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ED208295.Pdf DOCUMENT RESUME ED 20,B 295 cc015 465 AUTHOR Pinney, John M., Ed.:' And Others . TITLE The Health Consequendes of Smoking for. Women. A Report, of the Surgeon General 1979. 'INSTITUTION Public Health Service (DHHS), Rockville, Md. PUB DATE .(79] NOTE 356p. BDRS PRICE MF01/PC15 Plus Postage. DESCRIPTOR, BehaVior, Patterns; *Cancer; *Females; Health Materials; *Heart Disorders;-*Physical Health; Pregnancy; Prenatal Influences; Prevention; Psychological Patterns;,*Smoking:. Tobacco ABSTRACT, This report focuses on the evidence about the health .consequences of smoking for women, and is intended to serve.the public health and medical communities as 'a unified source of existing scientific research. The major issues about tobacco use and women's health are examined, including trends in consumption, biomedical evidence, and determinants of smoking ititiation, maintenance, and cessation. The biomedical aspects ofsmoking are presented in terms of mortality, morbiplity, cardiovasculaidiseases, cancer, pregnancy and infant,health,, Teptic ulcer disease, drug reactions and , interactions, food constituents, and responses to,diagnostic tests. The psychosocial and behavioraj. aspects, of smoking in women are discussed, along with the docffiented increases in- the risk of contracting lung cancer, heart,disease, or lung disease. The harmful effects of pregnant mothers smoking behaviors, are also docudented. Adhitionally, recent data are enumerated to indicate a trend of ,decreasing tobacco usage among women in response to the warnings of the gavernMent, voluntary agencie, and physicrins. (Author /NRB)' ************4*********************************************************. * Reproducions supplied by EDRS are the best that can be wade 10' from the original document. *) 0**************J4**************************************************** t-r\ THEHEALTH s.).; CONSEQUENCES If, Or SMOKING " FOR WQMEN La vi eteport of the Surgeon General 1979 US DEPARTMENT OF EDUCATION NATIONAL INSTITUTE OF EDUCATION EDUCATIONAL RESOURCES INFORMATION CENTER ,ERIC) 7Pe> bocumsnt ors ben rppo4uCe-0 rs rwceNed 1111 pf,..c,rirorcon,13,,A. cgrQ,,,)tnq rt 7%1'4°0' male ,T0Ove fOrnf,(1.1(tron clulhry If) '%0 Pests ,Tpd m h (TWIT de) E,r,,snt off caI NIE -.7' v 4LC) O CO C) J U S DEPARTMENT OF HEALTH AND HUMAN SEPVI Pubiu ifedith Serv,co Office of the Assistant Soc rotary for HPaIth Office on Smoi,-or) and Heatth . ti Tp4C C-"AEARY OF .E.PAPE NSSN C < 0 t1 The Honorable Thomas P, O'Neill,Jr. 1 Speaker of the House of Representatives 'Washington,. D.C. 20515 Dear Mr. Speaker: I hereby submit to 12th annualreport that the Department of Health,,Edudation, andWelfare (DHEW) has prepared for Congress as required bythe Public Health Cigarette Smoking Act Of 1969, PublicLaw 91-222, and its predecessor, the Federal CigaretteLabeling and Advertising Act. This report'is one of themost alarming in the series. Jok, -tt clearly establishesthat women smokers face the same nisks aS"'"Me...n smoker's of lungcancer, heart disease, lung disease and other consequences. Perhaps more disheartening is the Harm which mothers' smokingcauses to their unborn babies -and infants. , The report is not all badnews. It presents recent data showing that women are turningaway from smoking in' response to the warnings of government, voluntaryagencies and physicians. The precipitate rise in women'sdeaths from lung cancer and chronic lung diseasedemand that this trend away from cigarettes be accelerated. Our scrintists expect that by 1983, the lung cancerdeath-ratewill exceed.thatof any other type of cancer among women. Citigens of our free societymay decide for themselves whether to sMoice cigarettes. The health consequences of this decision make it imperativefor their government to assure that the decision is a informed one. This series /of reports is one way in which EW is striving to meet this critical. responsibility. e% your S_1_ Patricia Roberts Harris tr PREFACE This report is more than a factual review of the health conse-* quinces of smoking for women. It >i a document which, chal- lenges our society and, in particular, our medical and public health communities. T is report points out that the first signs of an epidemic of smo g-related disease among women are now appearing. Be- cause women's cigarette use did nut become widespread untili the onset of World War II, those women with the greatest inter sity of smoking are now only in their thirties, forties, and fiftie. As these women g-rc lder, and continue to ,smoke, their bur- den of smoking-rel sease-will grow larger. Cigarette smok- ing now contributes one -fifth of the newly diagnosed cases of cancer and one-quarter" or all cancer deaths arming wpmen more cancer and more cancer deaths among women than can be attributed