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Below is a news report, and then an official summary  of the Surgeon General's new report on women and smoking.
To read the executive summary, click on:  Executive Summary
To read the entire report, click on:  Surgeon General's Report: Women and Smoking 2001

Excerpts from: Number of Women Smokers Increases

                     by LAURAN NEERGAARD, AP Medical Writer [03/27/00]

                     WASHINGTON (AP) -- The latest surgeon general's report gives dire new
                     meaning to that old cigarette ad, ''You've come a long way, baby.'' Women now
                     account for 39 percent of smoking-related deaths, a proportion that has more
                     than doubled since 1965.

                     Worse, more teen-age girls are smoking, and increased tobacco industry
                     marketing threatens to derail recent progress in fighting the killer habit, concludes
                     Surgeon General David Satcher in a report released Tuesday.

                     ''What starts out as a simple puff is turning into a death sentence,'' said Health
                     and Human Services Secretary Tommy Thompson, pledging to use his office as
                     a bully pulpit as he travels the country to expound on the ''evils of smoking.''

                     ''Speaking only for myself, I think tobacco should be regulated,'' Thompson told
                     reporters Tuesday. But because of the court action, ''It's up to Congress to pass
                     legislation.''

                     Legislation to reopen FDA regulation has been introduced. While he wouldn't
                     endorse a specific bill, Thompson said curbing tobacco marketing that
                     encourages teens to smoke will be key -- because 80 percent of smokers,
                     women and men, start as teens.

                     States, however, can fight tobacco without awaiting federal action. Satcher's
                     report cites a California program that cut lung cancer among women even as it
                     rose across the rest of the country, and a Florida program that has reduced
                     smoking by middle-school girls by 40 percent in just two years.

                     Lung cancer is smoking's top harm. Once rare among women, it's now the top
                     female cancer killer, claiming 27,000 more lives each year than does the breast
                     cancer that so many women dread.

                     Smoking also causes numerous other cancers, heart disease and other lung
                     diseases in male and female smokers alike. But women face some unique
                     additional risks, the nation's top doctor stressed: dangerous blood clots among
                     users of birth control pills; menstrual irregularities and earlier menopause;
                     infertility; bone-thinning osteoporosis; cervical cancer. That's in addition to the
                     dangers of smoking during pregnancy, which include low-birth-weight babies,
                     stillbirths, miscarriages.

                     About one in five women smokes, a rate that hasn't changed much in the last
                     decade. In a government survey last year, 30 percent of high school senior girls
                     said they had smoked in the previous month, an increase from the early 1990s.

                     Studies show tobacco ads do influence people's decision to smoke -- and
                     tobacco companies for decades have specially targeted women, starting with the
                     1960s' Virginia Slims' ''you've come a long way, baby'' campaign. The newest
                     promotion to draw the surgeon general's ire: R.J. Reynolds matchbooks that say,
                     ''Until I find a real man, I'll take a real smoke.''

                     There are solutions, Satcher said. He pointed to California, where a statewide
                     program that includes major advertising about tobacco's deadliness found lung
                     cancer declined by 4.8 percent among California women in the last decade --
                     even as it rose in other regions. A Florida anti-smoking program reduced
                     smoking by middle-school girls from 18.1 percent in 1998 to 10.9 percent last
                     year, he said.

                   This year alone, lung cancer will kill nearly 68,000 U.S. women.
                   That’s one in every four cancer deaths among women, and about
                   27,000 more deaths than from breast cancer (41,000). In 1999,
                   approximately 165,000 women died prematurely from
                   smoking-related diseases, like cancer and heart disease. Women
                   also face unique health effects from smoking such as problems
                   related to pregnancy.

                  The Trends:

                   In the 1990s, the decline in smoking rates among adult women
                   stalled and, at the same time, rates were rising steeply among
                   teenaged girls, blunting earlier progress. Smoking rates among
                   women with less than a high school education are three times
                   higher than for college graduates. Nearly all women who smoke
                   started as teenagers - and 30 percent of high school senior girls
                   are still current smokers.

                   The Hope:

                   We have the solutions for preventing and reducing smoking among
                   women. Quitting smoking has great health benefits for women of
                   all ages. Thanks to an aggressive, sustained anti-smoking
                   program, California has seen a decline in women’s lung cancer
                   rates while they are still rising in the rest of the country. The
                   voice of women is needed to counter tobacco marketing
                   campaigns that equate success for women with smoking.

