Although nongender-specific risks of smoking have been well publicized, many women are unaware of the tobacco-related risks unique to women, according to a report by the U.S. Surgeon General. The full text of "Women and Smoking: A Report of the Surgeon Ge

Since the first Surgeon General's report on women and smoking was published in 1980, an epidemic of tobacco-related diseases has occurred. Lung cancer, once rare among women, currently accounts for 25 percent of all female cancer deaths. Surveys indicate that many women are not aware that lung cancer has surpassed breast cancer as the leading cause of female cancer deaths. The once-wide gender gap in smoking prevalence has narrowed, and the rate is nearly three times higher among women with only nine to 11 years of education than among college-educated women. Although smoking rates among girls declined in the 1970s and 1980s, much of that progress was lost in the 1990s, and recent data suggest that cigar smoking among women and girls is increasing. Females in the United States lost an estimated 2.1 million years of life in the 1990s as a result of smoking-related deaths. Smoking has been linked to increased risks for several cancers, including cancer of the cervix, vulva, oropharynx, bladder, pancreas, liver, kidneys, and colorectal system. Women who smoke are also at increased risk for acute myeloid leukemia, coronary heart disease, ischemic stroke, subarachnoid hemorrhage, peripheral vascular atherosclerosis, ruptured abdominal aortic aneurysm, estrogen-deficiency disorders, Graves' ophthalmopathy, peptic ulcers, Crohn's disease, cataracts, and age-related macular degeneration. Limited data suggest that women smokers may be at increased risk for human immunodeficiency virus infection. Smokers are more likely than nonsmokers to be depressed or have anxiety disorders, bulimia, attention deficit disorder, schizophrenia, or alcoholism. Menstrual disorders associated with smoking include dysmenorrhea, secondary amenorrhea, menstrual irregularity, and younger age at menopause. Women who smoke have increased risks for conception delay and primary and secondary infertility. Pregnant women who smoke increase the risk for preterm premature rupture of membranes, abruptio placentae, placenta previa, preterm delivery, perinatal mortality (including stillbirth and neonatal deaths), and sudden infant death syndrome. Smoking during pregnancy appears to have decreased over the past decade, although the rate still may be as high as 22 percent. Some clinical intervention studies have suggested that women may have more difficulty quitting smoking than men, but data show that women are quitting at similar or even higher rates than men. Prevention and cessation efforts generally have similar efficacy rates among women and men. To date, few gender differences in factors related to smoking initiation and cessation have been identified, although adolescent girls are more likely than adolescent boys to respond to smoking cessation programs that include social support.

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