What are the effects of smoking on women?

Risk Factors

Despite numerous media campaigns and medical efforts to educate the general population on the health hazards of cigarette smoking, the percentage of smokers still remains relatively high. According to the Centers for Disease Control and Prevention (CDC), in 2013, slightly more than 15 percent of all adult women in the United States (or fifteen out of every one hundred ) smoked cigarettes on a regular basis. Furthermore, the CDC reported that almost 30 percent of high school females in 2014 smoked some form of tobacco product, which included traditional cigarettes, e-cigarettes, and hookahs. Teen girls are more likely to have peers and /or parents or family members who smoke, thereby promoting the activity as normal.

Most women smoke cigarettes rather than pipes or hookahs, but cigar use is becoming more widespread. Women in general begin smoking for a number of reasons, many of them social and cultural. Many young women start smoking because they believe it to be a weight-loss tool, because they are using it as a means to rebel against authority figures such as parents or teachers, and/or because of peer pressure or depression. Men typically begin smoking to obtain a popular social status or to manage stress. Male athletes tend to chew smokeless tobacco rather than smoke cigarettes or electronic cigarettes.

Educational and ethnic disparities exist among female smokers. Cigarette smoking is more common among females who do not have a high school or a college diploma. Women in the United States and other developed countries are more likely to smoke than women in developing countries. Women of non-Hispanic American Indian and Alaska Native descent have the highest rates of smoking (26 percent) when compared with women of Asian (9.6 percent), Hispanic (12 percent), African American (18 percent), and Caucasian (19 percent) backgrounds.

Health Concerns

The original studies of the 1960s documenting the health hazards of smoking were based solely on men because they were the predominant cigarette smokers of that era. As it became more socially acceptable for women to smoke in public, health experts came to recognize that women were experiencing health effects, such as lung cancer, which were similar to those of men; however, women also were experiencing previously unrecognized health concerns specific to women.

The US Department of Health, Education, and Welfare (now the Department of Health and Human Services) reported on these effects in 1980s, as the US surgeon general issued the first groundbreaking report on the matter. Since this report was released, a wealth of new medical and scientific research has accumulated, showing, for example, that the health effects of cigarette smoking on women differ from men because of gender differences in body physiology and genetics. It has been suggested that women and men have different genetic predispositions to both initiating cigarette smoking and to developing gender-specific, smoking-related medical problems.

In 1991, the National Institute for Occupational Safety and Health, which is part of the Centers for Disease Control and Prevention, released a report that publicized the dangers of secondhand smoke and claimed that even nonsmoking individuals were at risk from the dangers of smoking if they were exposed to what was termed "passive smoking." The report was part of the trend at that time that advocated for the banning of smoking in public places.

The most common health concern in smokers of either gender is lung cancer. According to the CDC , the incidence of lung cancer was the leading cause of cancer death among women in 2014 at 36.4 percent. Breast cancer deaths accounted for 21.3 percent that same year. Smoking more frequently and for a long time increases the risk for developing lung cancer. The risk also exists for other lung diseases, such as chronic obstructive pulmonary disease (COPD), emphysema, and chronic bronchitis. While once thought to not be a risk factor, several studies and the US Surgeon General report that there is suggestive evidence that smoking and exposure to secondhand smoke play a role in the development of breast cancer. The risk is highest among certain groups, such as women who started smoking before they had their first child. Women smokers are also at increased risk for developing cancer of the cervix, bladder, mouth, larynx, pharynx, pancreas, esophagus, and kidney and for acute myeloid leukemia.

In 2015, the CDC announced that cigarette smoking was the leading preventable cause of death in the United States and increases the risk for death from all causes. The second largest health danger among female smokers is the risk for cardiovascular disease, including coronary artery disease (CAD), stroke, other aneurysms, and peripheral vascular disease. Women who smoke have twice the risk for CAD as nonsmokers. The younger the woman, the more likely CAD is related to smoking; the risk for CAD is higher for heavy, long-term smokers.

Women who smoke and who take oral hormonal birth control pills have a higher risk for CAD, including blood clots, heart attacks, and strokes. The risk with oral contraceptives is even greater if the woman is older than thirty-five years of age; therefore, smoking is a contraindication to this form of birth control after this age.

