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Overview - key points

How much are women smoking?

Smoking among European women has risen greatly since World War II, following the wave of smoking among men.

Rates may still be rising in some groups, such as younger women in southern and eastern Europe.
Overall prevalence may be falling slowly, but the gap between men and women is closing.
Women’s rates peak as this gap becomes small, as in Nordic and western countries, and tobacco use is then linked to disadvantage.
In many western European and Nordic countries girls are more likely to smoke than boys.
Smoking rates remain high among older women in some countries, but there have been few specific projects.
Action point - promote and share research on how smoking rates change in different social and political cultures.

What are women smoking?

In 1988 three-quarters of European women chose ‘blond’ filter cigarettes, compared with just over half of men.
By 1995 half also chose ‘Light’ or ‘low-tar’ brands, particularly those women with health concerns, compared with less than a third of men.
The tobacco industry has promoted ‘Lights’ as more feminine and less risky, which may discourage quitting.
Yet ‘Lights’ offer little health benefit, and may pose extra risk.
Other additives may also increase risk, or increase addictive potential.
Action point - promote legislation on product control, and publicise risks of ‘low tar’ brands, and other tobacco toxins and additives.

Risk of illness

Every year smoking claims the lives of around 200,000 European women. This includes over 100,000 in the EU, which represents a doubling from 1975-95
Estimates suggest that, among women who start smoking regularly as teenagers, around half will die as a result of tobacco use.
Smoking-related deaths are mainly from cardiovascular disease (81,000 attributable across Europe in 1995), cancers (55,000 attributable), and respiratory disease.
Lung cancer rates are generally rising everywhere, reflecting smoking some 25 years ago.
Poorer women have greater risk of disease, due both to higher smoking rate and other disadvantage.
Individual quitting brings short and long-term benefits, even for older women.
Action point - promote research on specific health risk and benefit, and how smoking interacts with disadvantage in creating ill-health.

Sexual health

Smoking is linked to many sexual health problems, from period pain to early menopause.
Women smokers suffer more gynaecological problems, low fertility and miscarriage. Low infant birthweight increases perinatal mortality.
Smoking also has major impact on child health, increasing risk of sudden infant death, respiratory problems and ear infections.
Few pregnant smokers are able to quit, especially among poorer women, but Scandinavian projects have had some success.
Women smokers who use oral contraceptives have greater risk of arterial disease.
Early menopause among smokers increases risk of arterial disease and osteoporosis.
Action point - build on strong interventions, and develop a co-ordinated approach from teenage years to early motherhood.

Health and well-being

Smoking is linked to a range of conditions which limit physical health.
Dental, musculoskeletal, and sensory problems may bring substantial health care costs.
Poor reported health and early ageing are also linked to tobacco use.
Yet smoking plays many roles for women, and may be seen as a source of well-being.
Poor mood is strongly linked to smoking and risk of relapse, especially for women.
Women who stop eventually benefit from stress levels below those of continuing smokers.
Action point - promote strategies to increase emotional health for populations and individual smokers.

Environmental tobacco smoke (ETS)

Many women are exposed to other people’s smoke at home, work or in public places.
Protection from ETS is both a civil rights and health and safety issue.
Lung cancer, heart disease and other smoking-related conditions are causally linked to ETS, and women may be at greater risk.
Child health is also put at risk, but timely information on ETS may help prevent relapse after pregnancy.
ETS is a key issue in public attitudes to smoking, and women especially support restrictions.
However few policies are in place, and restrictions are often ignored.

Action point - promote policies which are sensitive to local cultures and women’s needs, within national and regional guidelines.

Other campaigns

Control of product content, appearance and sales is important within a comprehensive strategy.
Tax has a key population role, but the evidence on particular groups of women and girls is unclear.
Promotions also keep populations smoking, with some particularly targeting women. New EU regulations may reduce tobacco consumption by around 7% on average.
Yet positive media images, new marketing techniques, and heavy promotion outside the EU will continue to attract new women smokers.
Campaigns against poverty may have long-term potential, but demand a different approach to ‘health work’.
Action point - promote development of co-ordinated strategy, at European, governmental and local level.

Stopping smoking

Brief health service advice and unpaid media may be key population strategies.
Use of NRT or buproprion (Zyban) roughly doubles success rates, but treatment may not be accessible.
A ‘stepped care’ approach promises more effective targeting of services.
Women are as likely to quit as men, but may respond differently to nicotine withdrawal.
Control of mood and weight, and social support are key issues.
Poorer women tend to be more nicotine dependent.
Most, but not all, projects for pregnant women have had limited success.
Action point - develop and share information on how women respond to different cessation services, and to media and community campaigns.

Young women and smoking

Smoking at an early age damages current health, increases risk of later disease, and establishes nicotine dependence..
Research is difficult, since smoking behaviour may vary greatly both for individual youngsters and between age groups.
However, in many European countries more girls now smoke than boys.
This gap is not understood, though girls and boys may use smoking in different ways.
The principles of prevention are becoming clearer, but few school projects do more than delay regular smoking.
A broader approach may be needed, including tobacco control measures, and community wide interventions.
Action point - share information on promising control strategies.

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