                   " When calling attention to public health problems, we must not
                   misuse the word ‘epidemic.’ But there is no better word to
                   describe the 600-percent increase since 1950 in women’s death
                   rates for lung cancer, a disease primarily caused by cigarette
                   smoking. Clearly, smoking-related disease among women is a
                   full-blown epidemic."

                                                   David Satcher, M.D., Ph.D.
                                                            Surgeon General

                   W omen and Smoking: a Report of the Surgeon General makes its
                   overarching theme clear–smoking is a woman’s issue. This report
                   summarizes what is now known about smoking among women,
                   including patterns and trends in smoking habits, factors
                   associated with starting to smoke and continuing to smoke, the
                   consequences of smoking on women’s health and interventions for
                   cessation and prevention. What the report also makes apparent is
                   how the tobacco industry has historically and contemporarily
                   created marketing specifically targeted at women. Smoking is the
                   leading known cause of preventable death and disease among
                   women. In 2000, far more women died of lung cancer than of
                   breast cancer. A number of things need to be acted on to curb
                   the epidemic of smoking and smoking-related diseases among
                   women in the United States and throughout the world.

                   •  Increase awareness of the impact of smoking on women’s
                   health and counter the tobacco industry’s targeting of women.

                   •  Support women’s anti-tobacco advocacy efforts and publicize
                   that most women are nonsmokers.

                   •  Continue to build the science base for understanding the health
                   effects of smoking on women in particular.

                   •  Act now: more than enough is already known to enable us to
                   support efforts to stop smoking at both individual and societal
                   levels.

                   •  Do everything possible to stop the epidemic of smoking and
                   smoking-related diseases among women globally.

                   Major Conclusions of the Surgeon General’s Report

                   •  Despite all that is known of the devastating health
                   consequences of smoking, 22.0 percent of women smoked
                   cigarettes in 1998. Cigarette smoking became prevalent among
                   men before women, and smoking prevalence in the United States
                   has always been lower among women than among men. However,
                   the once-wide gender gap in smoking prevalence narrowed until
                   the mid-1980s and has since remained fairly constant. Smoking
                   prevalence today is nearly three times higher among women who
                   have only 9 to 11 years of education (32.9 percent) than among
                   women with 16 or more years of education (11.2 percent).

                   •  In 2000, 29.7 percent of high school senior girls reported having
                   smoked within the past 30 days. Smoking prevalence among white
                   girls declined from the mid-1970s to the early 1980s, followed by
                   a decade of little change. Smoking prevalence then increased
                   markedly in the early 1990s, and declined somewhat in the late
                   1990s. The increase dampened much of the earlier progress.
                   Among black girls, smoking prevalence declined substantially from
                   the mid-1970s to the early 1990s, followed by some increases
                   until the mid-1990s. Data on long-term trends in smoking
                   prevalence among high school seniors of other racial or ethnic
                   groups are not available.

                   •  Since 1980, approximately 3 million U.S. women have died
                   prematurely from smoking related neoplastic, cardiovascular,
                   respiratory, and pediatric diseases, as well as cigarette-caused
                   burns. Each year during the 1990s, U.S. women lost an estimated
                   2.1 million years of life due to these smoking attributable
                   premature deaths. Additionally, women who smoke experience
                   gender-specific health consequences, including increased risk of
                   various adverse reproductive outcomes.

                   •  Lung cancer is now the leading cause of cancer death among
                   U.S. women; it surpassed breast cancer in 1987. About 90
                   percent of all lung cancer deaths among women who continue to
                   smoke are attributable to smoking.

                   •  Exposure to environmental tobacco smoke is a cause of lung
                   cancer and coronary heart disease among women who are lifetime
                   nonsmokers. Infants born to women exposed to environmental
                   tobacco smoke during pregnancy have a small decrement in birth
                   weight and a slightly increased risk of intrauterine growth
                   retardation compared to infants of nonexposed women.

