New York's Selma Rosen was eleven years old when she started smoking and "became addicted," as she explains it. She smoked for 34 years and even quit for a stretch until she relapsed back into her habit. Now 57, Rosen is a lung cancer survivor, a condition that she says has changed her life dramatically. "I was working full-time and now I no longer am. I have emphysema, anemia and shortness of breath because I had half of my right lung removed," she says.
Rosen is not alone. Lung cancer will kill nearly one in four cancer-stricken women this year, a higher rate than deaths from breast cancer, U.S. Surgeon General David Satcher recently reported. Among additional stark findings of importance to the 22 million adult women who smoke in America, researchers say that tobacco companies have stepped up marketing efforts to women, stalling progress in programs that support those who try to stop smoking.
Satcher and officials like Tommy Thompson, who heads up the U.S. Department of Health and Human Services, beat the drum hard on the report's findings, but anti-tobacco advocates say the March 27 study contains nothing new.
"The numbers on lung cancer versus breast cancer deaths are startling people, but we've known about [the figures] since the mid-1980s. Why more women's organizations don't get wound up on this issue is beyond me," says Joel Spivak, spokesperson for the Campaign for Tobacco-Free Kids .
Rosen agrees lung cancer has been sorely overlooked by society. "There's a nihilism that exists when it comes to cancer...and a 'blame the victim' mentality. A lot of education is needed for the public and former smokers about the high risks of lung cancer," she says.
Women's groups typically place abortion, breast cancer and birth control at the top of agendas and have little or no funding or support for lung cancer, despite the major role it plays in women's health.
Advocates somewhat sheepishly admit more action is needed. "Some women's groups have been angry about [the high rates of lung cancer], but there's a missing link between anger leading to action. It took steps to make the populace at-large mad at tobacco companies before things started to change," says Cindy Pearson of the Washington, D.C.-based National Women's Health Network , a nonprofit group that lobbies for improved federal policies on women's health.
"Change" is found in actions such as California's ban on smoking in bars and restaurants, she says.
Money also plays a role in which issues advocates will tackle. Pearson says the network's resources to address lung cancer are small. "It's been an issue at a certain level forever... but it's been tough to give [a lot of attention to it]. I'm glad this report is getting attention, even if the attention is, 'Hey, why aren't you doing more?'" she says.
States are just starting to address prevention and health education to improve women's health, according to Making the Grade on Women's Health, a national report released last August.
Only one state, Utah, met the goal for reducing the share of adults who smoke to 15 percent or less. Utah specifically had a 12.6 percent rate of women who smoke, while Kentucky was at the high end with 28.5.
Utah officials say that the number of people who smoke in the state is low because of the high number of practicing Mormons. "Our religious culture, which is a non-drinking, non-smoking culture, plays a big part in [the low smoking rates]. We'd like to think prevention efforts play into it, too," says Steve Haddem of the Utah Department of Health's Tobacco Prevention and Control Program.
Utah has a statewide indoor clean air act that prohibits people from smoking in certain places and anti-smoking programs that target women who are pregnant. The state also encourages doctors and other health care providers to urge their patients to stop smoking. In that way, "a young woman of 15 will hear from several different places [about the dangers of smoking], and it works that person toward quitting," says Haddem.
Kentucky has a long history to overcome before making a dent in smoking rates. As a primary tobacco-growing state, "smoking is historically more acceptable here than in other parts of the country. That's why young women pick it up and it's more accepted. It's like a social practice," says Gwen Mayes, who heads up the state's Office of Women's Physical and Mental Health.
Mayes says she was alerted recently just how far the state has to go when she spoke before a group of lawmakers. "Our capitol annex is not a smoke-free building and I testified before members who were smoking. What kind of message does that send to young people?" she says.
What's in the works to change things in the state? As in Utah, state officials want to educate doctors and nurses, so that they'll either help patients stop smoking or prevent them from ever taking a puff.
Kentucky also wants to design prevention programs that more effectively reach women, not only to counter marketing ads but because studies have shown that women are more vulnerable than men to nicotine dependency. "Tobacco companies have targeted women and girls, giving the illusion that smoking affords you an independent or sleek lifestyle, which may be motivating women to smoke," Mayes says.
Recent statistics show just how much work Mayes and her colleagues have before them. Forty percent of high school girls surveyed said they smoked in the prior month, according to the 2000 Kentucky Youth Tobacco Survey.
"There's a lot that needs to be done. We need to provide more public prevention programs and increase efforts to raise the state excise tax. Using tobacco settlement money, we will also hire and train smoking cessation counselors to provide education in local health departments," Mayes says.
Tobacco manufacturers say they support the Surgeon General's report. They also take the position, however, that adult women should make up their own minds about smoking. "Our marketing is aimed at adults who've made the choice to smoke and we'll continue to do our best to market responsibly to adult smokers. Smoking has serious health impacts for men and women, and the safest thing to do for everybody is not to smoke," says Philip Morris' Brendan McCormick.