Tobacco and Public Health - TCSC Indonesia

AMANDA AMOS AND JUDITH MACKAY 335
women. As in men, women who smoke have a greater risk of developing these diseases.
Nor are the serious effects confined to older women. The relative risk for coronary
heart disease associated with smoking is higher among younger than older women
(Ernster 2001).
In most developing countries the impact of smoking on women’s health is currently
much lower than in many developed countries because they are at an earlier stage of
the epidemic. For example, in China, the risks for those who smoke have been found to
be much the same for women and men, but because smoking has been low among
women, only 2.7% of the deaths of women aged 35–69 are attributed to smoking compared
with 13.0% of those of men (Liu et al. 1998). Also the impact on women’s health
can vary depending on the type of tobacco use in these countries. For example, in India
where betel quid chewing is common among women, oral cancer is more common
among women than breast cancer (Jacobs 2001).
In addition to the health risks that women share with men, women face particular
problems linked to tobacco use (RCP 1992; Ernster 2001; Jacobs 2001; USSG 2001).
These include:
◆ Cancer: Female-specific cancers, such as cancer of the cervix.
◆ Coronary heart disease: increased risk with use of oral contraceptives.
◆ Menstruation: Irregular cycles, higher incidence of painful cramps (dysmenorrhea).
◆ Menopause: Women who smoke tend to enter menopause at age 49—1–2 years
before nonsmokers. This places them at a greater risk for heart disease and osteoporosis,
including hip fractures (SG), as well as an increased incidence of hot
flushes.
◆ Pregnancy: Smoking in pregnancy causes increased risks of spontaneous abortion
(miscarriage), ectopic pregnancy, low birth weight, higher perinatal mortality, longterm
effects on growth/development of the child. Many of these problems affect not
only the health of the fetus, but also the health of the mother. For example, a miscarriage
with bleeding is dangerous for the mother, especially in poor countries
where health facilities are inadequate or nonexistent.
◆ Infertility: Smoking is also linked to infertility and delays in conceiving.
However, many women are unaware of these risks, even in countries such as the USA.
For example, a US study found a serious lack of knowledge among women regarding
gender-specific health risks of smoking (Roth and Taylor 2001). The study surveyed
female hospital employees, who represented a wide span of age, socio-economic, and
educational backgrounds, as to their awareness of reproductive health risks associated
with smoking. While nearly all were aware of increased complications in pregnancy
(91%), only a minority knew of the increased risk of miscarriage (39%), and even
fewer knew of the increased risk of ectopic pregnancy (27%), cervical cancer (24%),
and infertility (22%).