U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Office on Smoking and Health (US). Women and Smoking: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2001 Mar.

Cover of Women and Smoking

Women and Smoking: A Report of the Surgeon General.

Show details

List of Tables and Figures

Chapter 1. Introduction and Summary of Conclusions

  • Prevalence (%) of current smoking among adults aged 18 years or older, by gender, National Health Interview Survey, United States, 1965-1998 8
  • Prevalence (%) of current smoking and daily smoking among high school senior girls, by race, Monitoring the Future Survey, United States, 1976-1997, aggregate data 9
  • Age-adjusted death rates for lung cancer and breast cancer among women, United States, 1930-1997 10
  • Prevalence (%) of cigarette smoking during pregnancy, 1989-1998 11

Chapter 2. Patterns of Tobacco Use Among Women and Girls

  • Sources of national survey data on tobacco use, United States 24
  • Prevalence (% and 95% confidence interval) of ever smoking among women aged 18 years or older, by selected characteristics, National Health Interview Survey, United States, 1965-1998 34
  • Prevalence (% and 95% confidence interval) of current smoking among women aged 18 years or older, by selected characteristics, National Health Interview Survey, United States, 1965-1998 36
  • Prevalence (% and 95% confidence interval) of current smoking among adults aged 18 years or older, by gender and selected characteristics, National Health Interview Survey and National Household Survey on Drug Abuse, United States, 1997-1998 41
  • Distribution (% and 95% confidence interval) of the number of cigarettes smoked and percentage smoking 25 or more cigarettes per day, among women current smokers aged 18 years or older, by selected characteristics, National Health Interview Survey, United States, 1965-1998 44
  • Prevalence (% and 95% confidence interval) of ever smoking among young women aged 18-24 years, by selected characteristics, National Health Interview Survey, United States, 1965-1998 50
  • Prevalence (% and 95% confidence interval) of current smoking among young women aged 18-24 years, by selected characteristics, National Health Interview Survey, United States, 1965-1998 52
  • Prevalence (% and 95% confidence interval) of ever trying smoking or ever smoking and current smoking among girls less than 18 years of age, by selected characteristics, National Household Survey on Drug Abuse and Youth Risk Behavior Survey, United States, 1998-1999 56
  • Prevalence (% and 95% confidence interval) of ever smoking and current smoking among high school seniors, by gender, Monitoring the Future Survey, United States, 1976-1998 60
  • Percentage (and 95% confidence interval) of girls less than 18 years of age who were current smokers who reported frequent or heavy use of cigarettes, by selected characteristics, National Household Survey on Drug Abuse and Youth Risk Behavior Survey, United States, 1998-1999 64
  • Prevalence (% and 95% confidence interval) of ever smoking and current smoking among high school seniors, by gender and sociodemographic risk factors, Monitoring the Future Survey, United States, 1994-1998, aggregate data 65
  • Trends (% and 95% confidence interval) in the beliefs and attitudes of high school seniors about smoking and smokers, by gender, Monitoring the Future Survey, United States, 1981-1998 68
  • Trends (% and 95% confidence interval) in the opinions of high school seniors about smokers, by gender, Monitoring the Future Survey, United States, 1981, 1990, 1998 69
  • Prevalence (% and 95% confidence interval) of use of cigarette brands among current smokers aged 10-17 years, by gender and race, Teenage Attitudes and Practices Survey II, United States, 1993 70
  • Trends (%) in live births in which mothers reported smoking during pregnancy, by selected characteristics, United States, 1989-1998 72
  • Mean age (years and 95% confidence interval) at smoking initiation of regular smoking for selected birth cohorts, by gender and race or ethnicity, United States, 1931-1962 76
  • Mean recalled age (years and 95% confidence interval) at smoking initiation among persons who ever smoked, by gender, United States, 1961-1979 77
  • Cumulative percentage (and 95% confidence interval) of recalled age at which respondents aged 30-39 years first tried a cigarette or began to smoke daily, by gender, National Household Survey on Drug Abuse, United States, 1998 80
  • Cumulative percentage (and 95% confidence interval) of recalled age at which respondents aged 18-21 years first tried a cigarette or began to smoke daily, by gender, National Household Survey on Drug Abuse, United States, 1998 81
