Cigarette smoking is the leading preventable cause of death in the US, yet despite the well-documented negative health consequences, nearly one in five women still smoke. The American College of Obstetricians and Gynecologists (The College) encourages women to abstain from smoking during the Great American Smokeout on November 17, 2011, and use that day as a starting point to quit smoking for good.

More than 71,000 women will die from lung cancer—the leading cause of cancer death among women—in 2011. Eighty percent of lung cancer deaths are attributed to smoking. Smoking shaves an average of 14.5 years off the lives of female smokers.

“In addition to a greatly increased risk of lung cancer, women smokers have a higher risk of heart attack, stroke, emphysema, bronchitis, osteoporosis, rheumatoid arthritis, cataracts, infertility, early menopause, and more than 10 different cancers (including breast and cervical cancers) than nonsmokers,” said James N. Martin, Jr, MD, president of The College.

Pregnant women who smoke put their babies at a higher risk for preterm birth, low birth weight, placental abruption, sudden infant death syndrome, poor lung function, asthma, and bronchitis. The harmful chemicals in cigarette smoke are also passed through breast milk to babies. Exposure to secondary smoke has also been shown to be harmful.

Fortunately, smokers who quit can stop or reverse the damage caused by cigarettes. In the days and months after a person stops smoking, heart rate and blood pressure drop to healthier levels, and breathing, circulation, and sense of smell and taste may improve. Heart attack risk decreases by 50% after the first year of quitting, and the risk of developing lung cancer, heart disease, and other ailments fall to nearly that of a nonsmoker in the first few years.

Pregnancy is often a great motivator to quit smoking. Data from the Centers for Disease Control and Prevention show that in 2008, roughly 20% of pregnant women who smoked quit during pregnancy. “Women who stop smoking before 15 weeks of gestation receive the biggest maternal and fetal benefit,” said Dr. Martin. “Quitting in early pregnancy minimizes the risk of having a low birth weight baby caused by smoking during pregnancy.”

It takes most smokers several tries to successfully quit, and going “cold-turkey” can be extremely difficult because of nicotine withdrawal and cravings. There are a number of smoking cessation resources available. People who use telephone counseling are twice as likely to stop smoking as those who don’t get this type of intervention. Help from a counselor can keep quitters from making many common mistakes.

Women should talk to their doctor about methods that may increase the odds of permanently quitting, such as support groups, other local smoking cessation resources, and medical therapies. For nonpregnant women, nicotine replacement products that combat cravings (patches, gums, nasal sprays, etc) or medications (such as bupropion or varenicline), in combination with nicotine replacement, can double the chances of quitting. These methods have not been sufficiently evaluated for their safety or efficacy during pregnancy, however they can sometimes be used under close medical supervision.

For more information on the Great American Smokeout and smoking cessation, click here.

A new campaign launched by local health officials is targeting pregnant and postpartum women in the wake of some alarming statistics about tobacco use. According to the county’s Community Health Services Department, nearly one quarter of Lambton women who gave birth at Bluewater Health between 2006 and 2009 reported smoking during pregnancy. “When we saw that number, we were surprised that it was that high,” said health promoter Rose Atkins. “Since we’ve seen that, we’ve been trying to do a few things to bring it down.”

As part of its “You can make it happen” campaign, the health unit is urging local health care providers to talk with women about tobacco use, and the means to help them quit.

Packages containing information and posters have been delivered across the county, reminding health care workers to talk with patients about smoking, and encouraging women to ask for help.

“I think people just don’t know where to go for help,” she said, noting that expectant dads are also the focus of a new “Right Time, Right Reasons” campaign.

“It’s just another way to help — if dad quits smoking, then maybe that will help mom,” she said. “So we’re trying to approach both sides of the equation.”

The latest numbers from Health Canada show 17 per cent of Canadians, or about five million people age 15 years or older, are smokers.

In Lambton, smoking rates are significantly higher compared to the provincial average, particularly among females (24.5% vs. 17.1%).

“Cigarette smoke contains 4,000 chemicals, including 69 that cause cancer, and pregnant women risk passing these to their unborn child through the placenta,” said Atkins. “Smoking while pregnant causes serious risk for a baby. The sooner a smoker quits, the lower the risk of chemicals being passed on to a fetus.”

