1.  2007 Johns Hopkins Bloomberg School of Public Health Women and Tobacco Natasha Jategaonkar, MSc British Columbia Centre of Excellence for Women’s Health Framework Convention Alliance

2.  2007 Johns Hopkins Bloomberg School of Public Health 2 Learning Objectives Discuss the reasons why women and tobacco are a specific area of inquiry  Specific concerns  How tobacco use affects women’s bodies and lives Demonstrate statistics and figures on tobacco use among women Explain ways in which tobacco production and marketing have an influence on women’s lives, even among women who don’t smoke

3.  2007 Johns Hopkins Bloomberg School of Public Health 3 Text source: The Tobacco Atlas 2 nd Edition. (2006); Image source: Lung Health Image Library. (2007). Permission granted for educational use. Tobacco Patterns Are Changing Men  48% of the world’s men smoke (35% in developed countries; 50% in developing countries)  Men’s smoking rates have peaked and are now in a slow decline Tobacco continues to kill four million men per year

4.  2007 Johns Hopkins Bloomberg School of Public Health 4 Text source: *The Tobacco Atlas 2 nd Edition. (2006); †Greaves, L., et al. (2006); Image source: Lung Health Image Library. (2007). Permission granted for educational use. Tobacco Patterns Are Changing Women  12% of the world’s women smoke (22% in developed countries; 9% in developing countries)*  By 2025, it is predicted that 20% of the world’s women will smoke †

5.  2007 Johns Hopkins Bloomberg School of Public Health 5 Text source: The Tobacco Atlas 2 nd Edition. (2006); Image source: Lung Health Image Library. (2007). Permission granted for educational use. Tobacco Patterns Are Changing Youth  Globally, boys are more likely than girls to smoke  However, in half of the countries surveyed in the Global Youth Tobacco Survey, there was no gender difference in youth smoking  Worldwide, tobacco use among girls is increasing

6.  2007 Johns Hopkins Bloomberg School of Public Health 6 Stages of the Tobacco Epidemic Source: adapted by CTLT from Lopez, A.D., et al. (1994).

7.  2007 Johns Hopkins Bloomberg School of Public Health 7 Image sources: (bottom) Lung Health Image Library. (2007); (top) © ILO/Deloche, P.(2000). Permission granted for educational use. How Tobacco Affects Women’s Lives

8.  2007 Johns Hopkins Bloomberg School of Public Health 8 Images source: Lung Health Image Library. (2007). Permission granted for educational use. Forms of Tobacco Other than Cigarettes Bidis: small, thin, hand-rolled cigarettes Water-pipe: tobacco burns and then the smoke passes through water before it is inhaled (hookah, shisha, or narghile) Snus: a form of oral smokeless tobacco

9.  2007 Johns Hopkins Bloomberg School of Public Health 9 Source: Greaves, L., et al. (2006). Women, Tobacco, and Health 1964: U.S. Surgeon General’s report showed “definite” link between tobacco use and cancer for men, and a “probable” link between tobacco use and cancer for women Smoking has negative effects on nearly every system of a woman’s body “Light” and “low tar” cigarettes are designed for and marketed to women, but health risks remain the same

10.  2007 Johns Hopkins Bloomberg School of Public Health 10 Source: Greaves, L., et al. (2006). Women and Cardiovascular Disease Cigarette smoking dramatically increases the risk of heart disease and stroke Heart disease is a major cause of death for women in the developed world and, increasingly, in the developing world Women who smoke and simultaneously take oral contraceptives further increase their risk of heart disease Bidis also increase risk of heart disease

11.  2007 Johns Hopkins Bloomberg School of Public Health 11 Source: Greaves, L., et al. (2006). Women and Cancer Lung cancer is the most common cancer caused by smoking In several developed countries, lung cancer is surpassing breast cancer as the leading cause of cancer death for women Smoking increases women’s risk of cancer of mouth, throat, larynx, esophagus, stomach, pancreas, bladder, kidney, cervix, and uterus New evidence links smoking to breast cancer Bidis increase risk of cancer of the lung, mouth, stomach and esophagus

12.  2007 Johns Hopkins Bloomberg School of Public Health 12 Source: Greaves, L., et al. (2006). Women and Lung Health Girls who smoke cigarettes have poor lung growth Women who smoke cigarettes have an earlier decline in lung function Cigarette smoking causes emphysema and chronic bronchitis, increases risk of acute lower respiratory illnesses, and worsens asthma Cigarette smoke adds to other lung burdens, such as coal residue, and wood smoke Bidis also increases risk of chronic bronchitis

13.  2007 Johns Hopkins Bloomberg School of Public Health 13 Source: Greaves, L., et al. (2006). Women and Reproductive Health Smoking increases the risk of painful and irregular menstruation Smoking during pregnancy increases the risk of ectopic pregnancy, miscarriage, stillbirth, and Sudden Infant Death Syndrome (SIDS) Water-pipe smoke can lead to complications of pregnancy Smokeless tobacco use during pregnancy reduces fetal birth weight and doubles the risk of stillbirth

14.  2007 Johns Hopkins Bloomberg School of Public Health 14 Women and Addiction, Mental Health, and Other Issues Addiction and mental health  Nicotine is an addictive agent  In some countries, smoking is more common among women with mental health conditions Other health issues  Cigarette smoking can lower bone density, contribute to cataracts, and cause periodontitis  Working in tobacco fields may cause green tobacco sickness Source: Greaves, L., et al. (2006).