  • Percentage (and 95% confidence interval) of current women smokers aged 18 years or older who reported that they smoked their first cigarette within 10 or 30 minutes of awakening, by selected characteristics, National Health Interview Survey, United States, 1987 84
  • Prevalence (% and 95% confidence interval) of selected reasons of current smokers for using cigarettes, among girls aged 10-17 years and young women aged 18-22 years, by selected characteristics, Teenage Attitudes and Practices Survey II, United States, 1993 86
  • Percentage (and 95% confidence interval) of current women smokers aged 18 years or older who reported selected indicators of nicotine dependence, by race or ethnicity and quantity of cigarettes smoked, National Household Survey on Drug Abuse, United States, 1992-1994, aggregate data 87
  • Percentage (and 95% confidence interval) of adolescents aged 12-17 years and young adults aged 18-24 years who were current smokers who reported selected indicators of nicotine dependence, by gender and age, National Household Survey on Drug Abuse, United States, 1992-1994, aggregate data 91
  • Percentage (and 95% confidence interval) of current women smokers aged 18 years or older who reported an interest in quitting smoking or who recently attempted to stop smoking, by selected characteristics, National Health Interview Survey, United States, 1995 94
  • Mean number (and 95% confidence interval) of attempts to quit smoking among current smokers aged 18 years or older, by gender and selected characteristics, National Health Interview Survey, United States, 1992 97
  • Percentage (and 95% confidence interval) of women aged 18 years or older who used selected methods to quit smoking during most recent attempt, by smoking status, National Health Interview Survey, United States, 1987 and 1992 98
  • Percentage (and 95% confidence interval) of women smokers aged 18 years or older who have quit smoking, by selected characteristics, National Health Interview Survey, United States, 1965-1998 102
  • Percentage (and 95% confidence interval) of smokers aged 18 years or older who have quit smoking, by gender and selected characteristics, National Health Interview Survey and National Household Survey on Drug Abuse, United States, 1997-1998 104
  • Stages of smoking cessation (% and 95% confidence interval) among women smokers aged 18 years or older, by selected characteristics, National Health Interview Survey, United States, 1992 109
  • Percentage (and 95% confidence interval) of young women smokers aged 18-24 years who have quit smoking, by selected characteristics, National Health Interview Survey, United States, 1965-1998 112
  • Percentage (and 95% confidence interval) of persons aged 18 years or older who had smoked in the previous 12 months who reported receiving advice to quit smoking from a physician or other health care professional in the preceding 12 months, by gender and selected characteristics, National Health Interview Survey, United States, 1991 114
  • Prevalence (% and 95% confidence interval) of ever and current cigar smoking among women aged 18 years or older, by selected characteristics, National Health Interview Survey, United States, 1970-1998 117
  • Prevalence (% and 95% confidence interval) of current cigar smoking among adolescents less than 18 years of age, by gender and selected characteristics, National Household Survey on Drug Abuse and Youth Risk Behavior Survey, United States, 1998-1999 118
  • Prevalence (% and 95% confidence interval) of current use of smokeless tobacco among adults aged 18 years or older, by gender and selected characteristics, National Health Interview Survey, United States, 1970 and 1991, 1992, 1994 (aggregate data) and 1998 120
  • Percentage (and 95% confidence interval) of nonsmoking women aged 18 years or older who reported that anyone smoked in their immediate work area and the proportion of those exposed who reported being bothered by cigarette smoke in their immediate work area, by selected characteristics, National Health Interview Survey, United States, 1992 124
  • Percentage (and 95% confidence interval) of adolescents in grades 9-12 and less than 18 years of age who were attempting to lose weight, by gender and smoking status, Youth Risk Behavior Survey, United States, 1999 126
  • Perception of overweight (% and 95% confidence interval) among normal and under-weight women aged 18 years or older, by smoking status and selected characteristics, National Health Interview Survey, United States, 1991 127
  • Average body mass index (and 95% confidence interval) among women aged 18 years or older, by smoking status and selected characteristics, National Health and Nutrition Examination Survey III, United States, 1988-1994 128
