The nation is in the midst of an epidemic of smoking-related deaths among women that could continue because of high smoking rates among teen-age girls, U.S. Surgeon General David Satcher said yesterday.
Women now account for almost 40 percent of deaths linked to tobacco - twice the percentage recorded in 1965, he said.
Perhaps most worrisome is that the percentage of teen-age girls who smoke rose markedly in the early 1990s, virtually erasing the decline that had begun in the mid-1970s.
Last year, almost 30 percent of high school girls reported that they had smoked at least once in the previous month. Smoking among white girls - much higher than among African-American girls - stood at about 40 percent.
"We're losing our mothers, our grandmothers, our sisters and wives too soon directly because they have smoked," said Tommy G. Thompson, Health and Human Services secretary.
"What starts out as a simple puff is turning into a death sentence."
Smoking rates among women with less than a high school education were three times higher than for college graduates, the report said.
This year, lung cancer will kill nearly 68,000 women. In 1999, about 165,000 women died from smoking-related diseases including cancer and heart disease.
"Today, the nation is in the midst of a full-blown epidemic," Satcher said in his report. "Lung cancer, once rare among women, has surpassed breast cancer as the leading cause of female cancer death in the United States."
Lung cancer deaths among women, steeply rising since the mid-1960s, surpassed breast cancer deaths about 10 years ago.
The report urges a new push to fight smoking among women. It called for stronger efforts to promote the benefits of quitting and wider availability of proven methods to help people stop.
Satcher also called for efforts to "expose and counter" advertising that links smoking to women's rights and progress. The industry pours more than $8 billion annually into advertising and deliberately targets women, he said.
Last year, the Supreme Court blocked a plan by the U.S. Food and Drug Administration to regulate tobacco as a drug, ruling that Congress had not first paved the way. Enabling legislation is now before Congress.
Thompson said the FDA should be empowered to regulate tobacco as a drug, but Congress should determine the extent of the agency's authority.
He also opposed increasing federal taxes on cigarettes to deter young people from buying them.
Male smokers have always outnumbered female smokers, but the gap between the two has narrowed in recent years.
In 1965, 52 percent of men and 33 percent of women smoked. In 1979, smoking among men had declined to 37.5 percent among men but to only to 30 percent among women.
By 1998, the gap had narrowed further - 26.4 percent of men smoked, compared with 22 percent of women.
A recent survey in Maryland found that 19.5 percent of adult males smoked, compared with 15.7 percent of women.
But among teen-agers, smoking was slightly more common among girls: 16.4 percent of female middle and high school girls smoke, compared with 16 percent of teen-age boys.
The persistence of smoking among women and particularly teen-age girls has baffled experts. Many are left wondering why anti-smoking campaigns have not been more effective. "We need to know why this is happening, and why the messages aren't clear," said Dr. Kathy Helzlsouer, professor of epidemiology at the Johns Hopkins School of Public Health.
She said advertising that associates smoking with a thin body - beginning with the Virginia Slims campaign in the 1970s - might be partly to blame. The campaign also presented smoking as a woman's hard-fought right.
Also contributing to the problem is the widespread assumption that lung cancer and heart disease - problems associated with smoking - are less of a women's problem than breast cancer, she said.
Researchers are exploring the possibility that women are more easily addicted to nicotine than men. Although the idea is far from settled, she said it makes some sense because depression is more common among women.
Both depression and addiction involve problems of brain chemistry, and some smokers have quit with the aid of anti-depressants.
Women who smoke face some unique risks, Satcher said. These include menstrual problems, early menopause, lower fertility, low bone density and cervical cancer.
Also, smoking during pregnancy increases the risks of a low-birthweight baby, stillbirths and miscarriages.