                   •  Women who stop smoking greatly reduce their risk of dying
                   prematurely, and quitting smoking is beneficial at all ages.
                   Although some clinical intervention studies suggest that women
                   may have more difficulty quitting smoking than men, national
                   survey data show that women are quitting at rates similar to or
                   even higher than those for men. Prevention and cessation
                   interventions are generally of similar effectiveness for women and
                   men and, to date, few gender differences in factors related to
                   smoking initiation and successful quitting have been identified.

                   •  Smoking during pregnancy remains a major public health
                   problem despite increased knowledge of the adverse health
                   effects of smoking during pregnancy. Although the prevalence of
                   smoking during pregnancy has declined steadily in recent years,
                   substantial numbers of pregnant women continue to smoke, and
                   only about one-third of women who stop smoking during
                   pregnancy are still abstinent one year after the delivery.

                   •  Tobacco industry marketing is a factor influencing susceptibility
                   to and initiation of smoking among girls, in the United States and
                   overseas. Myriad examples of tobacco ads and promotions
                   targeted to women indicate that such marketing is dominated by
                   themes of social desirability and independence. These themes are
                   conveyed through ads featuring slim, attractive, athletic models,
                   images very much at odds with the serious health consequences
                   experienced by so many women who smoke.

                   Patterns of Tobacco Use Among Women and Girls

                   •  The prevalence of current smoking among women was 22
                   percent in 1998. Smoking prevalence was highest among American
                   Indian or Alaska Native women, intermediate among white women
                   and black women, and lowest among Hispanic women and Asian or
                   Pacific Islander women. By educational level, smoking prevalence
                   is nearly three times higher among women with 9 to 11 years of
                   education than among women with 16 or more years of education.

                   •  Much of the progress in reducing smoking prevalence among
                   girls in the 1970s and 1980s was lost with the increase in
                   prevalence in the 1990s: current smoking among high school
                   senior girls was the same in 2000 as in 1988. Although smoking
                   prevalence was higher among high school senior girls than among
                   high school senior boys in the 1970s and early 1980s, prevalence
                   has been comparable since the mid-1980s.

                   •  Smoking declined substantially among black girls from the
                   mid-1970s through the early 1990s; the decline among white girls
                   for this same period was small.

                   •  Smoking during pregnancy appears to have decreased from
                   1989 through 1998. Despite increased knowledge of the adverse
                   health effects of smoking during pregnancy, estimates of women
                   smoking during pregnancy range from 12.9 percent to as high as
                   22 percent.

                   •  Since the late 1970s or early 1980s, women are just as likely to
                   attempt to quit and succeed as are men.

                   •  Smoking prevalence among women varies markedly across
                   countries; it is as low as an estimated 7 percent in developing
                   countries to 24 percent in developed countries. Thwarting further
                   increases in tobacco use among women is one of the greatest
                   disease prevention opportunities in the world today.

                  Health Consequences of Tobacco Use Among Women

                   •  A woman’s annual risk for death more than doubles among
                   continuing smokers compared with persons who have never
                   smoked in all age groups from 45 through 74 years.

                   •  The risk for lung cancer increases with quantity, duration, and
                   intensity of smoking. The risk for dying of lung cancer is 20 times
                   higher among women who smoke two or more packs of cigarettes
                   per day than among women who do not smoke.

                   •  Smoking is a major cause of cancers of the oropharynx and
                   bladder among women. Evidence is also strong that women who
                   smoke have increased risks for liver, colorectal, and cervical
                   cancer, and cancers of the pancreas and kidney. For cancers of
                   the larynx and esophagus, evidence among women is more limited
                   but consistent with large increases in risk.

                   •  Smoking is a major cause of coronary heart disease among
                   women. Risk increases with the number of cigarettes smoked and
                   the duration of smoking. Risk is substantially reduced within 1 or 2
                   years of smoking cessation. This immediate benefit is followed by
                   a more gradual reduction in risk to that among nonsmokers by 10
                   to 15 or more years after cessation.

                   •  Women who smoke have an increased risk for stroke and
                   subarachnoid hemorrhage. The increased risk for stroke
                   associated with smoking is reversible after smoking cessation;
                   after 5 to 15 years of abstinence, the risk approaches that of
                   women who have never smoked.

