Smoking and women: tragedy of the majority

N Engl J Med. 1987 Nov 19;317(21):1343-5. doi: 10.1056/NEJM198711193172108.


PIP: An increasing number of women are becoming victims of their smoking habit. A broader cross-section of women, other than the very rich and the "indecent," began to smoke in the 1920s, and over the past 50 years tobacco advertising has linked smoking with women's emancipation and achievement of equality with men. The marketing efforts directed to women include special packaging for feminine appeal, "designer" cigarettes, and offering discounted women's products with the purchase of a particular brand of cigarettes. Sponsorship of sporting events coupled with sports themes in cigarette advertisements associates smoking with enhanced physical capacity--a deception. The marketing experts promote smoking as a way of remaining slim in a culture obsessed with thinness. The woman who smokes today is a heavier smoker, on average, with the percentage of women smoking more than 25 cigarettes/day almost doubling from 13% in 1965 to 23% in 1985. Women start smoking at younger and younger ages. 84% of women smokers who are now 28-37 years began to smoke before age 20 as compared with 42% of those now 58-67 years. Today more young women than young men smoke. In addition to the risk of lung cancer, women who smoke also have sex-specific risks, such as those pertaining to a women's reproductive organs and processes. When smoking is of long duration, it appears to increase the risks of intraepithelial neoplasia of the cervix and of invasive cervical cancer. An antiestrogen effect of smoking may provide the explanation for why smoking women reach menopause 1-2 years earlier than nonsmokers. The same mechanism, which has been supported by several case-control studies, may increase postmenopausal osteoporotic fractures, particularly among nonobese women. Possibly the worst consequences of smoking by women are its effects on reproduction and on children. Both a dose-response depressant effect of smoking on fetal development and birth weight have been confirmed. Smoking also reduces fertility, increases the rate of spontaneous abortion of chromosomally normal fetuses, and increases the incidence of abruptio placentae, placenta previa, bleeding during pregnancy, and premature rupture of the membranes. A growing body of evidence also suggests that smoking during pregnancy has longterm effects on children. Those organizations at work to promote the rights of women might consider devoting some attention to help women stop smoking.

Publication types

  • Editorial

MeSH terms

  • Coronary Disease / etiology
  • Female
  • Humans
  • Neoplasms / etiology
  • Smoking / adverse effects*
  • Smoking / psychology
  • Women / psychology*