to any other kriown agent. Within three years, the lung cancer death rate is expected to surpass that for breast cancer. A similar epidemic of chronic obstructive lung disease among women has also begun. Four rfrain themes emerge from this report to guide future public kiealth efforts. First, women are not immune to the aamaging effects cif smoking already documented for men. The apparently lower ,susceptibility to smoking-related diseases among women smok- ers is an illusion reflecting the fact that women lagged one quarter century behind men in thew Ividespread.use of cigar- ettes: Second, cigarette smoking ismajor threat to the outcome of pregnancy and tvell-being of the newborn baby. Third, women may not startsmoking, continue to smoke, quit smoking, or fail to quit smoking for precisely the same reasons as men. Unless future research clarifies these differences, we will find it difficult to prevent jnittation of to prvote oessation of cigarette smoking among women.' t 'Fourth, the reduction of cigvarette smoking is the keystone in our nation's long term strat to promote a healthy lifestyle for women and men of all race and ethnic groups. The Fallacy of Women's Immunity All of the major prospective studies of smpking and mortality have reached consistent conclusions.Death rates from coronary heart disease, chronic lung disease, lung cancer, and overall mortality rates are significantly increased droungouth women and men smoky-s. These risks increase 'with the amount smoked, duration of smoking, depth of Inhalatioh, and the "tar" V and nicotine delivery of thecigarette smoked. In these studies, conducted during the past threedecades, relative mortality risks among female smokers' appearedto be less than those of male smokers. Itis now clear, however, that these tudies were comparing the deathrates of a generation of establNhed, lifelong male smokers witha generation of women who had not yet taken up smoking ;cab fullintensity Even those older women whu reported smokinga large number of cigarettes per day .1-iad not smoked cigAettesin the same way as.' their male counterparts. Now that thecigarette smoking char- acteristics of women and men are becoming increasinglysimi- lar,' their relative risks of smoking-related illnes become increasingly similar. This fallacy of women's apparentimmunity is clearly illus- trated by differences in the timing of the growthin lung cancer among men and worm in this century. Lungcancer deaths amon.gmales began to increae during the 1930s,as those men who had converted from other forms oftobacco to cigarette smoking before the turn of the century gradually ac'cumglated decades of inhaled tobaccoexposure. By the time of the first retrospective studies of smoking and lungcancer in 1950, two entire generations of men had already become lifelongcigarette smokers. Relatively few women from th,esegenerations smoked cigarettes, and even fewerialad smoked cigarettessince their adolescence. Those young women who had takenup smoking intensively duxing World War IIwere only in their twenties and thirties. In 1950, women accounted for less than.one in twelve deaths from lung cancer. Thereaftej, the age adjusted lungcancer death rate among women accelerated, and the male predominancein lung cancer. declined. Lung cancer surpasseduterine cervical cancer as a cause of death in women. By 1968, as the findings ofmany large population prospective studieswere being published, women akounted for one-sixth of all lungcancer deaths. These studies found that women cigarette smokers had 2.5to 5 times greater death rates from lung cancer thanwomen nonsmokgrs. By 1979, women accounted for fully one-fourth of all lung catcer deaths. Over the next few years, women cigarette smokers'risk of lung cancer death will approach $ to ,12 tires that ofwomen nonsmokers, the same relative riskas that of men. Lung cancer has four main histologicaltypes; epidermoid, small cell, adenocarcinoma, and large cellcarcinoma, As several studies have shown, theincidence of each of these types of lung cancer displays a clear relationship to cigarette smokingamong 'both men and women Epidermoid and small celllung cancer appear to be more prominent among men, while adenocar- V1 1 / i.....,--''' A cinoma of the lung now appears to be more- prominentamong women. ., , Theecent acceleration of lung cance"r incidenCeamong women has in fact IS'erimore rapid than the corresponding growth of lung canceramong men in the .1930s. Again, this dif- ference in the initial rate of acceleration.of lungcancer inci- dence does not refute,the demonstrated causalrelation between cigarettesmoking and lungicanceramong both sexes. Instead, differences in therate ofincrease of lung cancer incidence may reflect changes in the carcinogenic,properties of cigarette
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