Smoking harms and kills both men and women, but women face unique and even greater health risks from smoking than men. This Women’s Month, health organisations forming part of the #protectournext partnership, including the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA), the South African Medical Research Council (SAMRC) and the Heart and Stroke Foundation of South Africa (HSFSA), are driving awareness of these risks and encouraging women to quit through the Tobacco: The Ugly Truth campaign.
Although death rates among female smokers were previously thought to be lower than among male smokers for lung cancer, chronic obstructive pulmonary disease and other tobacco-related diseases, women’s risk from smoking has risen sharply, and women who smoke are now as likely as men to die from many smoking-caused diseases. (3) Researchers attribute this increase in large part to a convergence in smoking patterns among men and women, with women starting to smoke earlier in adolescence and smoking more heavily.
In South Africa, 6.9% of women (about 1.3 million) smoke cigarettes, putting them at risk for heart attacks, strokes, lung cancer, emphysema and other life-threatening illnesses.(1) As a result, nearly 7,000 women die of smoking-caused disease each year, with additional deaths caused by the use of other tobacco products such as smokeless tobacco. However, these figures underestimate the direct health burden to smokers, as only those who have died from tobacco related illnesses are counted. Those who are sick or have been exposed to second-hand smoke, a risk many women face with South Africa’s overall high smoking prevalence, are excluded. Nearly 80,000 women were admitted into hospital due to smoking related diseases in 2016.
Smoking reduces a woman’s life expectancy by at least 10 years, on average. Like men, women who smoke have a death rate three times higher than those who never smoked.9 Smoking is a leading cause of cardiovascular diseases, including coronary heart disease, atherosclerosis and stroke, among others.(11) Women smokers have a higher relative risk of developing cardiovascular disease than men. This could be due to tobacco smoke having an adverse effect on estrogen. (13) Women who smoke are twice as likely to suffer a heart attack as non-smoking women, while women who smoke and use oral contraceptives are up to 40 times more likely to have a heart attack than women who neither smoke nor use birth control. (14)
Smoking causes 80 percent of all lung cancer deaths among women.(17) The risk of lung cancer is 25 times higher for current women smokers compared to women who have never smoked - a nearly tenfold increase from 1959.19 While women smoke less than men, many nonsmoking women still suffer increased risk of heart disease (15) and lung cancer (21) from exposure to secondhand smoke because their husbands or partners smoke.
Smoking is also a known cause of cancer of the lung, larynx, oral cavity, bladder, liver, pancreas, cervix, kidney, colon and rectum, stomach, blood and oesophagus. (24) In fact, smoking accounts for one-third of all cancer deaths. (22) Each year, more than 275,000 women are diagnosed with a tobacco-related cancer and more than 145,000 will die from a tobacco-related cancer. (23)
Women who smoke are more likely to have menstrual problems including painful periods, irregular bleeding, missed periods and early onset of menopause. (36) Women smokers tend to take longer to conceive than women nonsmokers, and are at a higher risk of not being able to get pregnant at all. Smoking is known to cause ectopic pregnancy, a condition in which the embryo implants outside the uterus. Ectopic pregnancy is very rarely a survivable condition for the fetus and is a potentially fatal condition for the mother. (26)
Research studies have found that smoking and exposure to secondhand smoke among pregnant women is a major cause of spontaneous abortions, stillbirths, and sudden infant death syndrome (SIDS) after birth. (27) Mothers who smoke have double the rate of premature delivery compared to nonsmoking mothers. (29) There is a clear relationship between the number of cigarettes smoked during pregnancy and low birth weight babies. (30)
Smoking and exposure to secondhand smoke during pregnancy directly increase the risk of health and behavioral problems including: abnormal blood pressure in infants and children, cleft palates and lips, childhood leukemia, infantile colic, childhood wheezing, respiratory disorders in childhood, eye problems during childhood, intellectual disability, attention deficit disorder, behavioral problems and other learning and developmental problems. (31)
Cigarette smoking is a risk factor for osteoporosis and could become a more powerful factor among today’s youth who have begun smoking at earlier ages. Women who are current smokers increase their risk for hip fractures and postmenopausal women who are current smokers have lower bone density versus women who never smoked. (37)
Female smokers increase their risk of death from bronchitis and emphysema by nearly 10 times. (38) Chronic obstructive pulmonary disease (COPD) includes emphysema, chronic bronchitis, and other conditions that damage airways. People with the disease suffer from shortness of breath and lack of oxygen that worsens over time. COPD has no cure. Nearly 9 out of 10 cases of COPD are caused by smoking. Women smokers in certain age groups are up to 38 times more likely to develop COPD than women who have never smoked. More women than men are now dying every year from COPD, and women appear more susceptible to developing severe COPD at younger ages.
