The following facts may help you counsel your patient and understand the problems related to your patients who smoke. Link to our Tips for Providers for specific recommendations.

Prevalence:

The prevalence of smoking among women remains high and increasing among some groups.

• 23% of adult women are smokers (compared to 27% of men).
  
  
• American Indian women have high rates (35%).
  
  
• As a group Asian-American/Pacific Islanders have low rates of smoking (4% women) but rates among certain groups are much higher: 51.2% of Laotians , 41.7% of Vietnamese and 32.8% of Cambodians are current smokers.
  
  
• Lower rates are found in Hispanic (15%). Smoking among teens and young women has increased dramatically over the 1990s.
  
  
• Smoking among high school girls increased from 17% in 1991 to 34.7% in 1997.
  
  
• 35.2% of female high school seniors are current smokers.

Health Effects

Cigarette smoking doubles the risk of coronary heart disease and accounts for 43% of lung cancers in women.

In the 1980s, lung cancer overtook breast cancer as the leading cancer killer of women.

Smoking by women is also linked to:

• osteoporosis
• cervical cancer
• spontaneous abortions
• stillbirths
• premature menopause
• infertility
• low birth weight

Environmental Tobacco Smoke and Women

Secondhand or environmental tobacco smoke (ETS) has been ranked as the third leading cause of preventable death in the United States, after active smoking and alcohol use. Annually, 53,000 deaths are attributed to ETS. About half of these death occur from exposure in the workplace.

Exposure to tobacco smoke can be up to five times higher in restaurants than other work places. About 80% of waitstaff and 53% of bartenders are female.

Maternal smoking is strongly linked to Sudden Infant Death Syndrome (SIDS) in the United States. SIDS is a major cause of infant death between the ages of 1 month and 1 year. The link of maternal smoking to SIDS is independent of other known risk factors, including low birth weight and low gestational age. Both are associated with smoking during pregnancy.

Getting Your Patients to Quit

Providers have a powerful influence on quit rates. Patients whose providers actively advise quitting are 1.6 time more likely to quit.

Women have a more difficult time quitting than men. Women have lower cessation rates and those between 12 and 24 years of age are more likely to report being unable to cut down than boys and men the same age.

Women are more likely than men to report feeling dependent on cigarettes, and more likely to report feeling sad, blue, or depressed during quit attempts.

Recognizing and addressing these difficulties with your patients can improve their chances of quitting.

Web resources

http://www.acpm.org/tobpol.htm

Guidelines on Tobacco Cessation Counseling from the American College of Preventive Medicine. A three paged evidence based guide for clinicians.

http://www.surgeongeneral.gov/tobacco/

Tobacco Cessation Guideline from "The Virtual Office of the Surgeon General"