Women are, in general, more susceptible to lung cancer than men, according to the association, and women smokers are at least 10 times more likely to develop lung cancer than nonsmoking women. The Department of Health and Human Services blames smoking for the heart disease deaths of an additional 61,000 women each year.

Danielle Milano, a physician in a community health center in New York City, advises all patients who smoke to give up cigarettes, warning them of the multiple dangers. Dr. Milano and other medical experts say that smoking leads to emphysema and bronchitis, promotes dental problems, and exacerbates other diseases such as diabetes. It is also associated with hearing loss, vision problems and increased headaches.

To encourage women to stop, Dr. Milano also warns of the negative effects that cigarettes can have on how they look and feel. “I tell them that smoking leads to wrinkled skin, stained teeth, and hair and clothes that reek of smoke.”

Women Aware of Breast, Other Cancers-But Not Lung Cancer

Why, despite all the dangers associated with the use of tobacco, do approximately 23 million women and 1.5 million teen-age girls continue to smoke? And why do they start in the first place?

The National Council on Women's Health says that while women have increased their awareness of breast and other women's cancers, they have remained dangerously “out-of-awareness” regarding lung cancer risks and tobacco use.

Most smokers, including more than 80 percent of women, began the habit in their teens.

The American Lung Association says teen-age girls often start to smoke to avoid gaining weight. They, along with adult women, fall prey to the negative images of overweight as a fate much worse than smoking. They don't think about death.

“Teen-agers like to look sexy, to be accepted and to be rebellious against parents,” said Fern Carness, a registered nurse and smoking cessation expert, during an Internet health chat.

Tobacco advertising also is a major factor in getting girls and women to start smoking.

Jerry HallThe lung association states that since the 1920s, the tobacco industry has targeted women with images of liberation, glamour, slimness, and feminism, and that the sales and advertising drive for women's cigarettes in the late 1960s and early 1970s coincided with a sharp increase in the number of 12- to 17-year-old girls who began smoking.

After stabilizing for a few years, the Centers for Disease Control says, the smoking rates for students in grades 9 through 12 went up 7 percent between 1991 and 1999, and that 34.7 percent of girls in these grades are current smokers.

Cigarette companies spend upwards of $5 billion dollars each year on advertising and promotion campaigns-more than $15 million a day, the lung association reports. And the National Coalition FOR Women AGAINST Tobacco, charges that since the 1998 $206 billion Master Settlement Agreement between eight state attorneys general and the tobacco companies restricted some of tobacco companies' visual marketing practices, their response has been to step up advertisements in magazines that target women and girls, particularly those with a large minority readership.

Dr. Elizabeth M. Whelan, President of the American Council on Science and Health, which over the past decade has surveyed the overall health coverage of popular women's magazines, says she is greatly disturbed by the scant coverage of the hazards of smoking by women's magazines, and even more so by the volume of cigarette ads they carry.

The council's most recent survey-covering the 1997 and 1998 May through September issues of 13 magazines, for a total of 130 individual issues-found that the magazines downplay or ignore the hazards of cigarette smoking among women and girls. During this period, only one out of 519 health-related articles in the 13 magazines surveyed-Cosmopolitan, Elle, Family Circle, Glamour, Harper's Bazaar, Ladies Home Journal, Mademoiselle, McCall's, New Woman, Redbook, Self, Vogue, and Woman's Day-featured the hazards of smoking.

Facts That Women and Girls Should Know About Smoking:

“But far more disturbing,” says Dr. Whelan, “was the number of cigarette ads the magazines carried per issue.” On average, the magazines surveyed carried about three cigarette ads per issue, for a total of 399 such ads over the two 5-month periods covered. In 1997, cigarette ads outweighed antismoking messages by a ratio of six to one; in 1998 that ratio almost doubled, to a rate of 11 cigarette ads for every mention of smoking risks.

In addition to the powerful role that advertising plays in promoting smoking among women and girls, experts cite two other critical factors-peer pressure and living with relatives who smoke.

According to the American Cancer Society, a young person who lives in a non-smoking home has a one-in-20 chance of becoming a smoker. These odds escalate to a one-in-5 chance for a young person who has lived with parents or siblings who smoke.

Carmen Rodriguez, a 60-year-old middle school teacher says half-jokingly, “I think I've always been a smoker.” She recalls “playing house” with her little friends in Arizona when she was 9 or 10 years old. Imitating their mothers, the girls would serve imaginary coffee and tea in their play cups, and sit around with legs crossed, pretending to smoke unlit cigarettes. “One day, my mother walked in on us and smacked the cigarettes right out of our months,” she said.

But that didn't deter Rodriguez from smoking. When she got to college she and several friends would stay up nights studying for exams with a supply of coffee, cigarettes, and “stay awake” pills close at hand. “I got hooked,” she said, “and I've been smoking ever since.”

Rodriguez says she has cut down to about half a pack a day. “I smoke a cigarette when I get up, while I'm driving to work, during breaks, and before I go to bed,” quickly adding that she is careful not to smoke in front of her students. “I don't want them to see me as a negative role model,” she says. Rodriguez says she feels embarrassed about her habit and a sense of guilt because her two daughters both smoke. “That's what bothers me the most-that I have passed it on to them.”

Next Week: Women Trying to Kick the Tobacco Habit

Adelita Medina is a freelance writer, researcher and fundraising consultant. Originally from northern New Mexico, she now lives in Brooklyn, N.Y.