Dear Dr. Garner,
I caught my 17-year-old daughter smoking with her friends the other day. I was very upset, as we have always taught her about the harms of cigarette smoking. It seems that the smoking problem is more prevalent in girls. Could you please address this issue? We could then use the column as a means to bring up the subject with her.
Concerned Mother in Maspeth
 
Dear Concerned Mother,
I was just talking about this problem with my good friend and noted pulmonologist, Dr. Tony Saleh.

Unfortunately, cigarette smoking among young girls is on the rise. This is due in part to the tobacco industry advertising campaign that has successfully targeted this group. They have equated cigarette smoking with being slim, popular, and calm. Girls see it as an opportunity to lose weight as well.

Once someone has started smoking it is very difficult to stop.

Smoking is a deadly habit, with more than 400,000 people in the U.S. expected to die as a result. About twice as many women will die from lung cancer as from breast cancer.

Women face unique health effects from smoking. One difference involves the hormone estrogen, which is found in much larger quantities in women than in men. Estrogen has a combined effect with nicotine to make it more potent in its ability to create addiction. In addition, the blood vessels in women are smaller and also more prone to have irritation of the lining. This predisposes to blood clots, which can cause heart attacks and strokes.

Below are some of the key differences in the effects of tobacco on women:

• Women are more susceptible to the damaging effects of chronic cigarette smoking.

• Girls are more susceptible to advertising.

• Females are more sensitive to second-hand smoke, and the largest group of lung cancer cases in non-smokers is female.

• Women are more susceptible to tobacco’s cancer-producing particles than men. There are over 60 different cancer-producing elements in cigarette smoke.

• Women, ages 35-52, who smoke 20 cigarettes per day have a six-fold increased risk of heart attacks, almost double that of men.

• Smoking increases the levels of LDL (bad cholesterol) in women more than men.

• Smoking lowers the levels of estrogen in women, predisposing to osteoporosis.

• Nicotine causes a calming effect in women, which helps to perpetuate cigarette use.

• Nicotine enhances the effects of alcohol in women.

• Women experience more severe withdrawal symptoms than men when quitting.

• Women who quit smoking relapse for different reasons than men – the two main causes are fear of weight gain and stress.

How can women use this information in regard to cigarette smoking?

1. The first and foremost advice is not to start. We know that the rate of smoking is lowest in the most educated groups. We have to target those at low educational levels. This education should start early on, even in kindergarten, as the age that many start to smoke is as early as 12 years old. There has to be greater control over advertising. Even though it has been banned in radio and television, it is still out there.

It is known that smoking is more prevalent in white populations than in African-Americans or Hispanics, and this segment should be targeted as well.

2. Families – Girls are twice as likely to start smoking in families where parents smoke. Mothers should absolutely stop smoking, if not for themselves, then for their children’s benefit.