The surprising reason why more women are smoking than men

Image: Gwyneth Paltrow in The Royal Tenenbaums

Walking to the train this morning I passed two young women smoking in the street. I wanted to go up to them and say “Stop, it may kill you. And it looks so ugly”. But I didn’t.

Apart from feelings of hypocrisy – I used to smoke at their age – it was really none of my business. But perhaps it should be.

Rates of smoking in Australia have significantly dropped over the last 3 years – from 15.1% to 12.8% of adults. But the highest rate of smoking is found in young people aged 20-29. Young women are more likely to smoke than young men. Between 2007-08 and 2011-12, the rate of smoking among men aged 15-17 decreased from 9% to 5%, while the rate for young women increased from 5% to 9%.

Women are more vulnerable to the harmful effects of smoking than men, due to a slower metabolism of nicotine, and a higher level of DNA pathways for nicotine. This is reflected in the 50% increase in lung cancer in women over the last twenty years, compared with a decrease amongst men. For the first time, lung cancer now kills more Australian women than breast cancer.

Women smokers are twice as likely to die from lung cancer than men smokers. However, if smoking is given up by the age of 30, more than 90% of the risk will be reduced. Women’s reproductive health is also at risk if they smoke, including higher rates of cervical and vulvar cancers, premature menopause, irregular menstruation, and reduced fertility. There is a tenfold increased risk of stroke and cardiovascular disease, if women both smoke and use oral contraceptives.

Young women smokers are at risk of serious complications related to pregnancy and infant health, including increased risk of sudden infant death syndrome, low birth weight, perinatal and neonatal deaths, and child learning and attention deficit disorder. As recent research shows that 17.4% of Australian mothers smoke during pregnancy, this is of major concern.

Young women are less worried about the long term health consequences of smoking than young men.

These health risks are well publicised – and prominently displayed on all cigarette packs. So why are increasing numbers of young women smoking?

One explanation put forward by researchers is that young women are less worried about the long term health consequences of smoking than young men. Valuing carefree indulgence and hedonism, concerns about health occur much later in life.

Young women are also more likely to use cigarettes to manage their weight – believing that lighting up is better than snacking on junk food, and being afraid of food cravings if they quit. They also use cigarettes as a way of managing mood – smoking when they feel anxious or stressed. As anxiety is higher in women than in men, and at its peak age 16-24, it’s not surprising that increasing numbers of younger women smoke.

Media images of women smokers as glamorous and cool also have an influence. Research has shown that young women see smoking as a reflection of sophistication, fashion and success. As a result, they smoke to express their individuality, look good, and get approval from friends.

The branding of ‘feminine’ and ‘fashionable’ cigarettes in slim, long packs was instrumental in glamorising women’s smoking.

Cigarette companies are well aware of this. Before the era of plain packaging, the branding of ‘feminine’ and ‘fashionable’ cigarettes in slim, long packs was instrumental in glamorising women’s smoking, and was influential enough to provoke brand switching.

Those days are gone. Current Australian anti-smoking campaigns use graphic medical images to depict the long-term negative effects of smoking on internal organs. However, research shows that these campaigns have little impact on young people, especially women, as we cannot see these organs, or the effects of smoking on them.

Anti-smoking campaigns that are overly fear inducing are also unsuccessful because people engage in a defensive denial of the existence or importance of the message. The moralistic and authoritarian tone of the anti-smoking messages is also rejected by young women. As would my comments have been, had I spoken to the two women I saw smoking this morning.

It is difficult to dissuade young women from smoking by emphasising its dangers, when risk may be part of the appeal.

Health behaviours are rarely logical or driven by a set of rational rules. Research has found that anti-smoking campaigns that promote the bad, dangerous and unhealthy side of smoking inadvertently position smoking as a legitimate way to resist the authority of medical experts, and may thus incite the behaviour. In other words, it is difficult to dissuade young women from smoking by emphasising its dangers, when risk may be part of the appeal.

So I probably made the right decision when I decided to say nothing to the two young women smokers I passed today. Smoking may be a health risk – but quitting is a decision they need to make for themselves.

Are you a smoker or ex-smoker? Tell us what you think about smoking here.