Tobacco use during pregnancy is linked to increased risk of stillbirth, premature and low weight, reduced neo-natal lung function, Sudden Infant Death Syndrome (SIDS) and neurological and developmental disabilities. Harmful chemicals can also pass to the child through breast milk.

Atkins pointed to the Smoker’s Helpline as another valuable resource for women looking to quit.

“They will connect with the moms before the due date, and up to six months after birth,” said Atkins. “Many people quit during pregnancy and then start back up again. So the Helpline follows up on a more long-term basis, which might give them more motivation to quit.”

Bonnie Kriz, senior coordinator with Smokers’ Helpline, said studies show that pregnant women are more motivated to quit than any other time in their lives.

“That’s the time to take advantage of your motivation to quit, for you and your baby.”

The analysis, which was written up in the Journal of Obstetrics and Gynaecology, involved eight previous clinical trials involving almost 3,300 pregnant women. This particular research was focused on determining whether counselling had an impact after six months on pregnant women who smoked. Of the eight trials, four showed no discernable difference between groups of pregnant smokers who quit smoking and had received counselling and groups that quit without receiving the counselling.

Four other trials showed a small difference in the quit rates of the two groups, with the group that had received counselling slightly more likely to have quit.

The lead author of the study, Dr. Kristian Filion, told Reuters Health that the researchers were “a little surprised” by the results that indicated “the small effect” of the counselling. He was cautious about recommending nicotine replacement therapies for pregnant women, saying that evidence of “the safety and effectiveness” of these products is limited in pregnant women, and that further research in this area is necessary to “understand the risk-benefit ratio” of NRT in pregnant women.

Smoking cessation medications such as Champix are recommended to most smokers, but the lack of clinical data regarding the safety of the medication for pregnant women means it is not generally recommended to pregnant women. Dr. Filion advised that the best time to quit using such methods is before getting pregnant.

Postmenopausal women who smoke have higher circulating levels of testosterone and other sex hormones than non-smokers, potentially increasing their risk of hormone-related diseases, a study suggests. As hormone levels fell immediately when a person quit smoking, the authors suggested the risks of conditions such as diabetes and low bone mineral density could potentially be modified by smoking cessation.

The study, including 2,030 non-users of HRT, found current smoking was linked with a 19-37% increase in testosterone levels and a 19-34% increase in women.

Obesity is an important contributor to premature death in women who have never smoked, especially among women in low income groups. Now a study is questioning the causes of premature death for women in certain social positions who have never smoked. Dr. Laurence Gruer from NHS Health Scotland and his colleagues reviewed the cases of 3,613 women who had never smoked. During the follow-up period of 28 years, half of the women died, including 916 from diseases of the heart and circulation and 487 from cancer.

The results show that women in lower occupational groups who were non-smokers were more likely to die from heart disease and were also more likely to be severely obese compared to the women who smoked.

Dr. Gruer commented that where obesity is more common in disadvantaged groups, it may contribute to health inequalities and increase the burden on local health and social services.

It is important to note just how bad smoking is, even if this study concluded a higher number of deaths resulted from obesity.

Professor Johan Mackenbach from the Erasmus Medical Center in Rotterdam was quoted as saying, “It is important not to forget that smoking is a much stronger risk factor for mortality than most other risk factors…inequalities in mortality persist among those who have never smoked partly because obesity takes over the role of smoking, but they persist at a much lower level, and that is good news for whoever wants to reduce health inequalities.”

Most people know that tobacco use is hazardous to a person’s health. It causes heart disease, cancer, stroke, respiratory disease and many other health problems. But did you ever wonder about the effects of tobacco on pregnant women and their unborn or newborn children? When a pregnant woman uses tobacco or is exposed to tobacco smoke during or after her pregnancy, she places her health and the health of her child at risk.

When a pregnant woman uses tobacco, so does her unborn baby.

Tobacco smoke contains over 4,000 chemicals; over 250 of these chemicals are toxic and nearly 60 are known to cause cancer.

