Tobacco and Public Health - TCSC Indonesia

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TOBACCO AND WOMEN
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% of smokers among adults
Stage I Stage II Stage III
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% of deaths caused by smoking
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Fig. 19.1 A model of the cigarette epidemic. (Source: Lopez et al. 1994.)
Stage IV
epidemic (Fig. 19.1), some countries in southern Europe (e.g. Portugal) and some
developed countries in Asia and the Western pacific (e.g. Japan) can be located currently
at stage 2 with smoking rates peaking at between 50% and 80% among men
while the trend among women is rising. Stage 3 countries have a longer history of
widespread smoking and include many southern, central, and eastern European countries
(e.g. Italy, Spain, Greece). In these countries prevalence rates among men are
decreasing but cigarette smoking is either still increasing among women or has not
shown any decline. Women’s smoking rates typically peak at 35–45%.
Stage 4 countries have the longest history of cigarette smoking (e.g. the USA, UK,
Canada, Australia, Finland, Germany) and in these countries cigarette smoking is
declining among both women and men (Graham 1996; Cavelaars et al. 2000). However,
the gap in smoking between women and men in these countries has also greatly
decreased. Indeed, in Sweden smoking rates in women are now higher than in men.
This has been due to a combination of a narrowing in the gap between uptake rates of
smoking in girls and boys, and relatively lower cessation rates in cigarette smoking
women compared to men. In several of these countries (e.g. UK, Sweden, Austria,
Denmark, Finland, Germany) (Wold et al. 2000), smoking rates among young girls are
higher than those among boys. In addition, smoking in these countries has now
become highly concentrated among the poorer and more disadvantaged sections of the
population. This reflects relatively lower uptake rates and higher quit rates in more
affluent groups. In these countries smoking is therefore an increasingly important
cause of inequalities in health.
Another cause for concern in developed countries is that the speed of transition
from one stage of the epidemic to the next seems to be getting faster, in part due to
tobacco companies targeting of young women in countries undergoing rapid social
and economic change. In Lithuania, for example, smoking among women doubled
over a five year period in the 1990s and increased by fivefold amongst the youngest
groups (Amos and Haglund 2000). In Sweden, one of Lithuania’s neighbours, where
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