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March 29, 2001

Editor of U.S. Surgeon General's Report on Women and Smoking will Speak at UCSF Women's Health Conference

Virginia Ernster, PhD, associate director for epidemiology, prevention and
control at the UCSF Comprehensive Cancer Center and senior scientific editor of
the just- released U.S. Surgeon General's report on women and smoking, will
speak about the tobacco industry's impact on women's health at the upcoming
UCSF Women's Health 2020 Conference, Saturday, March 31.

The report, released Tuesday (March 27) is a comprehensive compilation of
hundreds of studies published on women and smoking. Several years in the
making, it examines patterns of tobacco use among women and girls, factors
influencing women and girls to smoke and efforts to reduce tobacco use among

The report also outlines the devastating consequences smoking has had on women's health, one of the most significant being the dramatic increase in lung
cancer deaths. Lung cancer mortality rates among U.S. women have mushroomed 600 percent since 1950, reflecting increases in smoking rates among women beginning in the 1920s. Last year, 67,600 women died from lung cancer.

"What drives this point home is that in 1987 lung cancer surpassed breast
cancer as the leading cause of cancer death in women," Ernster said. "Last
year, 27,000 more women in the United States died of lung cancer than of breast

This is information that isn't widely known among women. Women should mobilize to raise awareness about lung cancer just as they have done so successfully with breast cancer, Ernster said.

"We need to learn from breast cancer advocates and call attention to lung
cancer as a women's disease," she said. "The leading cause of lung cancer is
smoking and if women didn't smoke, we could eliminate between 85 to 90 percent
of all lung cancer cases in women. Lung cancer was a very rare disease among
women during the first part of the 20th century because few women smoked."

In addition to being a major risk factor for lung cancer, smoking also can
increase the risk for women developing a host of other cancers, including
cancers of the mouth, bladder, pancreas, kidney and cervix. Smoking is also a
major contributor to heart disease, the number one cause of death in American
women. It also can lead to emphysema and bronchitis. Since 1980, about three
million women have died prematurely from a smoking related disease in the U.S.

"Anything that kills as many women from as many diseases as smoking does is
clearly a women's issue," Ernster said. "The tobacco industry has targeted
women. We need to create a strong advocacy community among women. We know the enemy. The enemy is smoking and the tobacco industry. We shouldn't tolerate the targeting of women by the tobacco industry any longer."

While men and women share many of the same smoking related disease risks,
tobacco also causes health problems unique to women. For example, women who smoke have more difficulty becoming pregnant. Other studies show that women who smoke go through menopause at a younger age than non-smokers. In addition, tobacco use causes a modest increase in risk for ectopic pregnancy and miscarriages.

Smoking can also increase the risk of osteoporosis, peptic ulcers, arthritis,
eye disease, facial wrinkling and is associated with depression in women. In
nonsmokers, exposure to environmental tobacco smoke also increases the risk of lung cancer and heart disease.

The report also discusses trends of smoking among women. One of the most
alarming facts is that smoking prevalence has jumped among teenage girls in the
1990s, despite smoking prevention and educational efforts to make the damaging
health effects of smoking well known. Last year, nearly 30 percent of high
school senior girls reported having smoked within the past 30 days.

"Most smokers begin in their early adolescence," Ernster said. "It's fairly
uncommon for people to start smoking after the age of 18."  Overall, about 22 percent of women smoke in the U.S., while about 26 percent of men smoke. These numbers represent a significant narrowing of the gender gap between male and female smokers. In 1965, about 52 percent of men were smokers, compared with 33 percent of women.

Cigarette smoking hasn't always been prevalent among American women, according to the report. While cigarette smoking had increased substantially among men around the time of World War I, it was then still considered socially taboo for women to smoke. But the tobacco industry recognized a huge market for its products in women and started creating advertisements targeted toward this demographic group. One of the first ads during the 1920s featured an attractive man and woman in a romantic moonlit setting. The man is smoking and the woman is looking longingly at the cigarette smoke with a caption that read: "Blow some my way." Other ads promoted the message that smoking would make women thin and glamorous. For example, a slogan for Lucky Strikes cigarettes was:  "When tempted, reach for a Lucky instead of a sweet." The tobacco industry has also has long tried to champion the themes of women's liberation and independence as evidenced by Virginia Slim's slogans: "You've Come a Long Way, Baby!" and "It's a Woman's Thing."

"Cigarette ads depict women smokers as free-spirited, attractive, glamorous and
athletic," Ernster said. "In reality, many women who smoke are victims of
smoking related diseases that are often painful and fatal."

Despite some of the grim statistics about women and smoking, there is hope on
the anti-tobacco front, Ernster said. While just over 20 percent of American
women smoke, close to 80 percent have chosen not to. Smoking prevalence peaked in the 1960s among women and since than has slowly declined. In adult women, the decision to not smoke in is closely tied to higher educational levels.

Moreover, in contrast to the rest of the nation, lung cancer death rates are
now decreasing in women in California, Ernster said. Much of California's
smoking prevention success is attributed to the passage of legislation that put
a tax on tobacco products and banned smoking in public places, such as
restaurants and bars. But the tobacco industry has found other venues for
selling its products, Ernster said.

"As we become more successful in preventing smoking in this country, the
tobacco industry is going abroad to developing countries and to Eastern Europe
in particular, where smoking prevalence among women traditionally has been
lower," she said. "The industry is now trying to recruit those women to
smoking. The writing is on the wall. It will be a tragedy if the smoking
related epidemic now seen among women in developed countries is repeated
elsewhere throughout the world. But it would be a great public health victory
if we can prevent that from happening."

Among the 60 contributing authors were the following UCSF faculty: Neal
Benowitz, MD, professor of medicine at San Francisco General Hospital Medical
Center; Deborah Grady, MD, professor and vice-chair in department of
epidemiology and biostatistics; Sharon Hall, PhD, professor in residence and
vice-chair in the department of psychiatry; Ruth Malone RN, PhD, assistant
professor of physiological nursing; John Wiencke, PhD, assistant professor of
epidemiology and biostatistics.

UCSF News Release

Leslie Harris, (415) 885-7277


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