  • Prevalence (% and 95% confidence interval) of other drug use among girls and boys less than 18 years of age, by gender and smoking status, National Household Survey on Drug Abuse and Youth Risk Behavior Survey, United States, 1998-1999 F
  • Prevalence (% and 95% confidence interval) of alcohol and marijuana use among adults aged 18 years or older, by gender, smoking status, and age, National Household Survey on Drug Abuse, United States, 1997-1998 132
  • Patterns of initiation of smoking and use of other substances (% and 95% confidence interval) among young adults aged 18-24 years who ever used cigarettes and another substance, by gender, National Household Survey on Drug Abuse, United States, 1997-1998 132
  • Mean age (years and 95% confidence interval) at first use of cigarettes and other sub- stances among young adults aged 18-24 years who had ever smoked cigarettes, by gender, National Household Survey on Drug Abuse, United States, 1997-1998 133
  • Prevalence (% and 95% confidence interval) of selected feelings during the 2 weeks before the survey among adults aged 18 years or older, by gender and smoking status, National Health Interview Survey, United States, 1991 134
  • Estimated smoking prevalence among females and males aged 15 years or older, by country and gender, latest available year (ranked in order of female smoking prevalence) 137
  • Smoking prevalence (%) among women in selected countries, 1970-1994 140
  • Prevalence (%) of current smoking among adults aged 18 years or older in the greater Milwaukee area and in the general U.S. population, by gender, 1935-1979 27
  • Prevalence (%) of current smoking for 5-year cohorts, by race and ethnicity, gender, and age, United States, 1890-1964 30
  • Age-adjusted prevalence (%) of current smoking among women aged 18 years or older, by racial or ethnic group, National Health Interview Survey, United States, 1978-1998, aggregate data 38
  • Prevalence (%) of current smoking among adults aged 18 years or older, by gender, National Health Interview Survey, United States, 1965-1998 40
  • Prevalence (%) of current smoking among women aged 18 years or older, by state, Behavioral Risk Factor Survey, United States, 1999 43
  • Prevalence (%) of ever trying smoking and current smoking among adolescents aged 12-17 years, by gender, National Household Survey on Drug Abuse, United States, 1974-1998 55
  • Prevalence (%) of current smoking among girls, by grade in school, Monitoring the Future Survey, United States, 1975-2000 57
  • Prevalence (%) of current smoking among adolescents aged 12-17 years, by race and gender, National Household Survey on Drug Abuse, United States, 1974-1998, aggregate data 58
  • Prevalence (%) of current smoking among young adults aged 18 years, for 1904-1969, National Health Interview Survey, and high school seniors, for 1976-1998, Monitoring the Future Survey, by gender and race, United States 62
  • Prevalence (%) of daily smoking among high school seniors, by gender, Monitoring the Future Survey, United States, 1976- 2000 63
  • Median age at smoking initiation among adults aged 18 years or older, by race, gender, and birth cohort, United States, 1885- 1944 75
  • Percentage of persons aged 18 years or older who ever smoked who started smoking fairly regularly by age 15 or 18 years, by race, gender, and birth cohort, United States, 1900-1954 79
  • Percentage of young female current smokers aged 10-22 years who smoked their first cigarette within 30 minutes of awakening, by age and quantity of cigarettes smoked, Teenage Attitudes and Practices Survey II, United States, 1993 85
  • Percentage of girls aged 10-17 years and young women aged 18-22 years who smoked during the past week who reported selected symptoms of nicotine withdrawal during previous attempts to stop smoking, by quantity of cigarettes smoked, Teenage Attitudes and Practices Survey II, United States, 1993 90
  • Percentage of girls aged 12-17 years and young women aged 18-24 years who were current smokers who reported selected indicators of nicotine dependence, by age and quantity of cigarettes smoked, National Household Survey on Drug Abuse, United States, 1992-1994, aggregate data 92
  • Percentage of smokers who have quit smoking among adults aged 18 years or older and young adults aged 18-24 years, by gender, National Health Interview Survey, United States, 1965-1998 105
  • Smoking continuum among women aged 18 years or older who ever smoked, National Health Interview Survey, United States, 1979 and 1990 108
  • Prevalence (%) of alcohol and marijuana use among high school senior girls, by smoking status, Monitoring the Future Survey, United States, 1998 131