Chemicals found in tobacco smoke include ammonia (found in household cleaners), carbon monoxide (a component of car exhaust), formaldehyde (found in embalming fluid), and arsenic (used as a deadly poison).

Pregnant women who use tobacco are at higher risk for miscarriage and premature labor than women who do not use tobacco during pregnancy.

Tobacco use during pregnancy also affects the body’s ability to deliver vital nutrients to a developing child, affecting growth and development during and after pregnancy.

Children who are exposed to tobacco smoke are three times more likely to develop asthma, and are at increased risk for chronic bronchitis, ear infections, attention deficit hyperactivity disorder and other learning problems.

The Centers for Disease Control and Prevention recommends making your home and vehicle smoke free, and insist that no one smoke or use tobacco products around you or your children.

If you use tobacco and are pregnant, thinking about becoming pregnant, or have children in your home, now is a good time to quit.

For information about available programs contact the Northwest PA Tobacco Control Program at 451-6709, the PA Quitline at (800) 784-8669, or visit Quitnet.com.

All programs are available at no cost.

Laura A. Beckes is tobacco program coordinator for the Northwest Pennsylvania Tobacco Control Program.

PAD (peripheral artery disease) is a build up of fatty deposits along the artery walls in the legs and pelvic area, which can block normal blood flow. If untreated, the disease can obstruct blood circulation to organs such as the kidneys, heart and brain; potentially causing heart attacks and strokes. But while it has commonly been linked to high cholesterol, this new study suggests it can also be attributed to smoking.

Published in the Annals of Internal Medicine, the findings showed that women who smoked, or had a history of smoking, had a significantly increased chance of suffering from the condition even if they had given up years before.

This was established via medical questions and symptoms tracking of nearly 40,000 participants who were investigated over several years by the authors of the research. The women who took part were also asked if at any point they had had procedures to improve blood flow.

Researchers found that smokers had ten times more chance of having the condition, confirmed through the treatments and symptoms they experienced over the years of the study. This presented the authors with positive information because it “indicate[s] one of the strongest associations for current smoking reported thus far,” they said.

PAD, while potentially life threatening, can be reduced through lifestyle changes and medications with full reversal a possibility. Low cholesterol diets and quitting smoking being the most important steps to take beyond medical treatment.

China is the largest market for cigarettes on the planet. But if Dr. Linda Sarna, DNSc, has anything to do with it, Chinese women will be sheltered from the nicotine habit. Sarna, a researcher from UCLA Nursing School, is on a mission to keep Chinese women from getting hooked. She is engaging China’s nurses – a mighty 1.65 million of them – in a program to identify and treat smokers.

“In the U.S., in the late 1960’s, few women smoked,” says Sarna. “Then smoking was aligned with feminism and equal rights. Tobacco companies created a brand for the independent woman adding a cigarette to the picture. It will only be a matter of time before the same thing happens in China.”

From a cultural perspective she has a battle on her hands. Inside China’s business environments strict hierarchy runs rampant where questioning the boss is difficult. China is also a masculine society where females are emerging slowly as leaders but typically the boss is a male.

The nursing profession is no different. Doctors, most commonly male in China, issue strict orders to their reports, the nurses. A large amount of these doctors smoke –not only in the break room — about a third of them admitted to smoking in front of patients. This creates a challenge for nurses that want to aid in breaking addictions.

“Doctors who smoke don’t tell patients to quit,” she says. “If we can empower nurses, who don’t smoke today, to take action they will be the front line of defense.”

Sarna’s project is gaining momentum with 1,000 nurses in Beijing preparing to engage in a year long distance learning program about reducing smoking. The program will be lead by Sarna and her advocate in China, Dr Sophia Chan, who initiated the partnership with UCLA over a decade ago.

Sarna believes the partnership eases the cultural divide. Chan’s team reviews materials and translations to ensure they are appropriate for Chinese audiences. “Our partners have made the job run smoothly,” says Sarna.

Sarn’s team has good intentions but the Chinese government may make things more challenging for the project in the coming months. The Chinese government is contemplating implementing the World Health Organization’s Framework Convention on Tobacco Control. China signed on in 2006, committing to make areas smoke free by law. China has yet to move forward with its promise.