Several studies have also linked smoking with worse COVID-19 outcomes. According to a meta-analysis in the Journal of Medical Virology, current and former smokers have a significantly increased risk of developing severe COVID-19 and that former smokers have a significantly increased risk of dying of the disease.
The women most likely to smoke today are among the most vulnerable— those disadvantaged by low income and less education. Women in these groups are also less likely to quit smoking when they become pregnant and are more likely to start smoking again after delivery. This worsens the dangerous health effects from smoking on mothers and their children. The Tobacco Control Data Initiative details the sociocultural factors that influence smoking behaviour in South Africa - including gender norms, wealth and education, attitudes of peers, age, and rural versus urban habitation. Stronger tobacco control measures included in the Control of Tobacco Products and Electronic Delivery Systems Bill will better protect women and children, make it easier for women not to smoke and discourage young women from starting to smoke. It’s time for our people and our government to implement global best practice to curb the onslaught of big tobacco, an industry that profits at the expense of addicted smokers, their families, and public health.
(ENDS)
About Protect our Next: The new Control of Tobacco and Electronic Delivery Systems Bill will make it easier for South Africans to choose smoke-free lives, regulate the danger of e-cigarettes and decrease the impact of second-hand smoke on the majority of the population, who are non-smokers. Tobacco industry profits are at the expense of addicted smokers, their families, and public health. Together, the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA) and the Heart and Stroke Foundation of South Africa are steadfast in campaigning for the new Bill to be passed. It’s time for our people and our government to show leadership in implementing global best practice to curb the onslaught of big tobacco. #protectournext
@protectournext
MEDIA CONTACT:
Tamaryn Brown – tamaryn@cart.agency / tamaryn@connectmedia.co.za
084 3510560
REFERENCES
1 Statistics South Africa. (2017). Mid-year population estimates, 2017. http://www.statssa.gov.za/?page_id=1854&PPN=P0302&SCH=7048 (accessed 11 March 2021).
2 Centers for Disease Control and Prevention (CDC) State System, 2005-2009 Smoking Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) Data. https://nccd.cdc.gov/STATESystem/rdPage.aspx?rdReport=OSH_STATE.CustomReports&rbTopicType=HLT&islTopic=500HLT&islMeasure=5 01SAM.
3 HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.
4 Thun, M, et al. “50-Year Trends in Smoking-Related Mortality in the United States,” New England Journal of Medicine, 368:4, January 2013.
5 HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.
6 HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.
7 CDC, “Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 2000-2004,” MMWR 57(45), November 14, 2008, http://www.cdc.gov/mmwr/PDF/wk/mm5745.pdf.
8 Jha, P, et al., “21st-Century Hazards of Smoking and Benefits of Cessation in the United States,” New England Journal of Medicine, 368;4, January 2013.
9 Thun, M, et al. “50-Year Trends in Smoking-Related Mortality in the United States,” New England Journal of Medicine, 368:4, January 2013. Jha, P, et al., “21st-Century Hazards of Smoking and Benefits of Cessation in the United States,” New England Journal of Medicine, 368;4, January 2013.
10 HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.
11 HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/index.htm. See also, HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.
12 HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004; See also, HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
13 Prescott, E, et al., “Smoking and risk of myocardial infarction in women and men: Longitudinal population study,” British Medical Journal (BMJ)316:1043-7, 1998. See also, HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.
14 HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
15 HHS, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006, http://www.surgeongeneral.gov/library/secondhandsmoke/report/.
16 American Cancer Society, Cancer Facts & Figures 2018, https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-andstatistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf.
17HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014,
http://www.surgeongeneral.gov/library/reports/50-years-of-progress/. HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
18 US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. See also, American Cancer Society, Cancer Facts and Figures, 2014, http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf.
19 Thun, M, et al. “50-Year Trends in Smoking-Related Mortality in the United States,” New England Journal of Medicine, 368:4, January 2013. See also, HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.
20 American Legacy Foundation, “Women and Lung Cancer Survey,” January 2001.
21 HHS, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006, http://www.surgeongeneral.gov/library/secondhandsmoke/report/.
22 HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/. See also, HHS, Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General, HHS Publication No 89-8911, 1989, http://profiles.nlm.nih.gov/NN/B/B/X/S/.
23 CDC, “Vital Signs: Disparities in Tobacco-Related Cancer Incidence and Mortality—United States, 2004-2013,” Morbidity & Mortality Weekly Report, 65(44): 1212-1218, http://www.cdc.gov/mmwr/volumes/65/wr/mm6544a3.htm.