Chapter 3. Health Consequences of Tobacco Use Among Women

  • All-cause mortality among women for life-long nonsmokers and current smokers, by age, Cancer Prevention Study II, 1982-1988 185
  • All-cause mortality among women for life-long nonsmokers and current smokers, by age, Cancer Prevention Study I, 1959-1965 187
  • Age-adjusted and multivariate relative risks for all-cause mortality, by smoking status and number of cigarettes smoked per day, U.S. Nurses' Health Study, 1976-1988 189
  • Relative risks among women for death from all causes, and smoking attributable fraction of deaths among smokers, with adjustment for age and multiple potential risk factors, Cancer Prevention Study II, 1982-1988 190
  • Relative risks of death from lung cancer for women and men, by quantity smoked, major prospective studies 196
  • Age-adjusted death rates, relative risks, and rate differences for lung cancer, among women and men who were current smokers and never smokers, Cancer Prevention Study I, 1959-1965, and Cancer Prevention Study II, 1982-1988 197
  • Age-adjusted relative risks for lung cancer associated with smoking status and smoking cessation among women, cohort studies 198
  • Relative risks for lung cancer among women smokers compared with nonsmokers, by smoking status and quantity smoked, case-control studies 199
  • Percent distribution of lung cancer cases, by gender, histologic type, and smoking status 202
  • Relative risks for lung cancer among women, by smoking status and histologic type, case-control studies 204
  • Relative risks for lung cancer associated with ever smoking for women and men, by histologic type 206
  • Age-standardized average annual death rate for lung cancer among women, 1990- 1993, and percent increase between 1985 and 1990-1993, selected industrialized countries 210
  • Relative risks for breast cancer for smokers compared with nonsmokers, case-control studies 214
  • Relative risks for endometrial cancer for smokers compared with nonsmokers, case-control studies 218
  • Relative risks for ovarian cancer for smokers compared with nonsmokers, case-control studies 219
  • Relative risks for invasive cervical cancer for smokers compared with nonsmokers and for quantity or duration of smoking, case-control studies 221
  • Relative risks for cervical intraepithelial neoplasia for smokers compared with nonsmokers, case-control studies 222
  • Relative risks for death from selected cancers among women, by smoking status, Cancer Prevention Study II, 1982-1988 225
  • Relative risks for primary liver cancer among women for smokers compared with nonsmokers, case-control studies 227
  • Relative risks for urinary tract cancer among women for smokers compared with nonsmokers, case-control studies 229
  • Relative risks for coronary heart disease among women for current smokers compared with nonsmokers, cohort studies 234
  • Relative risks for coronary heart disease among women, by time since smoking cessation, case-control studies 236
  • Relative risks for coronary heart disease among women, by time since smoking cessation, cohort studies 238
  • Relative risks for stroke among women for current smokers compared with nonsmokers, case-control studies 242
  • Relative risks for stroke among women for current smokers compared with nonsmokers, cohort studies 244
  • Relative risks of stroke for women former smokers versus women who never smoked, by time since smoking cessation, case-control and cohort studies 246
  • Rate of decline in forced expiratory volume in 1 second among women and men, by smoking status, population-based studies, 1984-1996 254
  • Prevalence of airflow limitation as measured by forced expiratory volume in 1 second among women and men, population-based, cross-sectional studies, 1989-1994 258
  • Findings regarding smoking and dysmenorrhea 267
  • Findings regarding smoking and menstrual irregularity or secondary amenorrhea 268
  • Smoking and age at natural menopause 270
  • Relative risks for conception among women smokers 274
  • Relative risks for conception delay among women smokers 276
  • Relative risks for infertility among women smokers, case-control studies 280
  • Relative risks for preterm premature rupture of membranes among women smokers, case-control studies 282
  • Relative risks for placental disorders among women smokers 284
  • Relative risks for spontaneous abortion among women smokers 288
  • Relative risks for preterm delivery among women smokers 292
  • Relative risks for stillbirth or neonatal death among women smokers, cohort studies 296
