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•-1 0 t . Statement prepared for Julius B: Richmond, M.D. for News Conference on Health Consequences of Smoking for Women FOR RELEASE: January 14, 1980, 11 a.m., e.s.t. allback: Carol Sussman (301) 43-5287 . Bob Hutchings (301) 443-5287 Each year, the Department of Health, Education, and Welfare is required by law to send a report to Congress on the health consequence's of smoking. This is the 12th reporc we have issued, and as Secretary Harris wrote in her transmittal to the Congress, it "is one of the most alarming in the series." The report addresses the critical health 4sue of cigarette smoking by women. (We chose this issue, not because more women smoke than men, nor because they suffer more cigarette-related illness and death than men: Men, at least so far, remain the greatest users of cigarettes,. and the greatest victims. But the picture may now be changing.) The report speaks to the Congres4,.to the medical and public health communities, and to the public, to deliver these three warnings. First of all, it establishes once and for all that women are not exempt from the hazards of smoking. The women who smoke like men will encounter similar-risks. (Second, it'warns us that an epidemic of lung cancer among women has now begun, the result of smoking initiated during World War II and in the years immediately following) And third, it adds new evidence.of the harm which cigarette smoking during pregnancy exerts on"the fetus and the newborn baby.

Cigarette smokin$, an early sign of woman's social emancipation, is now a major threat to her personal health and her ability to bear healthy children. The report presents recent information on cigarette consumption in this country. Smoking is continuing to decline overall, for both men and women. The life insurance industry has already recognized that giving preferred rates to non-sm,okers makes good business sense, and in a very informative study released late last year, the State Mutual Life Assurance Company of America concluded that "The differences between mortality of smokers and non-smokers are too large to be ignored." There are fewer smokers, proportionately, than at any time in at least 45 years. Per capita consumption has dropped to the levels of 1952. Cigarettes with lower yields of tar and nicotine are gaining popularity. ' 0 These encouraging findings extend to every age group from adolescence onward, with one exception. As of this moment, smoking among older girls and younger women has not declined significantly. And there are now more girls between 17 and 24 smoking cigarettes than there are boys.- For many years, there has been a general feeling that cigarette smoking is not as hazardous for women as for men. This myth has arisen, a least in part, because of the different smoking histories of men and women. Men began smoking intensively during World War I and the years immediately following; women began in significant numbers during World War II and the years imroediately afterward. Because of the long latency period of lung cancer, other cancers, and chronic obstructive lung disease, the full t

3- consequences of cigarette smoking by men began ippearing 30 years ago. - - - ! . .. . 0 They are just now beginning to appear among women. This explains the current rise in lung cancer among women. The death rate from this disease stood fairly steady until the early 1960s, when it was a little less than five deaths per 100,000. Then, the rate began to increase, first slowly and then at increasing speed. The rate has now tripled, to reach nearly 15 deaths per 100,000 in 1978. This translates into approximately 25,000 deaths per year. Using simple mathematical projections, our scientists project that the rate will approach 25 deaths per 100,000 by 1983, surpassing the death rate from breast cancer. The report also documents changes in women's smoking behavior. Earlier generations of women smoked quite differently from men. On the average, they started later, smoked less, inhaled less, and used cigarettes with lower yields of tar and nicotine; but with each new generation, these differences • have narrowed. Today, young women and girls smoke just like young men and boys except, as I have said, more of them smoke. Ever since Selikoff's pioneering studies, we have known of the inter- action between occupational exposures and cigarette smoking. In two occupations, asbestos and cotton manufacturing, enough women have been employed for enough years to establish the fact that women workers encounter these risks in the same manner as men workers. The relationship between cigarette smoking and the outcome of pregnancy has become thoroughly established over the years. It is now documented that women who continue to smoke during pregnancy have lighter weight, full-term babies than non-smokers, suffer more often from complications of 0 !

pregnancy, have more pre-term babies, and greater risks of neonatal death. The Surgeon General's report, released several months ago on health promotion and disease prevention, describes low birth weight as the greatest single hazard contributIng to infant mortality. In addition to cigarette smoking, the lack of prenatal care, poor nutrition, alcohol and drug abuse, age (especially youth of the mother), social and economic background and marital status are factors which are also associated with low birth weight. However, stopping cigarette smoking during pregnancy seems to offer a good opportunity to greatly reduce the risk, of a poor pregnancy outcome. If smoking presents these hazards, why do girls take up smoking and s why do women continue to smoke? The report reminds us that more than 70 percent of our adult female population does not smoke, and that almost 90 percent of all.the girls in our senior and 3unior high schools do not smoke. - • But some girls do start, and many women continue to smoke. It seems to me there are two reasons why. i Girls (and boys too) take up smoking because it still enjoys acceptability and respectability in our society, nurtured by the example of adults and by the expenditure of more than $800 million each year in advertising and promotion. And women (and men too) keep on smoking because cigarette smoking is psychologically and physiologically addictive and quitting can be difficult for many people. The current report indicates that every year one smoker out of three makes a serious attempt to quit smoking. And these smokers %J V.

are achieving a success rate of 20 percent overall. The report provides us with suggestions as to what we should do next what our Department should do, what the medical and health community should do, and what society should do. First of all, there are still - as the report makes plain -- unanswered questions, mainly in the area of smoking behavior. Smokers should be achieving a better than 20 percent overall success rate in quitting, and with greater knowledge it is zeasonable to believe this can be improved. If we can find out why and how the message is getting through to many • boys and young men, we,can hope to achieve the same successes with girls and young women. We need to continue to intensify our educational and information efforts, both by Government and by voluntary agencies. Our experience.'over the years has shown that when men and women are adequately informed of the hazards of smoking, they will turn away from the habit. We need to increase our efforts to help and inform those who are partioularly prone to the adverse health effects of smoking. These include, first of all, pregnant girls and women. They also include men and women exposed to occupational hazards, those with pre-existing physical problems and disabilities, and minority men and women. Most of all, it seems to me, we need to create a new environment for our young people where smoking is not encouraged, not held up as something glamorous and adult, where the risks of smoking are fully and sympathetically set forth in ways which every boy and girl and every young man and woman can understand. Given this information, we trust they will be led to make intelligent and sensible choices.

Present for technical back-up for Dr. Richmond and Mr. Pinney will be: Ellen Gritz, Ph.D. Research Psychologist, Veterans Administration, and Associate Research Psychologist, University of California School of Medicine. Dr. Gritz has written on women's smoking behavior and is author of the 1980 Report's chapter on this subject. Jeffrey Harris, M.D., Ph.D. Associate Professor of Economics, Massachusetts Institute of Technology. Dr. Harris is author of the "Smoking Patterns" chapter in the 1980 Report and of the AppQndix in the 1979 Report. He is a consultant to the Office on Smoking and Health. John Holbrook, M.D. Assistant Professor of Internal Medicine, University of Utah Medical School. Dr. Holbrook was for two years medical'director of the National Clearinghouse for Smoking and Health and is an authority on biomedical aspects of the smoking problem. Joanne Luoto, M.D., M,P.H. Medical Officer, Office on Smoking and Health. Dr. Luoto came to the Offict on Smoking and Health in October. She was formerly program director in gynecological oncology at the National Cancer Institute. She has trained in preventive medicine at the University of Maryland, and received her M.P.H. from Johns Hopkins University. Kelley Phillips, M.D., M.P.H. Consultant, Office on Smoking and Health. Dr. Phillips, a psychiatrists, began her residency at McMaster University in Hamilton and completed it at the National Institute of Mental Health. She has an M.P.H. from Johns Hopkins University.

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