Smoking Risk Factors in Women

Women who receive less formal education are more likely to become smokers, and smoking rates decrease with higher levels of formal education. In a 1995 study of women between 25 and 44 years of age, the percentages of smokers were as follows:

  • Did not finish high school—40 percent
  • Graduated from high school—34 percent
  • Some college education—24 percent
  • Graduated from college—14 percent

Living in poverty and suffering from a mental health disorder (e.g., >depression, alcohol abuse, other substance dependence) are other risk factors.

Effects of Smoking on Women's Health

Cigarette smoking is associated with a range of serious illnesses in women and men, including the following:

  • Cardiovascular disease (e.g., ischemic stroke, heart attack)
  • Pulmonary disorders (e.g., emphysema, chronic obstructive pulmonary disorder [COPD], lung cancer)
  • Reproductive system disorders
  • Several types of cancer

Smoking also increases the risk for and may worsen the symptoms of other conditions that commonly affect women (e.g., osteoporosis, macular degeneration).

Smoking & Cancer

Cigarette smoking is the major cause of lung cancer in women. Since 1950, the mortality rate for lung cancer in women has increased an estimated 60 percent in the United States.

In 1950, lung cancer represented only 3 percent of all cancer deaths among women; by 2000, lung cancer accounted for nearly 25 percent. Today, lung cancer remains the leading cause of cancer deaths among women. In 1987, lung cancer surpassed breast cancer as the leading cause of cancer death among women. In the year 2000, about 67,000 women died of lung cancer compared to 40,800 who died of breast cancer. This increase can be directly attributed to an increase in the number of women who smoke.

There is also significant evidence that smoking is responsible for or associated with these other cancers:

  • Bladder cancer
  • Cervical cancer
  • Colon cancer
  • Kidney cancer
  • Liver cancer
  • Oropharynx (mouth and throat) cancer
  • Pancreatic cancer
  • Rectal cancer
  • Skin cancer

Postsurgical Complications—Women who smoke after being treated for cervical cancer double their risk for postsurgical complications, including bleeding in the bowel, rectum, and bladder. Women who have been treated for breast cancer experience lower survival rates, if they smoke.

Smoking & Cardiovascular Disease

Smoking is the primary cause of heart disease, the number one killer of women in the United States. Women who smoke are 2 to 6 times more likely to have a heart attack (i.e., myocardial infarction) than women who do not smoke, and the risk increases with the number of cigarettes smoked.

Women smokers are also at high risk for ischemic stroke (deficiency of blood in an area of the brain), subarachnoid hemorrhage (ruptured blood vessel in the area surrounding the brain), and peripheral vascular atherosclerosis (clogging of the arteries that supply blood to arms or legs).

Smoking & Lung Disease

Smoking seriously decreases lung function over time. Girls who begin smoking at an early age reduce lung growth and function, and women who begin smoking at any age experience some decline in lung function. The primary symptom of decreased lung function is dyspnea or shortness of breath.

Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD). COPD involves emphysema, chronic bronchitis, and sometimes asthma. Mortality rates for COPD among women have risen for the past 20 to 30 years. Today, an estimated 90 percent of deaths from COPD among women in the United States is attributable to smoking.

Smoking & Reproductive System Disorders

Smoking may have an adverse effect on menstrual function and has been linked with an increase in menstrual pain and irregular periods. Women who smoke may experience early onset menopause (1 or 2 years earlier than nonsmokers) and menopause symptoms may be more severe.

Women who smoke may experience fertility problems including difficulty conceiving, primary infertility (inability to conceive), and secondary infertility (inability to conceive again after having a child). Components in cigarette smoke, such as the heavy metal cadmium and nicotine, damage the ovaries and interfere with estrogen production, causing the eggs to be prone to genetic abnormality. Second-hand smoke may also contribute to reproductive function abnormalities.

Pregnant smokers risk complications of pregnancy, including premature birth, low birth weight, stillbirth, and infant mortality. Carbon monoxide and nicotine in the smoke inhaled by a pregnant woman may prevent as much as 25% of oxygen from reaching the placenta, which depletes the fetus's oxygen supply. Nicotine passes easily through the placenta and becomes concentrated in amniotic fluid and fetal blood to levels as much as 15 percent higher than in the mother.

Smoking during pregnancy increases the risk for ectopic pregnancy (development of the embryo outside the uterus, usually in the fallopian tube) and miscarriage. Sudden infant death syndrome (SIDS) occurs twice as often in babies of mothers who smoked during pregnancy.

Smoking & Eye Disorders

Smoking increases a woman's risk for age-related macular degeneration, a progressive disease that affects the macula (central area of the retina) and destroys central vision. Macular degeneration is most common in women who have smoked for over 40 years. Women smokers are also at higher risk for cataracts (clouding of the eye's lens).

Second-Hand Smoke and Children

Smoking during pregnancy can affect the behavior of children during the toddler years and beyond. The effects can include childhood depression, anxiety, rebelliousness, and aggressive behavior. Some learning disabilities have also been associated with maternal smoking during pregnancy.

Children of mothers who smoke during pregnancy are also more likely to begin smoking at an early age. Research indicates that teenagers whose mothers smoked during pregnancy are at greater risk for drug abuse and conduct disorders. The effect appears greatest when the mother smokes more than 10 cigarettes a day while pregnant.

These behavioral effects may be caused by prenatal exposure to tobacco smoke, although more research is needed to understand exactly how this may affect a child's future behavior.

Second-hand Smoke Effects on Children's Health

Exposure to second-hand maternal smoke has negative health effects on children from infancy through adolescence. Infants, young children, and adolescents may experience reduced lung function. Second-hand smoke has been linked to SIDS (sudden infant death syndrome).

For children with asthma, second-hand smoke increases the severity of symptoms. It may also be a risk factor for developing childhood asthma. The Centers for Disease Control estimates that second-hand smoke worsens the condition of between 400,000 and 1 million asthmatic children.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 26 May 2002

Last Modified: 01 Oct 2015