  • Difference in birth weight between infants born to women nonsmokers and those born to women smokers 297
  • Relative risks for infants with low birth weight or small for gestational age among women smokers 298
  • Relative risks for congenital malformations among infants of women smokers 304
  • Findings regarding the relationship between smoking and abdominal obesity as measured by waist-to-hip ratio 312
  • Relative bone density among premenopausal women, for smokers compared with nonsmokers, cross-sectional studies 314
  • Relative bone density among postmenopausal women for smokers compared with nonsmokers, cross-sectional studies 316
  • Relative risks for hip fracture among women, among current smokers, cohort studies 319
  • Relative risks for hip fracture among women smokers, case-control studies 320
  • Relative risks for fractures other than hip fractures among women smokers 322
  • Relative risks for ulcerative colitis among former and current smokers, case-control and cohort studies 326
  • Relative risks for Crohn's disease among former and current smokers, case-control and cohort studies 328
  • Relative risks for Parkinson's disease among smokers, women and men, case-control studies 337
  • Epidemiologic studies of environmental tobacco smoke and lung cancer published during 1992-1998 346
  • Relative risks for lung cancer associated with workplace exposure to environmental tobacco smoke among women who never smoked 351
  • Associations between risk for coronary heart disease mortality or morbidity and exposure to environmental tobacco smoke among persons who never smoked, reviews 352
  • Associations between adult exposure to environmental tobacco smoke from spouses or household members or in the workplace and relative risks for mortality or morbidity from coronary heart disease, among persons who never smoked, cohort studies 354
  • Relative risks for coronary heart disease associated with adult exposure to environmental tobacco smoke among persons who never smoked or nonsmokers, case-control studies 358
  • Differences in birth weight between infants of nonsmoking mothers exposed to environmental tobacco smoke (ETS) and infants of mothers not exposed to ETS, based on measurement of biomarkers 362
  • Relative risks for spontaneous abortion among nonsmokers exposed to environmental tobacco smoke (ETS) compared with nonsmokers not exposed to ETS 365
  • Relative risks for congenital malformations among infants with prenatal exposure to environmental tobacco smoke 367
  • All-cause death rates for current smokers and lifelong nonsmokers, by age and gender, Cancer Prevention Study II, 1982-1988 184
  • All-cause death rates among women for current smokers and lifelong nonsmokers, by age, Cancer Prevention Study I, 1959- 1965, and Cancer Prevention Study II, 1982- 1988 186
  • Age-adjusted total mortality ratios among women (and 95% confidence interval) for current smokers compared with lifelong nonsmokers, prospective studies 188
  • Relative risks of death from all causes (and 95% confidence interval) for current smokers compared with lifelong nonsmokers, by years since smoking cessation, U.S. Nurses' Health Study, 1976-1988 191
  • Cumulative probability of death from all causes among women who stopped smoking, by smoking status and age at smoking cessation, Cancer Prevention Study II, 1984- 1991 192
  • Age-adjusted death rates for lung cancer and breast cancer among women, United States, 1930-1997 194
  • Lung cancer incidence rates among white women and black women, Surveillance, Epidemiology, and End Results Program, 1996- 1997 195
  • Trends in lung cancer incidence among women, by histologic type, Surveillance, Epidemiology, and End Results Program, 1973-1992 207
  • Age-adjusted death rates for chronic obstructive pulmonary disease, by gender and race, United States, 1980-1992 260
  • Exposure to environmental tobacco smoke from spouses' smoking and relative risks for mortality or morbidity from coronary heart disease, cohort studies 356
  • Exposure to environmental tobacco smoke from spouses' smoking and risk of coronary heart disease, case-control studies 360
  • Differences in mean birth weight (and 95% confidence interval) among infants of mothers exposed to environmental tobacco smoke (ETS) compared with infants of mothers not exposed to ETS 361
  • Relative risks (95% confidence interval) for low birth weight or intrauterine growth retardation among infants of mothers exposed to environmental tobacco smoke (ETS) compared with infants of mothers not exposed to ETS 363