24 HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. See also, HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/. 25 HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
26 HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/.
27 HHS, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, Atlanta, GA: HHS, CDC,
Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health, 2006, http://www.surgeongeneral.gov/library/secondhandsmoke/report/. On spontaneous abortions, see, e.g., Mendola, P, et al.,
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“Effects of Maternal Age, Parity, and Smoking on the Risk of Stillbirth,” British Journal of Obstetric Gynecology 101(4):301-306, April 1994;
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28 CDC, “Births: Final Data for 2019,” National Vital Statistics Reports Volume 70, Number 2, March 23, 2021, https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-02-508.pdf?ACSTrackingID=USCDC_371-
29 HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
30 HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic
Disease Prevention and Health Promotion, Office on Smoking and Health, 2004; HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/. On early delivery, low birth-weight babies, and growth problems after birth, see, e.g., Wiborg, K, et al., “Smoking During Pregnancy and Pre-term Birth,”
British Journal of Obstetrics and Gynaecology 103(8):800-05, August 1996; Dejin-Karlsson, E, et al., “Does Passive Smoking in Early
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31 On abnormal blood pressure in infants and children, see, e.g., Morley, R, et al., “Maternal Smoking and Blood Pressure in 7.5 to 8 Year
Old Offspring,” Archives of Disease in Childhood 72(2):120-24, February 1995; Blake, KV, et al., “Maternal Cigarette Smoking During Pregnancy, Low Birth Weight and Subsequent Blood Pressure in Early Childhood,” Early Human Development 57:137-147, 2000. On cleft palates and lips, see Nagourney, E, “Consequences: Linking Cleft Palates and Smoking Moms,” New York Times, April 12, 2000 [citing recent study in Plastic and Reconstructive Surgery, the Journal of the American Society of Plastic Surgeons]. On childhood leukemia, see, e.g.,
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First 18 Months of Life,” American Journal of Respiratory and Critical Care Medicine 52(3):977-83, September 1995; Lux, AL, et al., “Wheeze
Associated with Prenatal Tobacco Smoke Exposure: A Prospective, Longitudinal Study,” Archives of Disease in Childhood 83:307-12, October
2000. On eye problems, see, e.g., Hakim, RB & Tielsch, JM, “Maternal Cigarette Smoking During Pregnancy: A Risk Factor for Childhood
Stabismus,” Archives of Opthalmology 110(10):1459-62, October 1992. On impaired intellectual development, see, e.g., Frydman, M, “The
Smoking Addiction of Pregnant Women and the Consequences on the Offspring’s Intellectual Development,” Journal of Environmental
Pathology, Toxicology and Oncology 15(2-4):169-72, 1996; Olds, DL, et al., “Intellectual Impairment in Children of Women Who Smoke During Pregnancy,” Pediatrics93(2):221-27, 1994 . On developmental and behavioral problems, including criminality, see, e.g., Milberger, S, et al., “Further Evidence of an Association Between Maternal Smoking During Pregnancy and Attention Deficit Hyperactivity Disorder: Findings from a High-Risk Sample of Siblings,” Journal of Clinical Child Psychology
27(3):352-58, October 1998; Orlebeke, JF, et al., “Child Behavior Problems Increased By Maternal Smoking During Pregnancy,” Archives of
Environmental Health 54(1):15-19, 1999; Fergusson, DM & Horwood, LJ, “Prospective Childhood Predictors of Deviant Peer Affiliations in Adolescence,” Journal of Child Psychology and Psychiatry 40(4):581-92, May 1999; Orlebeke, JF, et al., “Increase in Child Behavior Problems Resulting From Maternal Smoking During Pregnancy,” Archives of Environmental Health 52(4):317-21, 1997. 32 HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/. See also, HHS, Let’s Make the Next Generation Tobacco-Free: Your Guide to the 50th Anniversary Surgeon General’s Report on Smoking and Health, 2014, http://www.surgeongeneral.gov/library/reports/50years-of-progress/consumer-guide.pdf.
33 HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
34 Djordjevic, MV, et al., “Nicotine Regulates Smoking Patterns,” Preventive Medicine 26(4):435-40, 1997. Farrow, DC & Samet, J, “Identification of the high risk smoker,” Clinics in Chest Medicine 12(4):659-68, 1991.
35 HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
36 HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
37 HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
38 HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
39 HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
40 Jha, P, et al., “21st-Century Hazards of Smoking and Benefits of Cessation in the United States,” New England Journal of Medicine, 368;4, January 2013.
41 HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.
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