Belgium has taken the lead in several tobacco control areas, including becoming one of the first countries to ban the misleading terms ‘light’ and ‘mild’ on cigarette packages. But tobacco control is hampered by a low level of funding and the division of responsibility between the national government and the Walloon (French-speaking) and Flemish (Dutch-speaking) governments. Smoking rates among women in Belgium are similar to the European average. The poorest women are much more likely to smoke and thereby increase their chance of ill-health.

How many women smoke or use tobacco?

• Just under a quarter of women in Belgium are daily cigarette smokers; 22% women vs. 33% men. This rate is lower than the western part of the WHO-Europe Region which is 25%.
• Smoking prevalence differs by region. In the Brussels area, nearly three in ten women smoke, In the Walloon provinces, around a quarter of women smoke and in Flanders the rate is slightly fewer than 25%.
• Less than one in five women smoke during pregnancy; one in eight during late pregnancy. However, this smoking rate nearly doubles following childbirth.
• Poorer women are much more likely to smoke than the wealthier. For example, among pregnant women, the poorest women are five times as likely to smoke as the most affluent.
• Between the early 1980s and early 1990s overall smoking prevalence fell by a third; a notably a shaper decrease among men than among women. Since 1994, smoking rates in Belgium fluctuated between 30%-36% for men and 19%-27% for women.
• The highest smoking rate, 42%, is seen in women between the ages of 35-44. Among these women, 39% smoke on a daily basis. Adult women over the age of 65 have the lowest smoking rate which is 10%.
• Women in Belgium generally smoke less than men and are more likely to choose ‘low tar’ cigarettes which provide no additional health benefit.

Smoking among young women

• Weekly smoking among girls in the Flemish Community starts at the age of 11 and 12 but is very low at 1%. Smoking becomes more common at the age 13 and 14 where 4% of girls smoke at least 1 cigarette per week but, are still not smoking on a daily basis.
• In the Flemish region, 5% of girls between the ages of 15 and16 are weekly smokers. Yet nearly 18% of Flemish girls between the ages of 15 and 16 are smoking every day. This daily smoking rate jumps to 27% among those girls aged 17 and 18. Smoking every day suggests that these young women are likely to be as nicotine dependent as adult smokers.
• Since 1998, there has been a small downward trend in smoking among girls. Daily smoking among 15 and 16 year old girls fell by 5% between 1998 and 2000 but increased by 3% between 2000 and 2002. Daily smoking among 17 and 18 year old girls decreased between 1998 and 2000 by 1% and between 2000 and 2002 by another 2%.
• Educational projects include:
  • The Flemish interactive exhibition ‘S.O.S. SMOOR’,
  • The ‘smokefree class’ competition - with participation rising every year
  • The CD-ROM class activity for 12-14 year olds and
  • Guidelines to create a non-smoking school policy.
• The Flemish Institute for Health Promotion has co-ordinated a project with the European Network on Young People and Tobacco (ENYPAT) to look at gender differences in smoking among young people. The report is available at www.ktl.fi/enypat/gender_report.htm

Health risks

• In 1995, an estimated 2,400 women in Belgium died as a direct result of smoking. That’s equivalent to 200 deaths every month. The number of smoking-related deaths among women has risen steadily from approximately 300 during 1955.
• In 2001, a total of 1,186 Flemish women died of smoking, including 333 from lung cancer, 318 from chronic obstructive lung disease and 209 from heart and vascular diseases.
• The death rate from lung cancer has risen steadily among women in Belgium; nearly doubling from 1980 to 1995.
  

Tobacco control

• In Belgium, the national government is responsible for legal and economic aspects of tobacco control. In January 2004, the Federal Minister of Public Health presented in a plan for tobacco control, but the measures have not been realised yet.
• There is no national comprehensive policy on tobacco control however; there are laws on advertising, production, packages and sale of tobacco and smoking in public places and on transport.
• A National Coalition against Tobacco was established in 1995 to implement a national strategy. However, most of the work to be done includes lobbying for more funds as each year Belgium spends only 0.25 Euro per person on tobacco control.
• The governments of the Walloon and Flemish communities are responsible for education and support for smoking cessation.
• Belgium has seen no consistent increase in real price of tobacco. A pack of cigarettes ‘costs’ around twenty minutes of average labour.
• Belgium would have been one of the first EU countries to completely ban tobacco advertising in 1999 if it had not been for a ruling deleted two key regulations. Presently, direct advertising is now banned except at point of sale, indirect advertising is permitted and sponsorship of global events ended in 2003.
• Smoking is still allowed in restaurants and bars ensuring there is a ventilation system and a smokefree area in larger premises.
• There are no specific laws on smoking in the workplace leaving employers responsible for resolving disputes over smoking at work. As every worker has the right to a smokefree workplace, a new law banning smoking in the workplace has been proposed and has yet to be approved. Exceptions include: restaurants and bar workers, people working in homes of others and those working outdoors.
• Belgium was one of the first countries in Europe to ban the use of misleading terms ‘light’ and ‘mild’, which appeal particularly to women. Furthermore, cigarette packages sold in Belgium contain clear and large health warnings covering on average 55% of the front and back.
  

Education and support to quit

• Past campaigns have focused on women, for example the awareness raising campaigns ‘Less smoke … more woman’ and ‘Mummy smokes’, which were developed to encourage women to stop smoking for their own sake.
• Support materials for health professionals include the action pack ‘Smokefree pregnancy’ and most recently ‘Pregnancy and Smoking’.
• Support for smokers is available through a number of organisations and professional groups. Flemish smoking cessation guidelines have been produced.
• On of June 1st 2004, a Belgian quitline "Tabak Stop Lijn" was launched (070 227 227), to provide information and advice on smoking cessation. The line is a realisation of the Belgische Federatie tegen Kanker.
• General practitioners are being encouraged to offer brief advice and ‘motivational interviewing’ to help their patients to stop smoking. Smoking cessation groups and individual counsellors provide more intensive support.
• General practitioners, gynaecologists and the national group ‘Child and Family’ assist pregnant women and their families to quit smoking. But relapse rates are high, particularly among poorer women.
• The group FARES was involved with the - European Action on Smoking Cessation in Pregnancy (EURO-SCIP) project.
• Buproprion and nicotine replacement therapy (NRT) are becoming increasingly popular. Nasal spray and inhaler are only available with prescription.
  
  13 July 2004

For more information

• Tobacco Prevention Unit, Flemish Institute for Health Promotion - Vlaams Instituut voor Gezondheidspromotie - http://www.vig.be/
• Belgian Cancer Foundation - Belgishe Federatie tegen Kanker - http://www.kanker.be/
• Flemish League against Cancer - Vlaamse Liga tegen Kanker - http://www.tegenkanker.net/
• F.A.R.E.S.- Fondation pour la prévention des Affections Respiratoires et l'Education à la Santé - http://www.fares.be/
• “Women and Smoking: a Report of the Surgeon General”
  US Dept of Health and Human Services. 2001
• “Women and the Tobacco Epidemic” WHO Geneva: World Health Organisation. 2001