                   •  Women who smoke have an increased risk for death from
                   ruptured abdominal aortic aneurysm. They also have risk for
                   peripheral vascular atherosclerosis, but cessation is associated
                   with improvements in symptoms, prognosis, and survival. Smoking
                   is also a strong predictor of the progression and severity of
                   carotid atherosclerosis among women, but smoking cessation
                   appears to slow the rate of progression.

                   •  Cigarette smoking is a primary cause of chronic obstructive
                   pulmonary disease (COPD) among women, and the risk increases
                   with the amount and duration of smoking. Approximately 90
                   percent of deaths from COPD among women in the United States
                   can be attributed to cigarette smoking.

                   •  Adolescent girls who smoke have reduced rates of lung growth,
                   and adult women who smoke experience a premature decline of
                   lung function.

                   •  Women who smoke have increased risks for conception delay
                   and for both primary and secondary infertility and may have a
                   modest increase in risks for ectopic pregnancy and spontaneous
                   abortion. They are younger at natural menopause than
                   non-smokers and may experience more menopausal symptoms.

                   •  Women who quit smoking before or during pregnancy reduce
                   the risk for adverse reproductive outcomes, including conception
                   delay, infertility, preterm premature rupture of membranes,
                   preterm delivery, and low birth weight.

                   •  Postmenopausal women who currently smoke have lower bone
                   density than do women who do not smoke. Also women who
                   currently smoke have an increased risk for hip fracture compared
                   with nonsmoking women.

                   •  The association of smoking and depression is particularly
                   important among women because they are more likely to be
                   diagnosed with depression than are men.

                   •  Exposure to environmental tobacco smoke is a cause of lung
                   cancer among women who have never smoked and is associated
                   with increased coronary heart disease risk.

                   Factors Influencing Tobacco Use Among Women

                   •  Girls who initiate smoking are more likely than those who do not
                   smoke to have parents or friends who smoke. They also tend to
                   have weaker attachments to parents and family and stronger
                   attachments to peers and friends. They perceive smoking
                   prevalence to be higher than it actually is, are inclined to risk
                   taking and rebelliousness, have a weaker commitment to school or
                   religion, have less knowledge of the adverse consequences of
                   smoking and the addictiveness of nicotine, believe that smoking
                   can control weight and negative moods, and have a positive
                   image of smokers.

                   •  Women who continue to smoke and those who fail at attempts
                   to stop smoking tend to have lower education and employment
                   levels than do women who quit smoking. They also tend to be
                   more addicted to cigarettes, as evidenced by the smoking of a
                   higher number of cigarettes per day, to be cognitively less ready
                   to stop smoking, to have less social support for stopping, and to
                   be less confident in resisting temptations to smoke.

                   •  Women have been extensively targeted in tobacco marketing,
                   and tobacco companies have produced brands specifically for
                   women, both in the United States and overseas. Myriad examples
                   of tobacco ads and promotions targeted to women indicated that
                   such marketing is dominated by themes of both social desirability
                   and independence, which are conveyed through ads featuring
                   slim, attractive, athletic models. Between 1995 and 1998,
                   expenditures for domestic cigarette advertising and promotion
                   increased from $4.90 billion to $6.73 billion. Tobacco industry
                   marketing, including product design, advertising, and promotional
                   activities, is a factor influencing susceptibility to and initiation of
                   smoking.

                   •  The dependence of the media on revenues from tobacco
                   advertising oriented to women, coupled with tobacco company
                   sponsorship of women’s fashions and of artistic, athletic, political,
                   and other events, has tended to stifle media coverage of the
                   health consequences of smoking among women and to mute
                   criticism of the tobacco industry by women public figures.

                   Efforts to Reduce Tobacco Use Among Women

                   •  Using evidence from studies that vary in design, sample
                   characteristics, and intensity of the interventions studied,
                   researchers to date have not found consistent gender-specific
                   differences in the effectiveness of intervention programs for
                   tobacco use.

                   •  A higher percentage of women stop smoking during pregnancy,
                   both spontaneously and with assistance, than at other times in
                   their lives. Using pregnancy-specific programs can increase
                   smoking cessation rates, which benefits infant health and is cost
                   effective. Only about one-third of women who stop smoking
                   during pregnancy are still abstinent one year after the delivery.

                   •  Successful interventions have been developed to prevent
                   smoking among young people, but little systematic effort has been
                   focused on developing and evaluating prevention interventions
                   specifically for girls.