Finland has a good tobacco control record demonstrating a fall in tobacco consumption by around a third since the Tobacco Act was launched in 1976.

Yet although overall rates are relatively low, smoking among women, actually increased slightly over the past two decades, and there is no sign of a downtrend. Furthermore, smoking has become much more common among the least educated women in Finland. The increases in women’s smoking may be due to of the change in women’s social position, urbanisation and the influence of the family has a decreased impact. Positive social and cultural connotations connected with a woman smoking may have been considered more important than health when smoking was adopted.

Smoking has also increased among Finnish girls suggesting a future increase in rates of lung cancer among women.

How many women smoke or use tobacco?

• About one in five adult women in Finland are daily cigarette smokers;19% women vs. 26% men which is lower compared to the 25% female average in the western WHO-Europe Region.
• 15% of women continue to smoke during their pregnancy.
• There had been a slow but clear upward trend in smoking over the last two decades, although rates are now stable. Male smoking rates in particular have fallen substantially.
• Smoking is linked with poor education. Smoking rates among the least educated Finnish women have nearly doubled over the last two decades. In 2003, 30% of women with the lowest among of education smoked compared to 20% with a moderate amount of education and 10% among those achieving the highest.
• In 1995, half of women smokers in Finland chose ‘low tar’ cigarettes, compared with a third of male smokers; 55% vs. 36% which provide no additional health benefit.

Smoking among young women

• Regular smoking among girls in Finland usually starts around age 13-15.
• By age 14-18 a quarter of girls are smoking daily and as seen in many European countries, surveys consistently demonstrate slightly higher smoking rates among girls which in Finland is 25% girls vs. 23% boys.
• By age 15, a fifth of girls are smoking every day, and are likely to be as nicotine dependent as adult smokers.
• Since 1993, surveys demonstrate a clear upward trend in smoking among girls.
• A survey in eastern Finland showed increasing rates of starting smoking among girls and young women since the 1970s; particularly more among the least educated groups.
• Finland was the first to develop the ‘smokefree class’ competition, and also piloted school projects as part of the North Karelia community trial.

Health risks

• Every year around 800 women in Finland die as a direct result of smoking. That’s equivalent to nearly seventy deaths every month.
• Around 11,500 Finnish women die of circulatory disease every year, including around 6,400 of ischaemic heart disease.
• In addition, over 400 women die of lung cancer, and nearly 400 of lung disease.
• The annual number of new lung cancer cases among Finnish women is now more than double that in the early 1970s and is still increasing.

Tobacco control

• Finland has a comprehensive range of control measures detailed in the Finnish Tobacco Act of 1976.
• All tobacco advertising and promotion are banned apart from those found in international publications.
• The real cost of tobacco increased substantially during the 1990s, and is now around average for the EU where a typical international brand now ‘costs’ around 29 minutes of average labour.
• Smoking is banned in all public places, workplaces, in theatres and cinemas, and is restricted in restaurants and bars. Environmental tobacco smoke (ETS) must be removed from all work premises, according to occupational safety and health laws. Only where that is not possible, employees must be protected from exposure in some other way.
• Finland classified ETS as a workplace carcinogen. Legislation has proved more effective than voluntary workplace restrictions in reducing passive smoking and have helped to reduce cigarette consumption.
• Overall policy is ‘gender sensitive’. For example, under the Labour Protection Act the pregnant worker must not be exposed to ETS or any other cancer-related substances. They may be assigned to other tasks where exposure is avoided. If this is not possible, they are entitled to special maternity leave and benefits.

Education and support to quit

• The major North Karelia trial showed the impact of community interventions – but this campaign was mainly aimed at men and demonstrated a sharp decrease in smoking and disease rates.
• Finland adapted the US ‘Quit and Win’ contest first as part of the North Karelia Project and then nation wide. These contests have been very popular.
• Some Finnish campaigns have been specially designed for women. For example, the Cancer Society campaign ‘Beauty begins with skin care’ includes a website and other women’s health resources to stop smoking.
• Support for smokers is also widely available through primary care and a national system of specialist clinics.
• Maternity clinics offer pregnant smokers cessation support however, implementation depends on local resources. Most forms of nicotine replacement therapy (NRT) are available without prescription in Finland.
• Increasing rates of smoking among less educated Finnish women suggest the need for gender-specific and long term programmes targeted to reduce health differentials between population groups. There is need for gender-specific community-level research on smoking cessation in different age groups.
  
  9 August, 2004

For more information

• ASH Finland at www.suomenash.fi
• Cancer Society of Finland at www.cancer.fi/, campaign at www.ryppy.net/
• National Quit and Win http://www.lopetajavoita.fi/
• www.tupakka.org
• INWAT (International Network of Women Against Tobacco) www.inwat.org has information related to women and tobacco including:
• “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