655 



WOMEN ANO TOBACCO 



Nicotine dependence, like other forms of drug dependence, is 

 a progressive, chronic, relapsing disorder. The severity of the dis- 

 order varies from low levels to levels at which the behaviour is 

 highlv resistant to change. 



Mortality and morbidity 



In 1980 the report of the US Surgeon-General on The heaii'n 

 consequences of smoking for women (34) exposed clearly the falla- 

 cy of the belief that women were immune to tobacco-related dis- 

 eases. This impression was gained from studies conducted between 

 1950 and 1980, which compared the death rates from tobacco- 

 related diseases among mien with those among women. More re- 

 cent research has shown that whenever the cigarette "smoking 

 characteristics — in particular duration and mtensity — of women 

 emulate those o'. men. their relative risks of smoking-related illness 

 are likely to be similar. 



Currently, tobacco use is estimated to account for 3 r '^n 

 deaths per year. More than half of these occur in developed , en- 

 tries, and more than 300 000 of them are among women in these 

 countries. The cumulative exposure of women to tobacco (primari- 

 ly from smoking) has been much higher in these countries than in 

 the developing countries and as a consequence the death rates 

 from smoking-reiated diseases among women in developing coun- 

 tries are likely still to be relatively low. However, the mortality 

 rates from other forms of tobacco use among women (primarily 

 chewing) is substantially higher in developing countries, with an- 

 nual estimates of at least 100 000 deaths in India alone. Current 

 trends suggest that among women who smoke, at least 25 ""b will 

 die from smoking-related diseases. 



In Chapter 2, it was pointed out that the uptake and increase 

 in tobacco consumption by women is mainly in the form of smok- 

 ing, panicularly cigarette smoking; consequently this chapter will 

 concentrate on this issue. However, in some developing countries 

 such as India, cigarette smoking represents only a small fraction 

 of the total tobacco consumption, in particular among women in 

 rural areas. In these countries, smokeless tobacco is also imposing 

 its burden of tobacco-related diseases and deaths. The risks of oral 

 cancer, as well as of numerous odontological disorders and dis- 

 eases of the mouth and gums, are greatly increased by the use of 

 sm.okeless tobacco. Smokeless tobacco use has also been shown to 

 be related to hypertension and an increased heart rfte. In addition, 

 tobacco chewing poses specific risks for women, e.g. for potential 

 adverse effects on the fetus during pregnancy. 



34 