Chapter 4. Factors Influencing Tobacco Use Among Women

  • Longitudinal studies with gender-specific findings on beliefs, experiences, and behaviors related to smoking initiation 456
  • Characteristics of 13 longitudinal studies of smoking maintenance and cessation among women who smoked regularly 480
  • Factors found to predict attempts to stop smoking, smoking cessation, and relapse to smoking among women who were current smokers in the 13 longitudinal studies reviewed 489
  • Expenditures for domestic cigarette advertising and promotion, 1995-1998 491
  • By the late 1920s, women were appearing in ads for Old Gold and other cigarette brands 494
  • In 1938, a Camel ad featured a business "girl," and in the World War II era, Chesterfield and Camel ads showed women in war industry garb and military uniform, respectively-all touting the mildness of cigarettes 495
  • A 1943 Marlboro ad in six women's magazines promoted a red beauty tip to hide lipstick stains 496
  • The best known advertising campaign of the American Tobacco Company appealed to the desire of women to be slim, as shown by 1920s and 1930s Lucky Strike ads 496
  • A 1946 Camel ad featured a female physician-one of the testimonials claiming benefits of cigarettes and the throat 497
  • In a 1952 ad, Pall Mall used the image of a fashionable woman as part of a health protection theme 498
  • Cumulative percentage of females who had become regular smokers, by birth cohort 499
  • Smoking initiation rates for 14- to 17-year-old girls, 1966-1979, and expenditures for three cigarette brands targeted to women, 1967-1978 501
  • Philip Morris launched advertising of Virginia Slims in 1968 with the slogan "You've come a long way, baby" and switched in the 1990s to "It's a woman thing" 502
  • Ads from the multicultural "Find Your Voice" campaign 503
  • Tobacco marketers targeted particular brands to women-Eve, Style, Satin, and More 507
  • By the late 1980s and into the 1990s, cigarette manufacturers were trying to make products more appealing to women: Superslims, with the claim of reduced side-stream smoke; "slim 'n sassy" Misty; and Capri, "the slimmest slim" 508
  • Dakota ad conveys the image of women enjoying warm, fun relationships with men 512

Chapter 5. Efforts to Reduce Tobacco Use Among Women

  • Women's access to worksite tobacco control resources in various industries during the 1990s 585
  • Changes in smoking behavior reported in studies of community-based smoking cessation programs 590
  • Support for policies that prohibit smoking in public places, by gender 593
  • Support for restrictions on vending machines, by gender 595
  • Support for restrictions on marketing and advertising of tobacco products, by gender 596

Chapter 6. A Vision for the Future: What Is Needed to Reduce Smoking Among Women

No tables or figures.

Image f3405_f1-1
Image f3405_f1-2
Image f3405_f1-3
Image f3405_f1-4
Image f3405_f2-1
Image f3405_f2-2
Image f3405_f2-3
Image f3405_f2-4
Image f3405_f2-5
Image f3405_f2-6
Image f3405_f2-7
Image f3405_f2-8
Image f3405_f2-9
Image f3405_f2-10
Image f3405_f2-11
Image f3405_f2-12
Image f3405_f2-13
Image f3405_f2-14
Image f3405_f2-15
Image f3405_f2-16
Image f3405_f2-17
Image f3405_f2-18
Image f3405_f3-1
Image f3405_f3-2
Image f3405_f3-3
Image f3405_f3-4
Image f3405_f3-5
Image f3405_f3-6
Image f3405_f3-7
Image f3405_f3-8
Image f3405_f2-11
Image f3405_f3-10
Image f3405_f3-11
Image f3405_f3-12
Image f3405_f3-13
Image f3405_f4-1
Image f3405_f4-2
Image f3405_f4-3
Image f3405_f4-4
Image f3405_f4-5
Image f3405_f4-6
Image f3405_f4-7
Image f3405_f4-8
Image f3405_f4-9
Image f3405_f4-10
Image f3405_f4-11
Image f3405_f4-12
Image f3405_f4-13
Bookshelf ID: NBK44304