Enacting measures prescribed by the WHO is no small feat: more people smoke in China than live in the United States. These smokers fill China’s coffers. Last year the state owned Chinese National Tobacco Company generated $76 billion dollars in taxes and profit. About $14.3B of that was profit, well eclipsing Phillip Morris International who eared $6.3B in 2010. This hefty contributor to China’s GDP – some analyst peg it at 8% of the total — will make China’s tobacco habit hard to break.

Competition is also arriving from the U.S. Phillip Morris recently signed a deal to sell its cigarettes inside the country. Sarna saw the implications of this first hand: Chinese women dressed up as Marlboro Cowboys giving away free cigarettes at a local shopping mall. Most industry analysts say this is only the beginning urging stock traders to buy now before Marlboro makes a mint when it’s brand takes hold inside China.

Dr. Sarna is undeterred. “Now is the time. We have yet to see a female focused cigarette or a marketing campaign designed to lure women into the habit.”

China is the largest market for cigarettes on the planet. But if Dr. Linda Sarna, DNSc, has anything to do with it, Chinese women will be sheltered from the nicotine habit. Sarna, a researcher from UCLA Nursing School, is on a mission to keep Chinese women from getting hooked. She is engaging China’s nurses – a mighty 1.65 million of them – in a program to identify and treat smokers.

“In the U.S., in the late 1960’s, few women smoked,” says Sarna. “Then smoking was aligned with feminism and equal rights. Tobacco companies created a brand for the independent woman adding a cigarette to the picture. It will only be a matter of time before the same thing happens in China.”

From a cultural perspective she has a battle on her hands. Inside China’s business environments strict hierarchy runs rampant where questioning the boss is difficult. China is also a masculine society where females are emerging slowly as leaders but typically the boss is a male.

The nursing profession is no different. Doctors, most commonly male in China, issue strict orders to their reports, the nurses. A large amount of these doctors smoke –not only in the break room — about a third of them admitted to smoking in front of patients. This creates a challenge for nurses that want to aid in breaking addictions.

“Doctors who smoke don’t tell patients to quit,” she says. “If we can empower nurses, who don’t smoke today, to take action they will be the front line of defense.”

Sarna’s project is gaining momentum with 1,000 nurses in Beijing preparing to engage in a year long distance learning program about reducing smoking. The program will be lead by Sarna and her advocate in China, Dr Sophia Chan, who initiated the partnership with UCLA over a decade ago.

Sarna believes the partnership eases the cultural divide. Chan’s team reviews materials and translations to ensure they are appropriate for Chinese audiences. “Our partners have made the job run smoothly,” says Sarna.

Sarn’s team has good intentions but the Chinese government may make things more challenging for the project in the coming months. The Chinese government is contemplating implementing the World Health Organization’s Framework Convention on Tobacco Control. China signed on in 2006, committing to make areas smoke free by law. China has yet to move forward with its promise.

Enacting measures prescribed by the WHO is no small feat: more people smoke in China than live in the United States. These smokers fill China’s coffers. Last year the state owned Chinese National Tobacco Company generated $76 billion dollars in taxes and profit. About $14.3B of that was profit, well eclipsing Phillip Morris International who eared $6.3B in 2010. This hefty contributor to China’s GDP – some analyst peg it at 8% of the total — will make China’s tobacco habit hard to break.

Competition is also arriving from the U.S. Phillip Morris recently signed a deal to sell its cigarettes inside the country. Sarna saw the implications of this first hand: Chinese women dressed up as Marlboro Cowboys giving away free cigarettes at a local shopping mall. Most industry analysts say this is only the beginning urging stock traders to buy now Marlboro makes a mint when it’s brand takes hold inside China.

Dr. Sarna is undeterred. “Now is the time. We have yet to see a female focused cigarette or a marketing campaign designed to lure women into the habit.”
randi Moore is a global strategist focused on the practices that deliver financially successful business relationships between India and US corporations. She is the founder of IndiaThink and the author of The Little BRIC Book: Cracking the Code of Projects in Brazil, Russia, India and China.