Chapter four
hough smoking represents a blanket threat to all sections of populations
exposed to tobacco use, the issue of women and smoking includes
distinctive problems that encompass themes of empowerment, while
extending far beyond.
The reasons are many, but can be seen in simple terms within three broad themes. First, women have been singled out for special treatment in the promotion of tobacco. Second, this special treatment is now in a new phase of expansion because women in developing countries are particularly vulnerable to the extension of the tobacco epidemic. Third, women are susceptible to particular health risks from smoking.
According to Margaretha Haglund, who leads the Tobacco Control programme at the Swedish National Institute of Public Health, the expansion of the tobacco industry early this century tackled the social taboos against smoking by women in order to open up a new market.
"In the '20s smoking among women was still considered a habit of scandalous or lower class women, but the period was a time of great change as many women began to move towards social and civic equality. And of course this led to a change in public opinion that converged with the ambitions of the tobacco industry. Pretty soon, tobacco advertising for women appeared on billboards and in magazines and newspapers throughout the US."
The period saw the emergence of a sub-branch of the tobacco industry specifically targeted at women smokers. Traditionally a male preserve, tobacco was adapted for women. New cigarette brands and a whole range of images associating cigarettes with stereotypes of femininity and women's emerging independence began to take hold.
These now strike us as naive and crudely manipulative, but though the content of marketing changed over the decades the mission of recruiting more women smokers has persisted. Now, with declining markets in countries where tobacco use has had its firmest hold, the industry is looking further afield and in doing so is keen to reap the profit potential of growing numbers of women smokers worldwide.
"By exploiting ideas of liberation, power and other key values for women, the tobacco industry is accelerating this process. The same marketing techniques that have been used to promote smoking among women in developed countries are now being applied to women and girls in developing countries, including in central and eastern Europe. The tragic tobacco history among women that started in the US in the late 1920s is now repeating itself in country after country.
"The health toll among women as shown in statistics has lagged behind that associated with smoking among men, reflecting the development of smoking trends between the genders.
"Tobacco use is one of the greatest burdens to the health and well-being of women around the world. At present it kills over half a million women each year, but this is expected to double by 2020. In some countries, lung cancer has already surpassed breast cancer as the main cause of cancer deaths among women."
"When women smoke during pregnancy, there are also serious risks to the unborn baby. And yet in many countries there is still a perception that smoking is mainly a male problem."
"There is a need to frame women's tobacco use and exposure as a major health and social problem, and to build consensus around this issue. Women's organisations, as well as other members of society could be activated to address the problem. It is also important that women's networks on all levels are formed--local, national, and international. This should include the creation of national coordinating bodies that focus on women and smoking."
Margaretha Haglund also heads the European section of the International Network of Women Against Tobacco (INWAT), which brings together some of the world's leading tobacco control advocates, and promotes information exchange and strategies on issues of women and tobacco.
"With coordinated efforts at all levels, we aim to reduce tobacco use among women and girls in developed countries, and prevent it from becoming established in the developing world. Only through these can we avert the next wave of the tobacco epidemic."n
Researchers from the University of Pittsburgh School of Nursing told of a study they conducted to evaluate the efficacy of two smoking programmes tailored to pregnant adolescents: the Teen Freshstart programme used singly and in conjunction with the Buddy programme. The study found that smoking reduction can be achieved using methods that relate well to the adolescents situation. The researchers believe their findings can be used to further programmes carried out by school and clinic nurses to help young pregnant women achieve and maintain smoking cessation.
In France, a project run by the Comite National Contre le Tabagisme aims to reduce smoking among women not only in pregnancy but also after delivery. Some 250,000 French women smoke during pregnancy, and the number is rising especially among young people. The rate of relapse following delivery or in the subsequent months is also high. The Comite has launched an education programme targeting pregnant women, their partners and health professionals to raise awareness of the hazards of smoking during and after pregnancy.
A four-year Dutch programme begun in 1994, run from the University of Limburg's Department of Health Education, aims to evaluate the extent to which smoking cessation during pregnancy can be enhanced and relapse rates diminished after birth. A total of 640 women will have been involved in the programme.
In Bremen, Germany, the Institute for Prevention Research and Social Medicine has carries out a survey and information intervention project. The latter includes, simply, the publication of a booklet, containing a self-help manual for smoking cessation, for use by gynaecologists and obstretricians. The booklet has been used widely.
At the University of Nottingham in Britain, on the other hand, researchers have focused on the problems of relapse after quitting during pregnancy, which, they have found, affects half of women monitored. The study emphasises that "to date there is a lack of successful intervention trials either during pregnancy or in the postnatal period to help maintain quit rates in the long term."
"If women who smoke run a higher risk of dying than male smokers, it makes it more important to reduce smoking in women", said Dr Eva Prescott, who presented the findings of the study at a conference in San Francisco.