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Tobacco and Women: Trends and Strategies for Quitting

Susan C. Stewart, M.D.

At the beginning of the twentieth century, if an American woman smoked a cigarette it was considered disgraceful behavior. Some localities even enacted laws to prohibit women from smoking in public. It was not until the 1920s and 1930s, when female leaders in society--debutantes and college women--were persuaded to smoke in public, that the headlong rush to smoke began.(1) By the 1960s, over 30% of the female population smoked. Many thought that women were not susceptible to smoking-related illnesses, like lung cancer, that were seen in men. What they did not realize was that men had had a 30-year headstart towards tobacco-related disease and death. In 1987 the death rate from lung cancer in women surpassed that of breast cancer, the most common cancer in women. Since 1987, the lung cancer death rate has been steadily rising.(2)

Figure 1.

Cancer Death Rates* Among Women, by Cancer Site -- United States, 1930-1991.
*Rates are adjusted to the 1970 census population.
Source: American Cancer Society.

Even before the first Surgeon General's report on smoking related illnesses (1964) was released, the number of male smokers in the U.S. was already decreasing. In the mid 1950s, close to 55% of the male population smoked; by 1993 it was 32%. On the other hand, in the mid 1950s, 25% of women smoked. The incidence actually increased to 35% in the early 1960s and then started a slow downturn, eventually paralleling males in the early 1980s (Fig. 2).

Figure 2.

Percentage of Adults Age = or >18 Years Who Are Current Cigarette Smokers,* by Sex -- United States, 1955-1993.
*Estimates since 1992 incorporate some-day smoking.
Source: Current Population Survey, 1995; National Health Interview Surveys, 1965-1993.

There are a few hopeful signs among young people. As opposed to the trend in the 1930s, college-bound young people are less likely to smoke. It is also true that the smoking incidence is lower in adults with the most years of formal education (Fig. 3).

Figure 3.

Percentage of Women Age = or >25 Years Who Are Current Cigarette Smokers,* by Education -- United States, 1965-1993.
*Estimates since 1992 incorporate some-day smoking.
Source: National Health Interview Surveys, 1965-1993

Another trend is a sharp decrease in smoking by young African-American women (Fig. 4.(2)

Figure 4.

Percentage of Female High School Seniors Who Are Daily Smokers,* by Race -- United States, 1976-1992.
*Smoking one or more cigarettes per day during the previous 30 days. Estimates are based on two-year floating averages.
Source: Institute for Social Research, University of Michigan, Monitoring the Future Project.

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