Effects on the Menstrual Cycle and Pregnancy

All women who are planning on conceiving or who are pregnant should discontinue cigarette smoking because of the scientifically established consequences on fertility and the developing fetus. Even with these risks, approximately 10 percent of women, especially teens and younger women, continue to smoke during pregnancy.

On average, women smokers take longer to conceive than do nonsmokers, both because of infertility and because of irregular menstrual cycles. Menstrual cycles may be absent or abnormal. Smokers experience a decrease in ovulation, impairment of fertilization, and reduced implantation rates of the embryo in the uterus. Smokers also tend to have more vaginal infections.

When pregnancy is achieved, smokers have an increased risk for a miscarriage, stillbirth, or ectopic pregnancy because the tobacco chemicals, including nicotine, are transmitted to the fetus. Additional adverse pregnancy outcomes include a risk for low birth weight and preterm delivery. Maternal smoking also can cause a newborn or infant to have reduced lung function; this is observed with both prenatal and postnatal exposure. If a woman smokes during pregnancy, the nicotine inhaled will be detected in a newborn’s bloodstream, and the newborn may go through nicotine withdrawal after delivery.

Smoking also is discouraged during breastfeeding because of the transfer of nicotine through breast milk. A newborn exposed to nicotine also is at an increased risk of sudden infant death syndrome. Overall, a fetus exposed to cigarette smoking in utero or a newborn exposed to secondhand smoke in the household has a higher risk of developing a common cold or other illness such as asthma or ear infections. Even though many women use their pregnancy as motivation to quit, a significant percentage resumes smoking after delivery.

Smoking also affects women before and in menopause. Women smokers enter menopause at a younger age than nonsmokers and may have more symptoms. They have decreased bone density, which places them at an increased risk for fractures. Older women have a greater chance for cataract development or rheumatoid arthritis. Women who smoke also tend to develop more skin wrinkles than do nonsmokers. Finally, lower levels of estrogen are noted in smokers.

Prevention and Smoking Cessation

As women are now smoking for longer periods of time and in greater amounts, cigarette smoking has become a well-established risk factor for increased mortality. The US Centers for Disease Control and Prevention reports that cigarette smoking contributes to the deaths of an estimated 178,000 women in the United States annually. If smoking is discontinued, especially at a younger age, this risk decreases dramatically. Additional education on the prevention or discontinuation of cigarette use is critical.

Studies indicate that a majority of women want to quit smoking but either do not know how or feel they cannot do so because of stress, anxiety, or depression. Treatments for women to help them cope with a possible underlying psychological diagnosis or stressor are necessary for optimal outcome. Nicotine replacement therapies have been more successful in women than in men.

It also is recommended that women quit smoking at a specific point of the menstrual cycle. The urge to smoke is greatest during the time of premenstrual symptoms, so discontinuing use after these symptoms have subsided shows greater success.

Specific websites and support groups for women are now abundant. As with the overall general population, continued medical, media, and school involvement is key to educating girls and women about smoking and its consequences.

Bibliography

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Hamajima, N., et al. “Alcohol, Tobacco, and Breast Cancer—Collaborative Reanalysis of Individual Data from 53 Epidemiological Studies, Including 58,515 Women with Breast Cancer and 95,067 Women Without the Disease.” British Journal of Cancer 18 (2002): 1234–45. Print.

"Smoking and Tobacco Use: Youth and Tobacco Use." CDC. Centers for Disease Control and Prevention/US Dept. of Health and Human Services, 14 Oct. 2015. 3 Nov. 2015.

"Tobacco Use and Pregnancy: How Does Smoking During Pregnancy Harm My Health and My Baby?" CDC. Centers for Disease Control and Prevention/US Department of Health and Human Services, 9 Sept. 2015. Web. 10 Nov. 2015.

US Department of Health and Human Services. The Health Consequences of Smoking for Women: A Report of the Surgeon General. Washington, DC: DHHS, 1980. Print.

"What are the Risk Factors for Breast Cancer?" Cancer. American Cancer Society, 19 Aug. 2015. Web. 10 Nov. 2015.