15.  2007 Johns Hopkins Bloomberg School of Public Health 15 Text source: *Greaves, L., et al. (2006); †California Environmental Protection Agency: Air Resources Board. (2005). Women and Secondhand Smoke SHS causes heart disease and lung cancer in adults Female nonsmokers are more likely than male nonsmokers to develop lung cancer* According to a 2006 study by the State of California Air Resources Board, exposure to SHS increases risk of breast cancer among nonsmoking pre-menopausal women †

16.  2007 Johns Hopkins Bloomberg School of Public Health 16 Women, Tobacco, and Poverty Women are more likely than men to be living in poverty  Spending on tobacco products reduces available family income for food, education, and health care Tobacco agriculture  Unequal power relationships between tobacco companies and tobacco farmers  Labour of women and children goes unrecognized and unpaid In developed countries, smoking increasingly concentrated among poor and disadvantaged communities Tobacco has a differential impact on women’s lives

17.  2007 Johns Hopkins Bloomberg School of Public Health 17 Text source: *Tobacco and the Environment Fact Sheet No. 22. Action on Smoking and Health. (2004); †The Tobacco Atlas (2006).; Image source: © ILO/Deloche, P.(2000). Permission granted for educational use. Women, Tobacco, and the Environment Tobacco plants require huge amounts of fertilizer and pesticides—up to sixteen applications during a three- month growing period* Chronic exposure to pesticides can cause health problems for the women, men, and children who work in tobacco fields † Women exposed to pesticides can give birth to babies with birth defects

18.  2007 Johns Hopkins Bloomberg School of Public Health 18 Text source: *Tobacco and the Environment Fact Sheet No. 22. Action on Smoking and Health. (2004); †Greaves, L. et al. (2006). Women, Tobacco, and the Environment Chemical runoff from tobacco fields and tobacco manufacturing pollutes local waterways* Raw tobacco is cured via wood- firing and globally causes losses of 200,000 hectares of forest per year* Women are often traditionally responsible for collecting water and firewood for the family and must walk further and work longer to fulfil household labour responsibilities †

19.  2007 Johns Hopkins Bloomberg School of Public Health 19 Image sources (left to right): Ruby Lane. (2007); Tobacco Documents Online. (1994). Permission granted for educational use. Women, Tobacco, and Sales and Marketing

20.  2007 Johns Hopkins Bloomberg School of Public Health 20 Image sources: (left) Tobacco Documents Online. (1996); (right) Trinkets & Trash. (2007). Permission granted for educational use. Women, Tobacco, and Sales and Marketing

21.  2007 Johns Hopkins Bloomberg School of Public Health 21 Image sources (left to right): Rediff.com. (2004); Campaign for Tobacco Free Kids. (1999). Permission granted for educational use. Women, Tobacco, and Sales and Marketing

22.  2007 Johns Hopkins Bloomberg School of Public Health 22 Images source: Campaign for Tobacco Free Kids. (2004). Permission granted for educational use. Women, Tobacco, and Sales and Marketing

23.  2007 Johns Hopkins Bloomberg School of Public Health 23 Image source: Wen, et al. (2005). Women, Tobacco, and Sales and Marketing Women’s bodies are often exploited to sell tobacco products

24.  2007 Johns Hopkins Bloomberg School of Public Health 24 Source: World Health Organization. (2005). Women and the FCTC Article 8: protection from exposure to tobacco smoke Article 11: packaging and labeling of tobacco products Article 12: education, communication, training, and public awareness Article 13: advertising, sponsorship, and promotion

25.  2007 Johns Hopkins Bloomberg School of Public Health 25 Women and the FCTC Article 14: Tobacco dependence and cessation Article 17: Provision of support for economically viable alternative activities Articles 20-22: Scientific and technical cooperation and communication of information Source: World Health Organization. (2005).

26.  2007 Johns Hopkins Bloomberg School of Public Health 26 Source: Greaves, L., et al. (2006). Policy Recommendations Sign, ratify, and implement the Framework Convention on Tobacco Control (FCTC) Design empowering messages and advertisements for improving women’s health Promote comprehensive tobacco policies that address not only health, but also social and economic policies

27.  2007 Johns Hopkins Bloomberg School of Public Health 27 Source: Greaves, L., et al. (2006). Research Recommendations Establish or expand existing surveillance data in order to monitor women’s and men’s tobacco use rates Conduct further research on the health effects for both women and men of tobacco products other than cigarettes Build capacity and engage women and girls in conducting tobacco research

28.  2007 Johns Hopkins Bloomberg School of Public Health 28 Source: Greaves, L., et al. (2006). Program Recommendations Implement tobacco prevention and cessation programs that are gender-specific and age-specific Provide information on occupational safety for women and girls involved in tobacco cultivation and production Develop women-centered programs that address tobacco use during pregnancy and postpartum Engage women in designing and delivering programs

29.  2007 Johns Hopkins Bloomberg School of Public Health 29 Summary Tobacco affects women’s lives in a myriad of ways  Smoking has negative effects on nearly every system of a woman’s body  Women’s bodies are often exploited in tobacco marketing  Tobacco farming and processing exploits the labor of women and girls We must curb women’s tobacco use while also creating opportunities for education and empowerment